I never know when a conversation is going to turn into a blog. This one started at the local roller-skating rink. As my intolerance to clutter reached into my Christmas list this year, I decided to give all the younger grandkids an experiential gift – five sessions of skating.

It was good to see a neighbor there with her husband and three kids. Without revealing her identity, let me say she has had an even more difficult year than most of us and is now in the position of providing care for several family members.

Still, she had a smile on her face and a lilt in her voice as she related some of her recent experiences. Her mistake was in sharing with me the difficulties she was having with administering medications. (The mistake was in telling me a problem, because certainly I felt the need to provide an answer.) I offered some suggestions, which she readily accepted. Immediately, I thought “topic for blog” because this is one of the most serious responsibilities of a caregiver and not one that just comes naturally. Here are some important guidelines for making that task easier. 

• Follow directions. In nursing school, I was taught the “five rights of drug administration:” the right patient; the right drug; the right dose; the right route; the right time. All of this information is on the label, which is a good reason to store medications in original bottles. A safe exception is using a pill planner system – a container in which medications are organized in labeled compartments to be dispensed daily for a week at a time. There have been so many advances in the way pharmacies dispense medications, that some do this for you – even in individual packages. Choose a method that works best for you.

• Another help I learned in nursing school which caregivers can benefit from is learning about the drugs you are administering. When we were assigned a patient, we had to make a med card on each medication that listed the name (generic and brand), indications, actions, side effects, interactions, correct dosage and frequency; whether it could be crushed and other pertinent information. This may be provided by your pharmacist (at least I get tons of information with each medication I have filled). Even so, it will be well worth your time to rewrite the basic information on an index card and store it with medications. 
  
  It is also helpful to keep notes regarding the efficacy and side effects of a drug – especially when taking it for the first time. Required in health care settings, a record of medications administered at home should be maintained by the caregiver. In a notebook, keep a list of all medications and instructions as well as reactions (positive and negative). This will be helpful information to review at doctor appointments and may help alert you to changes that need to be made. 
  
  
  
• My neighbor related that one of her recipients would examine the contents of the pill dispenser, then pick and choose which ones to take. I suggested she remove just the ones to be taken at a particular time with instructions such as, “These are the medications your doctor wants you to take now.” Some patients take all pills without nary a balk, while others examine each pill individually and ask a series of questions about why it is needed. Give clear, concise answers without becoming impatient. It may be more difficult for those with dementia or other cognitive impairments to understand the need for taking their medications. Of course, you cannot force someone to take a pill, but you need to develop a trusting relationship in which you can explain the importance of following the doctor’s orders. If medications are refused on a regular basis, you need to let the prescriber know.

• Scheduling medications to coincide with waking, meals and bedtime is usually a helpful strategy. Medication taken more than once a day should be taken on a regular schedule. B.I.D (twice a day) should be taken approximately 12 hours apart; T.I.D. (three times a day) meds do not necessarily have to be given every 8 hours as that might interrupt a wake/sleep pattern; but they should be given at regular intervals. If you have questions, ask your pharmacist to recommend the best schedule. 

• Remember, it is really not a spoonful of sugar that helps the medicine go down, but a full glass of water. Determine the best water temperature for your recipient – some people prefer very cold while others swallow better with tepid water. When I dispensed meds in nursing facilities, we were told to offer a straw to sip the water; I have never been able to swallow pills that way. I prefer a nice gulp of cold but not ice water – and definitely no crushed ice for me which I confuse with the pills. Personal preferences should be ascertained and provided. 

• Almost forty percent of people over age 75 take at least four medications daily. In long-term care, it was not unusual to have patients with ten or more prescribed drugs. Modern medications are a blessing that often ease or control and sometimes even cure senior ailments. However, polypharmacy, most commonly described as the use of five or more medications daily by an individual, can increase the chance of side effects or drug interactions, especially in the elderly. If you have concerns about the number of meds your loved one currently takes, do not hesitate to discuss this with his doctor.

Caring Tip: Even though most of us have a “medicine” cabinet in our bathroom, medications should be stored in a cool, dry place – not the bathroom or kitchen as deterioration can occur. And of course, store them out of reach of children and cognitively impaired seniors. Don’t forget to check expiration dates.