Medication Refusal

Mlent2021

Hello, I am looking for advice on what worked for others when their LO refuses to take meds. My mom is refusing unless I make the trek over to her small group care home every morning and night. She will only take them if I talk her into it. She can swallow the pills fine, she just says that the doctor told her she doesn’t have to take them any longer. We even typed up a fake doctor note telling her she has to and that doesn’t work. She’s getting aggressive with the caretakers over it all. We are working on reducing the number of meds but some she needs (like warfarin!!). She won’t even take them in ice cream  or with a shake (her favorite!)! I’m at a loss...

harshedbuzz

Assuming you have cleared crushing/hiding the meds to be given with the pharmacist how filled the prescription, how does she know the meds are in the treats she's being offered? 

The point of hiding them is avoiding this sort of confrontation.

A friend of mine got around this issue by making a video recording on her phone of mom's doctor telling her what meds she needed to take. By the midstages, assuming a PWD can read effectively is an iffy prospect. Dad could decode well still at this stage, but real comprehension had left the building.

HB

MN Chickadee

Talk to a pharmacist about crushing the pills. Most can be crushed, some cannot so you do need to consult a professional. Then hide the crushed meds in pudding or a shake or whatever may like and don't even discuss medication with her. Is the staff trained in dementia care? Someone with training and experience often has better luck with getting an ornery person to take meds one way or another.

terei

The suggestions above should work (pills in ice cream or pudding or crushed) at least for awhile.   The last year of her life, my mom strongly refused her meds. At the point that she was in what I think was about late stage 6, the aids were spending 10-20 minutes twice a day  cajoling my mother to take meds that she did not want.  I finally told them, offer her the meds once + if she does not want to take them, that is the end of it. 

The agitation she experienced twice a day was not worth the benefit of her medication, in my mind.

About the last 8 months of her life, she took no meds.   I did not see any dramatic change in her condition, just a gradual decline that was expected.    I also felt that if she had a stroke or heart attack or whatever, it was a better end than the hell she was going through.  She had a DNR + I refused to let her be hospitalized for anything after she quit taking meds.   She was not in pain from anything.

She ultimately died of Alzheimer’s.  We also, at her express request when she was competent, did NOT hand feed her after she could not feed herself, which lasted about 10 days off + on before she died, which I am sure also played a part in the timing of her death.

Bottom line, stopping meds at the LO’s refusal is a choice that can be made, especially if it is causing the LO stress + agitation over it.

MPTosa

According the the last MC facility my mom was in, it is illegal in WI to crush or hide meds without the patient’s consent. I am my mom’s POA, she’s been declared incapacitated, but my direction alone was not enough. I was told I would have to get a court order.

In the end, I just let her stop taking the meds. It wasn’t worth the battle. 

jfkoc

If  you find mixing with food works mix in a small amount so that you know she has taken all of it,

Tina me

I use a pill crusher and some time I mix in ice cream, and some time I put a lil milk in a spoon with one piece of cereal and at the tip of the spoon put all crushed meds there so she gets it all in one bite. Hope this helps you

Concernedwon

My DW is in early stage 5 Alz. She takes her diabetes and high blood pressure medicines faithfully, thanks to having begun them before onset. I have also developed a spreadsheet she can easily follow. She marks the time of each taken dose. The pills are in pill containers where the days of the week are relabeled with the time of day. I then set her smartphone alarms to each of these times with a brief label re: med type. There is a pill container for each day of the week and I refill them myself. I used a Dymo label maker on the containers. I often have to help her target the proper compartment when she is less in tune with reality. She often inspects each pill to be sure it is the correct med.

That said, the problem is that any new med prescribed by her medical team can't be sneaked into the system. She was prescribed Zoloft, but is refusing to take it. Since she is in stage 5, she still has the last word on her medications. So, her almost daily agitations continue. I have learned to ignore them mostly, because any logical discussion is impossible. She scares our beloved beagle, who always wants to go outside to avoid the outbursts, and wants me with her (she's 13). DW often follows us outside, accusing me of not wanting to listen to her.

So, on we go. Thanks to everybody for helping me understand this disease.

M1

Welcome to the forum. This is an old thread, and you may get more responses to start a new discussion.

That said, I be to differ when you say that "since she is in stage 5 she still has the last word in her medications." You are giving her way too much credit. You need to take over supervising them, and sooner rather than later. You are fast coming to the point that medication boxes and reminders and written directives are not going to work, and there is nothing is going to work short of direct supervision including watching her put them in her mouth. You are correct that logical discussion is impossible. There are liquid forms of some medications; you might be able to find a liquid formulation of sertraline/Zoloft that you can give her, or you can hide it/crush it up in ice cream or pudding.

I know how hard this is; my partner is on a lot of medication, and fought me tooth and nail when I took it over (stage 4). But she wasn't taking them correctly, could no longer use a medication box or any sort of reminder. I have the advantage of being a doc and therefore just pulled rank on her. But I had to lock up the bottles and hide them from her, as she very much resented my having control over this.

ButterflyWings

I agree with M1 about the new thread, as well as the specific feedback given. The only thing I would add is that by Stage 4, I had to watch DH not only put meds in his mouth, but covertly monitor to be sure he actually swallowed them.

Every so often, behavior would go off the rails and I'd find a stray Seroquel pill in his pocket, under the pillow, in a drawer, or on the floor while sweeping. I for sure would not have been able to trust him to follow instructions, read notes and labels, and remember what the alarm was for plus follow through to correctly execute this important task. Again, that was Stage 4. I think your LO needs a lot more help and if no one is supervising her med administration consistently, you might be surprised.

Even if you don't find them lying around as I did, they could be flushed or thrown away...you name it. Or, equally dangerous she could overdose. Dementia doesn't follow our rules and timetable for losing skills. Please reconsider the current arrangements.

harshedbuzz

@Concernedwon

Hi and welcome.

I agree with the others-- early stage 5 is late-stage dementia. Tam Cummings' 7-Stage Model compares this stage to the developmental stage of a child between the ages of 8-12. She's beyond such critical decision-making IMO.

Have you been able to do a 6 week trial of the Zoloft successfully? Zoloft is available as a suspension than can be mixed with orange juice if that's your custom at breakfast.

The SSRIs are great for depression and mild anxiety, but if her agitation is such that she's scaring the dog, you may need a different class of medication to relieve her symptoms. Until then, this doesn't sound great for your dog. Is there someone who could take her until this behavior is more settled?

HB