My m-i-l is now about fifteen years out from her initial diagnosis of dementia. She was placed on Aricept and suffered from terrible nightmares. She was high functioning and we respected her decision. She progressed very slowly and lived independently in a senior living community until recently. We revisited the subject with Neurologist about 4 years ago. He asked if her diminishing memory made her sad or anxious and she said no. His opinion was to leave it alone until that happened. This is such a complicated subject with so many factors impacting the patient. I agree that this is a discussion to have with a physician. We just saw a Geriatric Specialist and found it very helpful. They really have a wonderful knowledge of melds and how they impact Seniors. I also agree that the first logical step would be to ask specific questions before the visit so you have a better understanding of why the reluctance to take the medication - it may be a challenging discussion but it would helpful information to share with your medical professionals.
You mihht have her swallowing assessed by a speech language pathologist. My mom's lifelong pill swallowing difficulty got worse after her stroke. A speech therapist working with her showed her how to tuck her head down to ease swallowing, not stretch her neck upwards as she had been doing.
Metoprololl ER should never be crushed! also grapefruit juice will enhance the effects of this drug. Do not drink grapefruit juice with this drug. Do not crush this drug.
sherry1anne I have absolutely no problem with whatever people do. Its just that for anyone reading the blogs and seeing the comments ...they don't necessarily apply in the UK. ....so with apologies to everyone over the pond this is what our Act states:
A care worker (caregivers sic) (or registered nurse) should not mix medicine with food or drinkIF THE INTENTION IS TO DECEIVE someone who does not want to take the medicine. This is called ‘covert’ administration. The exception to this is when a medical practitioner states that the person lacks ‘capacity to consent to treatment’ and the medicine is essential to their health and well being.
So for example I have an advanced directive which stipulates (while I am of sane mind (sort of!) that in the event I become incapacitated to a level where I cannot physically feed or care for myself then I refuse, in advance, to be given medication serves only to prolong my life. If in these circumstances I were to be given medication then that would be covert administration and illegal - moreover my POA MAY NOT override this
So it is still a grey area over here but if anyone takes it upon themselves to covertly administer in the UK they could well find themselves charged under the Mental Health Act IF they don't get consent from a doctor first.
I think you have laws too that govern covert administration.
HOWEVER if you are administering it in pudding because the person physically can't swallow the meds the traditional way and KNOWS it is in the pudding then that is absolutely fine because there is no intent to deceive
Equally if a doc determines and reviews meds given the decreased level of mental capacity then they may well advocate covert administration and then again all is well
It was never intended to be a criticism of what others do merely keeping some people in the frame as to actions that could be taken.
I'm not implying that your mom's refusal to take meds is appropriate, but I would consider who her Healthcare POA is. Are they making the decisions on her behalf now? What did she say about taking life prolonging meds previously?
I have read a lot about planning for advanced dementia. It's accepted and even recommended that when it comes to terminal illnesses, and dementia comes in under that category, that the patient only take meds that keep the patient comfortable and pain free. Taking meds that prolong life is a decision to made by either the patient or the Healthcare POA, who is supposed to follow the instruction of the patient, assuming they told her what they wanted prior to becoming incompetent. Some patients only take those that keep them comfortable. It should be an informed decision though.
my father also refused to take his pills when he was at home, my mother would put them down with his breakfast, he would push them away, she would push them back and finally she gave up. they would be sitting there until lunch time. It is the disease and definitely do NOT crush any pills that should not be, they can harm the person more due to the medicine getting into their system quicker instead of the normal pace. But if you could mask them in pudding that would be good. or even try a liquid form of the medicine that could be mixed in with water. you would have to ask the doctor or pharmacists about if they have that. Now that my father is in the nursing home, they give him meds by pudding. But I truly has to do with the mind disease and them just not thinking about what they are for.
Dear ohJude, we do whatever it takes around here. I don't ask permission from the government to help my mother stay well. It's me who has to take the fall out if she refuses to take her meds. Fortunately for me almost all of my mother's meds are vitamins. She is 104.
Cwillie I couldn't agree more... you just simply cannot adjust medication or alter it in any way unless the doc OKs it. In the event that a court case should evolve for whatever reason and you have adjusted medication it will be you who is in trouble. Slow release tablets must never be crushed they are there to be released slowly hence the name taking them in a one could be lethal for some people.
We are lucky in the UK re medication my mothers is provided in rosette boxes which are sealed. She has one for breakfast lunch tea and evening and that means I know what she is talking because I give it to her AND STAND OVER HER TO WATCH SHE HAS TAKEN IT. Drastic? not after a young child died from eating the 'sweeties' that great grandma had down the side of her chair/.
I do place my trust in the hands of the professionals. If I don't know I ask and if Mum refuse to take meds I note what she is refusing and email the surgery for advice or indeed just to have it noted somewhere on file that I tried but that she refused. It doesn't happen often but I still take no chances.
I want to reiterate what others have already said, don't crush the pills without checking first if you should, as some meds can not be altered. Even then be aware that some meds are extremely bitter and in capsules or coated tablets for a reason. When my mom was in respite care at a nursing home they tried to get her to swallow two tylenol, a stool softener, blood pressure pill and her parkinson's med all in one spoon of applesauce. Seriously??? The next day they crushed her pills, even the extended release tylenol and the very bitter stool softener, which goes to show that even those who should know better don't always know what they are doing.
I worked in an assisted living as a caregiver for years. Everyday the same people refused to take the meds so the medication techs would crush up the pills and put in applesauce or pudding. My mom doesn't want to take her meds either but I would not stop unless the doctor said it was ok.
Also remember that she most likely will never be able to remember to take them without prompting to do so. It may even be dangerous not to be with her when she takes them.
My wife was in the early stages of FTD Dementia and really just had fuzzy memory...I thought....so she still put her med's in the pill box and took them without me watching. I found her on the couch one evening and she was not doing well, so I took her to the hospital where they immediately gave her almost 2 pints of blood. One of her med's was Plavix to reduce blood clotting. She was suppose to take one a day. But when I looked in her pill box, she had started putting one in the morning and evening compartment and was slowly bleeding to death through a stomach ulcer. That was the point I realized I needed to pay more attention to everything she did, just in case.
We now give my dad his crushed pills in a milkshake. He was also refusing to take them. He'd say I'll take them later. His health is more important to me than arguing over pills. No guilt here!
This is a typical symptom of mid-stage ALZ. I find helpful to see behaviors like this as a manifestation of the disease. Good idea to find out if she is having problems with swallowing. Is it just her meds or are there other foods that she has a problem swallowing. Persons with ALZ often resists meds--It is a symptom.
some pills must be given in the form that they are prescribed in - for example, capsules are slow release pills - they are designed specifically that way. How do you get around that? You can't put them in applesauce or coffee. And some other pills shouldn't be dissolved, either.
My husband (84) has started refusing both am & pm meds, he is mid - late stage AD and it's always the same response, I don't take pills, I've never taken a pill in my life, there's nothing wrong with me, so just a basic flat refusal, although he will finally look at them & say I better take my pills, it's a challenge and I cannot blink an eye or he will pour the water over them. Now in the am I put his two essential Seroqel and a calming Med into his coffee, they are tiny and melt perfectly, I tried that with other pills and they either won't dissolve & with Pradaxa he has to take the capsule whole. It takes a good half hour until he takes the pills so I just wait 5 then again, time to take your vitamins honey.
Yes, Im with feflyer crush them up in apples sauce and maybe sometimes just give her half. My mom sometimes would do that and I would just say ok well fine let me know when you want them, and still crush it real good in her food
My mom doesn't refuse, but before I started going to her house every morning and making sure that she took all of them (and gran ted, there are a lot for a variety of medical issues), she just wouldn't bother. I could tell that she was getting "fuzzy" and took over the medicine part. Those little daily pill receptacles are great. She tells me all the time "If it were up to me, I just wouldn't bother."
My answer depends on what he medication is for and how old your mom is. A couple of years ago our doc discontinued almost all mom's meds, the only prescriptions she has now are related to comfort and symptom control. At the time I freaked out and expected that she would stroke out any day, now I wonder what the heck is keeping her going. If she needs all her pills then you need to figure out why she won't take them, the others have some good recommendations.
I would first establish why she won't take it. If it's because she just forgets and is not capable, then maybe you could make sure she gets it by giiving it to her yourself or have someone else do it it. I don't know what kind of medication she takes, but she probably needs to take it. So, you can't leave it up to her.
You don't give many details. How is your mom refusing? Is she having difficulty swallowing? That can be scary. Is she able to communicate her thoughts/feelings? If so, what is she saying?
EEEEK are you allowed to do this in the USA? In the UK covert medication is classed as abuse because there is no rational decision being made by the recipient (because they have dementia) and could be really serious UNLESS you have a medical review and the DOCTOR and relevant others confirm and agree in writing (contained within the review) that this can be allowed.
That said in the early stages of dementia a person can OPT to have meds crushed if they find the pills difficult to swallow BUT I would still get that noted and confirmed by a doctor to protect myself from claims of abuse by others later.
Thats absolutely no criticism of your comments ff but I know some people are from different countries where legal issues can be different.
Could it be that your Mom doesn't like the side effects from the medication? Sometimes the side effects are worse than what the pill is treating.
I would make an appointment with her primary doctor to see if he/she could prescribe other meds to help with the same issues.
Otherwise, do what hospital and nursing homes do, they crush the pills [not all meds can be crushed] and place the crushed meds into apple sauce.... my Mom likes her meds in chocolate pudding or chocolate ice cream.
A care worker (caregivers sic) (or registered nurse) should not mix medicine with food or drinkIF THE INTENTION IS TO DECEIVE someone who does not want to take the medicine. This is called ‘covert’ administration. The exception to this is when a medical practitioner states that the person lacks ‘capacity to consent to treatment’ and the medicine is essential to their health and well being.
So for example I have an advanced directive which stipulates (while I am of sane mind (sort of!) that in the event I become incapacitated to a level where I cannot physically feed or care for myself then I refuse, in advance, to be given medication serves only to prolong my life. If in these circumstances I were to be given medication then that would be covert administration and illegal - moreover my POA MAY NOT override this
So it is still a grey area over here but if anyone takes it upon themselves to covertly administer in the UK they could well find themselves charged under the Mental Health Act IF they don't get consent from a doctor first.
I think you have laws too that govern covert administration.
HOWEVER if you are administering it in pudding because the person physically can't swallow the meds the traditional way and KNOWS it is in the pudding then that is absolutely fine because there is no intent to deceive
Equally if a doc determines and reviews meds given the decreased level of mental capacity then they may well advocate covert administration and then again all is well
It was never intended to be a criticism of what others do merely keeping some people in the frame as to actions that could be taken.
I have read a lot about planning for advanced dementia. It's accepted and even recommended that when it comes to terminal illnesses, and dementia comes in under that category, that the patient only take meds that keep the patient comfortable and pain free. Taking meds that prolong life is a decision to made by either the patient or the Healthcare POA, who is supposed to follow the instruction of the patient, assuming they told her what they wanted prior to becoming incompetent. Some patients only take those that keep them comfortable. It should be an informed decision though.
We are lucky in the UK re medication my mothers is provided in rosette boxes which are sealed. She has one for breakfast lunch tea and evening and that means I know what she is talking because I give it to her AND STAND OVER HER TO WATCH SHE HAS TAKEN IT. Drastic? not after a young child died from eating the 'sweeties' that great grandma had down the side of her chair/.
I do place my trust in the hands of the professionals. If I don't know I ask and if Mum refuse to take meds I note what she is refusing and email the surgery for advice or indeed just to have it noted somewhere on file that I tried but that she refused. It doesn't happen often but I still take no chances.
When my mom was in respite care at a nursing home they tried to get her to swallow two tylenol, a stool softener, blood pressure pill and her parkinson's med all in one spoon of applesauce. Seriously??? The next day they crushed her pills, even the extended release tylenol and the very bitter stool softener, which goes to show that even those who should know better don't always know what they are doing.
My wife was in the early stages of FTD Dementia and really just had fuzzy memory...I thought....so she still put her med's in the pill box and took them without me watching. I found her on the couch one evening and she was not doing well, so I took her to the hospital where they immediately gave her almost 2 pints of blood. One of her med's was Plavix to reduce blood clotting. She was suppose to take one a day. But when I looked in her pill box, she had started putting one in the morning and evening compartment and was slowly bleeding to death through a stomach ulcer. That was the point I realized I needed to pay more attention to everything she did, just in case.
ted, there are a lot for a variety of medical issues), she just wouldn't bother. I could tell that she was getting "fuzzy" and took over the medicine part. Those little daily pill receptacles are great. She tells me all the time "If it were up to me, I just wouldn't bother."
If she needs all her pills then you need to figure out why she won't take them, the others have some good recommendations.
That said in the early stages of dementia a person can OPT to have meds crushed if they find the pills difficult to swallow BUT I would still get that noted and confirmed by a doctor to protect myself from claims of abuse by others later.
Thats absolutely no criticism of your comments ff but I know some people are from different countries where legal issues can be different.
I would make an appointment with her primary doctor to see if he/she could prescribe other meds to help with the same issues.
Otherwise, do what hospital and nursing homes do, they crush the pills [not all meds can be crushed] and place the crushed meds into apple sauce.... my Mom likes her meds in chocolate pudding or chocolate ice cream.