Dementia- help with taking medication!

[StanleyLambchop]

My Mum has vascular dementia, she does not take any medication for it, but does take several tablets for other health problems. Trouble is, the dementia has got so bad that she just does not understand she has to take the tablets, or indeed how to physically take them. We have to take her through it step by step, 'put the tablets in your mouth' 'take some water' 'swallow them down'- it can take half an hour sometimes, and if she is in a bad mood she may spit them out, hide them under her tongue, clamp her mouth shut- it is all very frustrating. The dementia means you cannot reason with her that the tablets are for her own good.

Has anyone been through this, and have any tips? It is so frustrating!!!

Have her tablets been reduced to the absolute minimum? A medication review by her GP may be able to get the numbers down.

Concealing tablets in food is frown upon these days, but I can see situation where this may be preferable to lots of distress or meds not being taken.

Who gives her her tablets? You? Does she have carers? Or lives in a home?
It is important that it is done with time and no pressure. There is hardly any medication where the odd not-taken dose would make much of a difference btw. Find a balance between how important her meds are and how difficult it is to get them down.

My DMiL has vascular dementia, not v severely, but worsening really rapidly . Currently she takes her pills when prompted by her home carers, but who knows...

frowned sorry

As Pacific said get the meds reviewed to get the number to the minimum and get them into a form that is easy for her to manage (not too big, etc). Also GP can advise you on which meds are more vital than others so you can make sure those get priority.

Sadly this is an ongoing problem with quite a lot of dementia patients

Thanks for the reply, my Dad is her carer, but he can't cope with the meds refusal, so calls me in. Often she will take them easier for me, for some reason a different face seems to work. But I can't be there every morning to give her the tablets, have young DCs.

Two of the medications are essential , but a review might be in order to reduce the others if non essental. I will get onto GP tomorrow.

What support does your dad have? Is there a dementia nurse in your area?
It is such a horrible condition - not easy for any of you .
Yes, speak to your GP and take it from there.

I oncealed one in a yoghurt today. Did not know that was frowned upon. I did not know what else to do!!

Concealed- sorry

I don't know about dementia nurses- we have not been offered much support, the memory clinic was useless, they did loads of tests & assesments , then simply concluded she was losing her memory!! Eventually they begrudgingly said it was vascular dementia, but there was nothing they could do.

Ach, it's all to do with dignity and human rights - more of an issue for care homes where everything has to come with a protocol and a guideline and get passed by the care comission. And, as ever, it has been abused by, say, slipping a sedative in some food/drink which obviously is Wrong on many levels.

I'd have no qualms to do it if it helped a loved one. But I am not big on policy .

There IS nothingn you can do for vascular dementia.

Have a look at the Alzheimer Society website - I know it's not the same as Alzheimer's but they are a font of information.

My DMiL is widowed, lives at home, has carers coming in 3x/day and a dementia nurse 2x/wk who takes her out/shopping/to the dr's or hairdresser's. I don't know how long this will work, her rate of decline is shocking, but so far, so good

Thanks Pacific & Timid. Dementia absolutely sucks!!!

So sorry you're having to go through this. Ask GP for a medication review and see if any medications can be swapped for ones that are available in suspension (liquid) form, can then either be given using a syringe or at least can be taken off a spoon and reduce choking risk.

If she has been seen at a memory clinic there should be Commmunity Psychiatric Nurses linked to the team who her GP can refer to who would be able to offer some carer support and point to different ways to make life easier.

There is nothing medically you an do for vascular dementia apart from keeping risk factors like blood pressure and cholesterol under control. However practically lots can be done such as getting help at home and finding out about local support groups for both carer and the person with dementia. The local Alzeimers group may be the place to start.
Unfortunately many memory clinics do discharge people with vascular dementia and only keep people on who are on medication for Alzheimer's or mixed dementia. The local community mental health teams support the more complex cases but will discharge if things are stable. Re-referrals are common as things progress. Do not blame the staff for this it is now Trust policy. However they too should signpost to other support.

You can find information about concealing drugs under the heading "covert administration" which is the official term. The main things you have to worry about are safety and stability so e.g. some of the drugs used for osteoporosis can be very corrosive and burn if they get stuck in the oesophagus and some drugs could react with certain foods so it is best to get proper advice.

All GP practices in our area have a practice pharmacist on the team who would be the person best qualified to review the meds and advise you

Thanks everyone. I will try and chase up the dementia nurse to see if we can get some support. I do not really blame the memory clinic, but my DM found it so distressing to go, they were quite insensitive with their questioning, and we had to go three times , each time it got worse for her, then were just told that they could not do anything. I understand that this is their procedure, but it just seemed she went through all the stress of it for nothing. We received no advice/referrals to any further help- this thread has been an eye opener actually. Maybe it is different in different parts of the country? The availability of services, I mean.

BTW, she is not on tablets for osteoporosis. Mainly Blood ressure.

When my Dad got to similar stage my Mum crushed them down and hide them in his food (which she feed him). No idea if this is a good idea but it was the only way he would take the tablets.

I agree you should be able to get some help/assistance. It took my Mum a long time before she accept outside help but once she did things got easier.

She was sent to a group that main aim was to care for the carer. She went on days out, painting classes etc. It wasn't easy persuading her to go along but it was explained that if she accepted the help looking after my Dad she could go out occasionally which would mean she would be able to look after my Dad for longer (not get burned out etc). At 1st she would only allow me to help but eventually did allow professional carers to come in and help.

Good luck it's certainly a hard road to travel, but try to get as much support for your Mum and Dad as you can.

The main issue for the person with dementia about concealing medication is that they may start refusing food if they think things are hidden in it - and extend that to all food.

Your mums pharmacist may be able to help with some ideas about easier ways for her to take the medicines, and your dad could talk to her GP about if she really needs others.

Have a look if there are Admiral Nurses in your area. None around my mum, but it looks like they are brilliant

I have been through the process of dementia diagnosis with my MIL, she has Alzheimer's and vascular dementia, she is 83.

This may sound harsh but I would cease the medication as it extends life, a life which will only deteriorate. Give her food she enjoys, do not worry about cholesterol. Quality of life is so much more important than quantity.

I was driving myself crazy worrying about diet and medication, things have been a lot more pleasant since I started concentrating on food for pleasure. I buy all of her favourite things, Sunday tea that she remembers as a child.

This is one of the things you can discuss with GP/Practice Pharmacist, which medicines are essential (such as for blood pressure control) and which can be stopped (such as statins for cholesterol which are for long term health outcomes)

Do please check before crushing any tablets, some may act very differently if crushed.

Famously, Iris Murdoch took her pills crushed in orange squash with a dash of gin. It was the only way John Bayley could get them down her, and it worked.

Talk to the doc and stuff any qualms about hiding pills if necessary.

DMIL also has vascular dementia, is not yet at the stage where she doesn't know how to take tablets but just forgets to take them. We have decided it isn't worth forcing her (e.g. by getting a carer in to make her take them) as she is old lonely and depressed. So she takes them sometimes, but not others.
Irony is that she was once the pharmacist in charge of a large hospital pharmacy!

Medications for agitation have to be carefully monitored and often there is no dramatic improvement straight away. Medications such as Risperidone do have an increased risk of death during treatment and older adults with dementia may also have a greater chance of having a stroke or mini-stroke during treatment. The FDA cautions doctors on the use of antipsychotics in the elderly.

maybe it would seem appropriate to explore her concerns with respect to taking antibiotics; despite her confusion, you may be able to address her fears and gently persuade her to take treatment. If you are sure she has capacity, you may have little choice but to respect her decision, although it would be useful to know if her agenda was born out of depression or the wish to die. This being the case, you may be able to employ the use of psychiatric services.