alzheimer’s MEDICINE TIME CAN BECOME A PROBLEM
I have been a nurse for almost 30 years. I have given patients with Alzheimer’s Disease or another type of Dementia medications close to a million times. Sometimes it is an easy task, and other times it can be challenging.
There are times when they are simply not going to cooperate. So I will share with you some tips I have used over the years. These should help you give your family member with Alzheimer’s their medications.
If you would like information on the different types of medicines used to treat ALzheimer’s, please review the information Here.
UNDERSTANDING DIFFERENT PILL TYPES
Pills come in all shapes and sizes. However, it will help if you better understand the different types of medications on the market.
TABLETS
Tablets are the most difficult of the pills to swallow but usually the easiest to crush. They are also easy to cut if you need only to give half of a tablet.
CAPSULES
Capsules are powder or jelly medication in a cylindrical outer shell made of dissolving gelatin. The capsules are odorless and tasteless, making them easy for patients to swallow. Sometimes the edges are not sealed, and they can be opened and added to a liquid or food.
CAPLETS
Caplets are more miniature than tablets and usually easier to swallow.
SOFT GELS
Soft gels are one-piece capsules made of gelatin, used for liquid or oil-based medications. Compared to ordinary capsules, soft gels are easier to swallow. However, soft gels cannot be neatly broken down into smaller doses or easily opened. As a result, these are often the pill that is spit out by the Alzheimers patient.
CHEWABLES
Chewables are usually larger than tablets and have lower potency because of the added flavorings. Still, this may be your best choice for someone with a hard time getting to swallow medications.
EXTENDED-RELEASE
A slow-release drug is known as Extended-Release or sustained-release, designed to release the drug slowly over time. Slow-release medicines have the advantage of taking pills less often. It also means that there may be fewer side effects as the drug levels in the body are more consistent in extended-release formulations.
Extended-release tablets can be composed of multiple layers for different drug release times, as can beads within capsules. Common prefixes or suffixes for sustained-release, controlled-release, or controlled-delivery products include 12-hour, 24-hour, CC, CR, ER, LA, Retard, SA, Slo-, SR, XL, XR, or XT.
ENTERIC-COATED TABLETS
Enteric-coated tablets have a protective coating to prevent irritation to the stomach. In addition, an enteric coating delays the drug’s release until it reaches the small intestine. These usually have EN- and EC at the end of the name.
CRUSHING MEDICATIONS
Some people have difficulty swallowing tablets or capsules; some simply don’t like the taste. Crushing medications to be mixed with food or beverages is usually the best option.
But beware, not all medications are suitable for crushing. Generally, medications that should not be crushed are the extended-release and enteric-coated pills.
Some medications also come in a liquid form. Suppose you are having difficulty getting them to take a specific pill. In that case, you can always ask your pharmacist if there are other forms of medication.
When you crush a person with Alzheimers medications, try to put it into a small amount of food so they can get it all in one bite. If it is put into a larger amount they may not take it all and you will have no idea how much of the medicine they actually got.
It is also best to crush the medications into powder if possible. Little chunks left often are spit out.
Mixing Crushed Alzheimer’s Medication
The best food choices to add medicine to are applesauce, pudding, ice cream, and sherbert. Many nursing homes and hospitals use applesauce, but it doesn’t hide the taste well. Try it yourself and see.
Orange sherbert is my preferred food. I believe it hides the taste of the medicine the best, and the coldness helps. Also, fewer people spit their meds out with the orange sherbert.
EYE DROPS
Many elderly patients have eye drops ordered. But, I learned many years ago that the best time to give people with Alzheimer’s medications in the form of eye drops is while lying in bed.
Often eye drops are ordered twice a day, and I will put them in at bedtime and again in the morning before they get up for the day. Sometimes, eye drops are needed more often than twice a day. I recommend trying to put the drops in while they are sitting up in a kitchen chair and lean their head back.
It is essential to try to keep the tip of the bottle clean. Do not let the end of the bottle touch the eye. Bacteria can get into the bottle if you are not careful and could lead to an eye infection.
BOWEL MEDICATION
Often as people become less active, their bowels can slow down. Please keep track of how often their bowels move. There is the potential for a bowel obstruction if they do not keep their bowels moving, leading to a hospital stay. A hospital stay for someone with dementia can be detrimental to their health, usually because they are out of their routine and in a strange place with strange people.
People with dementia often get delirium while they are in the hospital. Delirium often leads to aggressive behavior, psychiatric medicines, restraints, and nursing home placement. Unfortunately, I still work in the hospital and see this happen almost daily. So it is imperative to prevent a bowel obstruction and keep them out of the hospital.
Getting plenty of fiber and water in their diet will help this, but often they may need some medication. Please talk to your doctor about what he would like you to use. Most doctors have a preferred bowel protocol. There are many medications for the bowels that work in different ways. You will need your doctor to determine which type your loved one needs.
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TIMING OF MEDICATIONS
Your family member with Alzheimer’s may need their medication times adjusted. It usually works out to give their medications in the morning with breakfast. However, I have run into people who are not morning people and would not take their medications until lunch or evening. If you are having problems with giving medications, talk to your doctor. They would often rather adjust the time of day than have them miss the dose completely.
Also, if they refuse their medications, wait 10-15 minutes and try again.
It will probably get tricky to get their medicines into them at some point. So you will need patience and may need to get a little creative.
Always give the essential medicine first!
One of my favorite lines is, “I just finished making this. Can you taste it and tell me if I need to add more sugar”. Of course, it doesn’t work all of the time, but it has helped many, many times.
Often using the term vitamin instead of medication will make a difference.
With Alzheimer’s, you choose your battles.
It is best to track the medications. Especially when they start refusing, your doctor will want to know what medications they are refusing and how often.
Not all medicines are necessary as dementia progresses. Please review each medicine with your doctor to determine its necessity as it continues to decline.
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Hi, I’m Larea, a Certified Dementia Specialist and Registered Nurse with 30 years of hands-on experience helping dementia patients in various settings, from hospitals to nursing homes and hospice. Drawing on personal experiences with my family members and patients over the years, I’m here to help guide you on your caregiving journey.