How to Manage Medications for Elderly Parents – Jan 8, 2020
The Caring Generation® – Episode 21 January 8, 2020 On this caregiver radio program Pamela D. Wilson, caregiving expert, talks about How to Manage Medications for Elderly Parents. Special Guest. Dr. Neha Jain, a geriatric psychiatrist from the University of Connecticut Health System, talks about Medication Issues in the Elderly.
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How to Manage Medications for Elderly Parents Radio Show Transcript
00:04 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones, and trying to maintain balance in life. The good news is, that it doesn’t have to be that way. The Caring Generation, with host Pamela D. Wilson, is here to focus on the conversation of caring. You’re not alone, in fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.
00:47 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, I’m your host, you’re listening to The Caring Generation radio program, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves, loved ones, juggling work-life balance, and everything in between, all tied together with humor and laughter that are essential to being a caregiver. Take The Caring Generation with you wherever you go on Apple Podcasts, Google Podcasts, Pandora, iHeart Radio, Spotify, Spreaker, Stitcher, SoundCloud, Castbox and more. Share the program with your elderly parents and family members. Download a podcast app to their cell phones and show them how to listen. It’s the perfect way to help begin conversations about caregiving by letting me do the talking for you. This week, we’ll be talking about how to manage medications for elderly parents.
01:46 Pamela D. Wilson: Medications are an important part of health as we age. Not taking medications as prescribed, or having reactions to medications are the sixth or seventh most common cause of elderly adults visiting hospital emergency rooms. In this program, I’ll share information about how to talk to physicians about medications that are prescribed so that your elderly parent can avoid unnecessary hospitalizations or emergency situations that are medication related. We will also talk about medications for mood, memory loss, and anxiety that are frequently prescribed for elderly adults. Medications that are used to treat these conditions in the elderly are a controversial subject. Some physicians refuse to write prescriptions that can be beneficial for elderly adults because they lack knowledge. Our special guest is Dr. Neha Jain, a geriatric psychiatrist, from the University of Connecticut Healthcare System. She will talk about medication issues in the elderly.
02:58 Pamela D. Wilson: Let’s start by talking about how to manage medications for elderly parents. In my opinion, the first step is to understand why elderly parents are taking prescribed medications. As a caregiver of an elderly parent, are you aware of your parent’s health conditions that are likely the reason they take one or multiple medications? How many of you see the commercials on television? All prescription medications have side effects. If we read the manufacturer’s warning labels, or listen to all of the precautionary conditions mentioned in television commercials seriously, we probably would never take any medication. How do you know when you should or shouldn’t be concerned about side effects before taking medications? How do you know when you should take a more active role to manage medications for elderly parents? It is important to know the side-effects, but even more important to understand the reason that a medication is being prescribed for elderly parents. Knowing the long-term effects of taking the medication is also essential. Even more important, learning about the medical condition for which the prescription is prescribed. Medications are prescribed for temporary and long-term chronic health conditions.
04:18 Pamela D. Wilson: Let’s begin with my 10 Points to Consider Before Starting to Take Medications or Supplements and how to manage medications for elderly parents. Number One, go to a doctor’s appointment with your elderly parent. Have a thorough discussion about medications. Based on my experience, an elderly parent goes to the doctor. Doctor prescribes the medication. Our elderly parent gets the prescription filled and takes the medication or stops taking the medication after a period of time, or in even a greater number of situations, if they worry about the medication copay, the prescription may never be filled. How much of this filling, or not filling, starting and not continuing to take a medication could be managed if we ask the doctor to explain the details of the condition for which the medication is prescribed? Which leads us to point Number Two. Ask if the condition for which the medication is being prescribed is temporary or long term?
05:25 Pamela D. Wilson: Ask if there is an alternative to taking the medication. Being practical in your approach to health should lead us to ask really good questions and be more informed about health concerns of elderly parents and ourselves, especially if learning how to manage medications for elderly parents will be one of our caregiving responsibilities. Here’s a simple example. Cholesterol medication is prescribed. What are the alternatives? Might the condition be managed if an elderly parent changes his or her diet, meaning, eating more oatmeal, avoiding fried and fatty foods? If an elderly parent is set in his or her ways, they may rather take a pill. So, then you ask the next question. What are the long-term consequences and the effects of high cholesterol, so that you and your elderly parent are aware of the risks and the future consequences of that diagnosis?
06:19 Pamela D. Wilson: You are the caregiver. The health concerns of an elderly parent will end up being your concern sooner or later. High cholesterol may result in heart problems, clogged arteries that may require stents, or bypass surgery. The likelihood of a stroke might increase. Chronic conditions have serious negative long-term effects that are not routinely discussed with the doctor unless you ask the questions. If you’re going to learn how to manage medications for elderly parents, have a thorough understanding of the health condition and the long-term effects. It’s so important. Point Number Three. If an elderly parent takes a medication, ask about the dosage.
07:01 Pamela D. Wilson: How much of the medication is required to have an effect? For example, one medication may begin at 25 milligrams and over time increase to 200. How do you know when you have the right dosage? Another practical consideration that physicians fail to consider is prescribing a whole pill that has to be cut in half. A small 25 milligram pill prescribed at 12.5 milligrams that has to be cut in half might crumble up and be wasted. Who’s cutting that pill? You or your elderly parent whose hands might be affected by arthritis. They can’t pick up the pills easily. They can’t work with a pill cutter. Talking about all of these details with the doctor might seem excessive unless you find yourself in this situation with an elderly parent who can’t manage their medications and experiences on-going health ups and downs.
07:55 Pamela D. Wilson: Point Number Four. Ask about the side effects of the medication and what your elderly parent might notice that would be different. For example, a side effect of cholesterol, or some heart medications, are leg cramps from the depletion of potassium in the body. Other side effects, thirst, dry mouth, skin rashes, constipation, stomach upset, dizziness, headaches. Positive effect, your elderly parent feels better. Negative effect, they feel worse. Negative and positive side effects are important to monitor when learning how to manage medications for elderly parents. If there is a negative side effect, have that side effect permanently noted in a medical chart. Have the pharmacy note the reaction in your parent’s file. Years into the future, when your parent is in the hospital room you may be asked about a medication allergy. Up next, Dr. Neha Jain, is a geriatric psychiatrist from the University of Connecticut Health System, talks about medication issues in the elderly. The controversy over prescribing medications for mood, memory loss, and anxiety for elderly adults. This is Pamela D. Wilson on The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio. Stay with me, we’ll be right back.
11:45 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, I’m your host. You are listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. We’re back to talk about medication issues in the elderly. Dr. Jain, thank you for joining us.
12:02 Dr. Neha Jain: I’m glad to be here.
12:04 Pamela D. Wilson: So, you are in a very unique setting at a hospital with an academic center. Can you give the listeners background about your role in working with geriatricians at the University of Connecticut Health System, and to prescribe medications for the elderly who have dementia, anxiety, and depression?
12:21 Dr. Neha Jain: Absolutely. So, we have this really interesting program at UConn called the UConn Center on Aging. And so I, and then my fellow geriatric psychiatrists, we work alongside geriatricians who are internal medicine doctors with a sub-specialty in geriatrics. And so, patients will typically come in to see the geriatricians often for memory concerns. But sometimes for regular physical checkups, or other physical complaints, and then they are referenced to us if there’s any concern about either psychiatric aspects of dementia, or there’s a separate psychiatry disorder such as anxiety, depression, or any other issues. So, we get to work alongside them, discuss patients, and really work as a team, providing care to the older adults.
13:09 Pamela D. Wilson: And what are the main concerns when you work with these geriatricians about prescribing medications for the elderly, for dementia or anxiety or depression?
13:19 Dr. Neha Jain: That’s a good question. So, there’s multiple issues when you look at medications used in the elderly. The first one is that our bodies change as we get older. So, if you’re 80, your kidneys are not going to work the same way as they did when you were 40. Which means that the medication that is typically excreted by the kidney may not pass through as well and you may end up with more medication in your system. So that’s one. The second one is, how these medications affect our body. So, as we get older, certain medications, especially sedatives or pain medications or anxiety medications, they affect our brain differently and we have to take that into consideration. The third thing would be, older adults are often taking multiple medications for multiple conditions, we call this polypharmacy. And the more medication somebody is taking, the higher the risk of any kind of drug-drug interaction or side effects, so we have to consider that.
14:18 Dr. Neha Jain: But in the same vein, they are sometimes seeing multiple specialists. They may go in and out a hospital or they need more med changes. So, we always have to keep that in consideration. And then lastly, if they do have dementia or other cognitive impairment, are they really able to manage often complicated drug regimens? Are they taking medications appropriately? And if they’re not, then that again increases the risk. So, all of these things are things we think about when it comes to medication use.
14:46 Pamela D. Wilson: A lot of elderly adults that I’ve worked with are depressed, and some of them have been screened for depression but they don’t present as depressed. Yet they certainly are. So, in your experience, why does that happen?
14:57 Dr. Neha Jain: And that’s a very good question. So, depression in the elderly or sometimes we say late-life depression, it presents differently than depression in younger adults. So, when we typically think of depression in the younger adult, they may say, “I feel down. I feel depressed.” Older adults often will not say that. They may present more commonly with something we call apathy, which is, they’re not sad but they’re just not interested in stuff or they may present with more memory complaints than actually complaints of depression. So typically, to make a diagnosis of depression, we rely on the DSM, which is a statistical manual for psychiatry. And the DSM criteria for depression don’t often fit older adults. So they’re often not diagnosed, but they might still be depressed, it just looks very different.
15:48 Pamela D. Wilson: And do you see older people who are depressed and you talk to them, and they might think that being diagnosed as depressed is like a bad thing or a shameful thing?
15:58 Dr. Neha Jain: Oh, absolutely. There is a lot of stigma. There is certainly stigma in younger adults as well. But especially when it comes to older adults and if it’s the first time that they’ve been depressed and they’ve lived most of their life without depression, it’s a big deal. First of all to recognize depression and then as they do recognize it, to come out and seek help. Absolutely.
16:19 Pamela D. Wilson: Do they then resist taking medications for depression when they’re prescribed? How do they respond?
16:25 Dr. Neha Jain: Not typically. So that’s the interesting thing and one of the reasons I really enjoy working with this population, is that once they do come to see you and you have a good discussion with them, most of the time, they are fairly open to taking medications. However, late-life depression can be more difficult to treat. So, even if they’re willing to take medications and usually taking it the way you prescribe it. It may be much more difficult to actually treat.
16:55 Pamela D. Wilson: And then sometimes, so, let’s say you prescribed something. Do you have to try a couple before one works?
17:01 Dr. Neha Jain: Oh, absolutely. So, we will start with one medication. We have to give it enough time. We have to use the right dosage. And if that doesn’t work, we’ll move on to other medications. If it works partially, we may have to augment it with something else. So, there’s lots of different ways we can approach that.
17:17 Pamela D. Wilson: Thank you. So we will continue our conversation with Dr. Neha Jain, a geriatric psychiatrist from the University of Connecticut Health System after this break coming up. Join me each week for The Caring Generation where we talk about how to be proactive to avoid surprises about health, well-being, caring for ourselves, balancing work, life and caregiving and taking care of our elderly parents. If you miss any of The Caring Generation shows, the podcast replays are available on my website at pameladwilson.com. Please do share the conversation of caring with elderly parents and family members. If you have an Amazon Alexa, all you have to do is say, “Alexa, play The Caring Generation Podcasts on Apple Podcasts.” The Caring Generation is also on your favorite podcast apps that you can download to the cellphone of elderly parents and family members. Check out The Caring Generation. We’re on Apple Podcasts and Google Podcasts. I’m Pamela D. Wilson, your host. You are listening live on the BBM Global Network, Channel 100, and TuneIn radio. Stay with us. We’ll be right back after this break.
20:47 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert, I’m your host, you’re listening to the Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. We are back with Dr. Neha Jain, a geriatric psychiatrist from the University of Connecticut Health System.
Dr. Jain, in the patients that you see who are elderly, how many of them either admit to, or do you find out that they have difficulty managing their medications?
21:22 Dr. Neha Jain: I would say at least half of them, if not more.
21:27 Pamela D. Wilson: And do their family members step in to manage, or how do you talk to them about that?
21:34 Dr. Neha Jain: So, we typically screen for that. So, we will ask them at the first interview or the first session, “Have you noticed any problem taking your medications?” And sometimes they will come out and tell us, “Yes, once in a while, once a week or so I forget to take them,” or “I forget that I have taken them.” If they don’t, often we will ask family members. So, if they’re living with the spouse or somebody else, they will be the ones to point that out. If we have concerns about their memory in general, then we will sometimes ask family members to check in on that. So even though they’re taking medications themselves, we may ask somebody to just keep an eye on the pill box and see if they’re being taken appropriately. And then, if there is a problem, family members or sometimes even paid caregivers will step in to take care of that.
22:25 Pamela D. Wilson: There is a term called black box warnings for medications that the elderly, that they say they shouldn’t take. How do you counsel families about the risks and benefits and medications that have these black box warnings?
22:38 Dr. Neha Jain: Yes, so the black box warning specifically, typically relates to medications known as anti-psychotics. And the warning states that in people with dementia, anti-psychotics increase the risk of death almost one and a half times. Aside from the anti-psychotics, there is also a large number of medications that just have safety warnings in the elderly. If you have heard of the Beers Criteria?
23:04 Pamela D. Wilson: Yes.
23:04 Dr. Neha Jain: It’s basically a list of medications, and a lot of medications that people typically take are on them. So, the most important thing I think, is to have a really frank discussion, not just with the patient, but also with their family, to say, “These are the benefits, these are the risks.” And there might be situations where benefits outweigh the risks, and then we take those medications. But there are also situations where sometimes the risk is just too much, and the patient and family may choose not to try them. But I think the most important thing is to have that clear understanding, and very clear communication as to what the risks and benefits are.
23:42 Pamela D. Wilson: I have had clients who have been prescribed Namenda and Aricept for memory loss, and then I’ve seen physicians and hospice agencies and other people just discontinue these medications and the clients become suddenly worse. Why is there this lack of education, or why do doctors just discontinue medications that are helpful?
24:02 Dr. Neha Jain: So that’s [chuckle] a good and complicated question. I think the most important reason is, especially in geriatrics, we are actually trained to reevaluate medications periodically. And then all of the reasons I mentioned, why there are issues with medications. We also always want to discontinue anything that may be unnecessary. Now this becomes interesting with memory medications, because at a certain point, you don’t know if this medication is still serving a purpose. If you’re on Aricept and the memory is declining still, there is no way for me to know if it would have declined more or less without the Aricept. Now in this situation, suppose the patient develops a new clinical symptom, which could potentially be a side effect of the Aricept or the Namenda, or whatever medication it might be. It sounds pretty reasonable that we would stop the medication. But like you said, there’s always that risk that something will actually worsen. And so, this is another situation where again, a very frank open discussion of the risks versus benefits. And if there is worsening, how are we going to handle that? That plan needs to be there. But yes, that’s the risk we take every time we make a change.
25:16 Pamela D. Wilson: A lot of primary care physicians are uncomfortable prescribing these types of medications for family caregivers who have elderly parents who need these meds. Where do they go, what options are out there for them?
25:30 Dr. Neha Jain: Yes, this is unfortunate for multiple reasons. Primary care doctors are often the first line of defense. They are sometimes the only person that the patients see on a regular basis, and also somebody who’s the most accessible to the patient. Certain primary care doctors are comfortable prescribing some types of medication. If they are not, there’s always options to get at least a consult or maybe a one-time visit with a geriatrician or geriatric psychiatrist who can then continue to collaborate with the primary care physicians. So even though the primary care physician is doing the managing, and the specialist maybe much less accessible, they can work together, and/or certainly always very open with anybody in primary care saying, “Reach out to us, call us, email us, we’ll work with you.” Because access is truly an issue. There’s some other more innovative stuff out there, Telemedicine is one very good way to expand the reach. But you’re right, there is a real unfortunate shortage of geriatricians and geriatric psychiatrists, and it can be very hard to find care sometimes.
26:43 Pamela D. Wilson: And so what do we do about that? I mean, even here in Denver, there’s a shortage of geriatricians, geriatric psychiatrists. What do we do about this?
26:53 Dr. Neha Jain: So, you know, I think there is really no way around it. We do have to address the shortage of geriatricians. Specifically, you know, the population, the older population that’s surging and the demand and supply gap that keeps on widening. I think there was a recent article in The New York Times that said something like in 2025 we need 35,000 doctors and we will have 7,000. And I think the biggest reason for that is really money. You know, compensation because geriatrics is actually lower compared to that for young adults. So, if you think about a young doctor in training, why would they want to do extra training to sub-specialize in something where they would actually end up really making less money? And we are talking about young doctors who are graduating with very, very big loans. They’re starting out in their career. They have family. They have all these economic realities that they have to face and geriatrics is very rewarding, but it is not a glamorous field. [laughter] And so, we really have to find some way to make geriatrics more attractive, not just in terms of the rewards, but also in terms of the compensation for our young doctors.
28:09 Pamela D. Wilson: I agree with you. Dr. Jain, thank you for your, joining us tonight. Thank you for everything that you do, and the work that you do, there is such a need. Coming up after this break, we will continue to talk about how to manage medications for elderly parents. Including looking at other options that include working with compounding pharmacies. Helpful information in past programs of The Caring Generation are on my website, PamelaDWilson.com. Click on the media drop down, and then The Caring Generation, you’ll find the shows there. I’m Pamela D. Wilson, your host, you’re listening to The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio, we’ll be right back after this break.
31:10 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert, I’m your host, you’re listening to The Caring Generation radio program for caregivers and aging adults coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation is the place where we share tips and things you should know about life. Help, hope and support for caregivers are available on my website at PamelaDWilson.com. We’re back to continue our discussion about how to manage medications for elderly parents. Number Five. In the list of medication considerations is to ask if there are foods, medications, or other over-the-counter products that make the medication that you are being prescribed less effective. When managing medications for elderly parents, you want to let the doctor know every medication and every over-the-counter supplement that your elderly parent takes.
32:07 Pamela D. Wilson: Some foods and over-the-counter supplements make medications ineffective. For example, a person taking Coumadin should avoid grapefruit juice and foods high in vitamin K, like green tea, spinach, and green leafy vegetables. For other medications, calcium in milk blocks the ability of the medication to be absorbed into the body. If you’re taking a medication, you want it to work. Talk to the doctor about these things. Number Six, and this is a very important consideration that you as the caregiver will want to monitor. When managing medications for elderly parents, only agree to add or discontinue one medication at a time. While we may just want to address all the health problems at once, adding a lot of medications, or discontinuing a lot of medications can be problematic. Adding multiple medications at the same time, doesn’t allow you to tell which medication is having a positive or a negative effect.
33:07 Pamela D. Wilson: If a medication is discontinued, talk to the physician, ask if there’s a specific timeframe that it takes for that medication to clear the body. As Dr. Jain mentioned, age, metabolism, weight, health conditions, they all affect the ability of the body to process and to clear medications. For elderly parents, the time to clear medications might be longer due to age, liver and kidney function, because the liver and the kidneys clear all the toxins from the body. Take the appropriate time to discontinue one medication and then begin the next. Next on the list, Number Seven, of how to manage medications for elderly parents is to help parents to fill and take medications. According to the research, 31% of prescriptions are never filled. People under age 52 are less likely to fill their prescriptions than older people, men slightly less likely than women. And as we talked about adults over age 65, they end up in the emergency room because they don’t take the medications. They take them incorrectly. They forget to take them.
34:17 Pamela D. Wilson: One of the easiest ways to manage medications for elderly parents is to get one of those medication reminder boxes. You can pick them up at a local pharmacy. After you pick up the medication, set up a couple of weeks in a box that has the morning slots, evening slots, sometimes noon and even bed time. Then all your elderly parent has to do is remember to take the pills from the slots. And if that’s a problem, there are electronic medications machines that have alarms and believe it or not, talking clocks. The more proactive that you can be about learning how to manage medications for elderly parents, the fewer issues that will happen with chronic health conditions that can result in more doctor appointments, unexpected hospitalizations, and more time for you as the caregiver to manage health concerns. Also make sure that your parents, this is a funny one, but are not accidentally taking each other’s medications. Label those boxes with mom or dad. Put them in different locations rather than having the boxes sit next to each other. Another issue to be aware of is formulary issues at the pharmacy. So, Number Eight on the list of how to manage medications for elderly parents is to make sure that the medication prescribed by the physician is in your prescription insurance formulary.
35:37 Pamela D. Wilson: What does that mean? It basically means that your insurance company approves it. So, have you ever arrived at the pharmacy to be presented with a $500 bill and you’re shocked? It’s because that prescription isn’t in your formulary. Ask your physician if they can confirm if medications that they are prescribing are within your health insurance plan. If they don’t know, I recommend asking for the names of a couple of more medications and then call your insurance company before you leave the doctor’s office. While that may seem to be a time-consuming effort, it will save you time, frustration and money in the long run, and you’ll continue to learn more about how to manage medications for elderly parents. Some non-formulary medications can go through a pre-authorization process, but that can take weeks. The easier path is to just have the doctor prescribe a medication that your insurance company approves and will reimburse. Checking that these medications are in the formulary is really part of advocating for the care of an elderly parent. Some elderly parents won’t take medications because they’re scared to death of the copay. They’re afraid their insurance company won’t approve it or they don’t want to call the health insurance company because it’s a hassle.
37:00 Pamela D. Wilson: Honestly, calling is never fun because of the long wait times. But the question to ask yourself is, “Would you rather be in control of your health or your parents’ health and know what’s going on or leave it up to the insurance company to make that decision for you? Do you want to be surprised with a $40 copay when the medication in the formulary could be $4? Do you want to have that choice? Do you want to leave it up to the insurance company or your pharmacy?” I don’t think so. Number nine in the list of how to manage medications for elderly parents is to make the pharmacist your new best friend. When that person at the counter asks, “Do you have questions?” Say, “Yes.” The pharmacists know more than most physicians about medications, interactions, side effects, allergies, all of that, and their job is to educate you and they love doing it. We are on our way to another break. Stay with me and we’ll continue our conversation about how to manage medications for elderly parents, including about how compounding pharmacies might be the answer to problematic medication situations. I’ll share some situations that you might come across with. This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation live from the BBM Global Network channel 100 and TuneIn Radio. Past podcast of the shows, you can find them on my website, PamelaDWilson.com. Stay with me. We’ll be right back.
40:46 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. You are listening to The Caring Generation, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Tips and information for caregivers and aging adults are on my website, PamelaDWilson.com, along with podcast replays of The Caring Generation. You can follow me on social media. On Facebook, my page is pameladwilson.page. On Twitter, I am CaregivingSpeak. On Instagram, WilsonPamelaD. And on LinkedIn, PamelaDWilsonCaregiverExpert. Last in my list of 10 Items on How to Manage Medications for Elderly Parents is, if you are an elderly parent, or concerned about taking the medication or have had a bad experience with side effects, investigate other options. For some medical conditions and medication issues in the elderly, there may be over-the-counter options. Some individuals prefer to see naturopathic physicians as an alternative to taking the drug. Over the years, I have worked with compounding pharmacies that can work magic.
41:54 Pamela D. Wilson: The cost is maybe different because you have to investigate with your insurance company if they pay for the compounding pharmacies, but they can solve a lot of medication issues. Some can give you access to discontinued medications. They might be able to recreate the basic ingredients of a medication that’s no longer available. Compounding pharmacies can also make medications easier to take or use. This idea comes in really handy when working with elderly parents, children, or even cats and dogs who may resist taking medications. Compounding pharmacies can create medications with flavors and in different forms. Medications in patches, gels, liquids, flavored powders, other forms. You don’t know what is possible until you ask. If you have a loved one who has sensitivities or allergies, like dyes, lactose, gluten or alcohol, a compounding pharmacist may be able to make a formula without those ingredients. They can also offer other advice and recommendations that sometimes regular pharmacies just don’t have access to or are not aware of, and they can help you solve these medication issues for elderly parents.
43:08 Pamela D. Wilson: Because they create products, compounding pharmacies may have solutions that even traditional medicine does not. When in doubt about solutions for medication side effects, allergies, discontinued medications, medications that are easy to take, and other solutions, find a local compounding pharmacy. You can Google it. You can look it up in a phone book. Now, let’s talk about, more about how to solve these medications issues in the elderly that you may not have come across yet. A few weeks ago, I was speaking with a family caregiver who was a great advocate for two people in her family. These two people lived in nursing homes, and she was very familiar with their health conditions and their medication history. But both of these nursing homes caused problems with medications that were prescribed. They either discontinued the medication or they changed the medication without talking to her. The first issue here is that many communities, doctor’s offices, and other healthcare providers, they’re rushed. They don’t recognize the roles and responsibilities of a family member who might be in a power of attorney, medical role or a guardian.
44:19 Pamela D. Wilson: When you begin a new relationship with a healthcare provider and you are in that legally responsible role, provide them with a copy of the document. Have a thorough discussion about your roles and your responsibilities. Even go to the extent to have them place a piece of paper in the file with a note saying that you must be contacted prior to them making any changes in treatments or medication. Unless of course something life-threatening happens. Know that you may have to make this request multiple times because they’re not good at asking permission. Doctors just want to change a medication. It’s much easier for them to make a change and talk to your elderly parent who probably would just agree rather than disagreeing. So, be forewarned. In that situation, with this caregiver who contacted me, her father’s medication had been discontinued because of a policy that nursing homes have, it’s a federal policy to reduce medications taken by elderly adults. And it’s a policy that I could argue against all day long. Because I have had similar experiences with many nursing homes on behalf of my clients, and I’ll give a simple example.
45:31 Announcer: A doctor discontinued my client’s evening blood pressure medication. I get a call from the nursing home saying, “Your client is experiencing a stroke.” Knowing what happens in nursing homes, my first question was, “Did anybody change the medication?” Their answer was, “Yes, the doctor discontinued the evening blood pressure medication because the blood pressure was stable.” That issue is one of my many concerns with the ways that nursing homes manage medications. Follow along with this logic. My client’s blood pressure was stable. Of course it was, . she was on medications to stabilize her blood pressure. The physician thought she didn’t need the evening dose, so he discontinued it without asking me. If he had asked, I would have said no. In my opinion, this was his attempt to follow a bad nursing home policy and the bad is really in my opinion. Most nursing home regulations, their staff would disagree with me, but the decision of that physician could have seriously harmed the health and well-being of my client. And in the situation of this caregiver that I spoke with, it definitely harmed the health of her elderly parent, because they were asking her to take him out of the nursing home because of behaviors. Yet, that behavior that happened — they discontinued or the medication that managed that behavior.
46:58 Pamela D. Wilson: You have to be so vigilant if you have an elderly parent in any type of CARE community. We’re going to continue to, this conversation about medications in the elderly after this break. Next week, we’re going to have a conversation about family caregiver support. Information from the AARP, Valuing the Invaluable project with Rita Choula, Director of Caregiving Projects. It’s a great study. Share The Caring Generation with your elderly parents, your brothers, your sisters, and your other family members. You can download the podcast app off of Apple, Google, Pandora, iHeartRadio, Spotify, Spreaker, Stitcher, SoundCloud and Castbox. Put it on their cell phones. Show them how to listen. Help them become more educated about caregiving, about health and about well-being. The radio show is the perfect way to help begin conversations about caregiving. I can certainly do the talking for you. Visit my website, PamelaDWilson.com for helpful information: podcasts, my library videos, a lot of helpful information is there for caregivers. I’m Pamela D. Wilson, your host. You are listening to The Caring Generation live from the BBM Global Network, Channel 100 and TuneIn Radio. Stay with me. We’ll be right back after this break.
51:37 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert. I’m your host. You’re listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s continue our conversation about medication issues in the elderly. Managing medications is even more important if you have a loved one diagnosed with any type of condition that results in behavioral, mood, or anxiety issues and they live in a care community or at home. These diagnoses are brain injuries, Alzheimer’s, dementia, Parkinson’s disease and any type of mental illness. As we talked earlier with geriatric psychiatrist Dr. Neha Jain, from the University of Connecticut Health Care System, finding the right doctor to treat these conditions can be challenging, but not impossible. Examples of the challenges are care communities sending your elderly parent to the hospital with behaviors only to refuse to accept them back after the hospital provides treatment. This happens more than you realize. In the healthcare circles we call this action “dumping a problem client.” Many mental health hospitals don’t have the ability to treat, or they don’t want to treat elderly adults who have dementia, Alzheimer’s, and mental health issues. In part because insurance companies don’t reimburse for that type of treatment.
53:03 Pamela D. Wilson: In talking with Dr. Jain, and previously with Dr. Mary Wyman from Wisconsin, the option is to try to have a loved one treated by a teaching hospital. If your loved one is a veteran by a VA hospital who has geriatric psychiatrists and specialists. Many regular physicians are fearful of prescribing these medications names like Seroquel, Namenda, Aricept, Zyprexa. Because many of the behaviors that benefit from these medications are unknown. Like Dr. Jain said, sometimes a medication works. Sometimes it does not, but the challenge is to find a physician who will work with you and your elderly parent. Insurance companies are reimbursing less for psychiatrists. Many only accept clients on a private pay basis. There are long waiting lists, some of them don’t want to work with elderly patients. So if you’re a caregiver in this situation, you might have an especially difficult time managing medications for elderly parents, and trying to get these issues resolved.
54:10 Pamela D. Wilson: Managing medications for elderly parents, it’s a significant gap in the healthcare system. One that you want to make sure that you can address. So, if you’re a caregiver, learn as much as you can about medical conditions and why medications are prescribed. Monitor your elderly parents for side effects, positive and negative. The more that you can learn, and the more that you are able to share with physicians about health conditions for your elderly parents the better. Medication management can be an area where you as a caregiver have to be a really strong advocate. I recommend creating and keeping a typed list of medications that you take with you to doctor appointments and everywhere. Listeners, I thank you so much for your interest in being proactive and interested about caregiving health and well-being. Caregivers, I thank you for everything that you do every day, every week, as a caregiver and in helping your loved ones, and the patients that you care for, if you are a professional caregiver, they need your time and attention.
55:11 Pamela D. Wilson: Please share this program with others seeking help and support. Add your favorite podcast to the cellphone of your elderly parent or your family member. Help them listen to the Caring Generation. We want to make caregiving something that we talk about. Helpful information for caregivers and aging adults is on my website PamelaDWilson.com. Thank you for joining me on the Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. I’m Pamela Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again next Wednesday evening. God bless you all. Sleep well tonight, have a fabulous day tomorrow, and a great week until we are together again.
55:57 Announcer: Tune in each week for the Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone, here on Pamela D. Wilson’s The Caring Generation.