Medication Adherence and Confusion

It's been over 15 years since my father passed away.  When I think of my dad, practical and organized come to mind.  Go to school, get a job and never go without some kind of medical insurance.  Stay in constant contact with your debtors to maintain good credit, return phone calls, always follow through and do what you said you are going to do and never strike your children.  Dad was a good man.

Dad lived on his own for quite a few years after Mom passed away.  He had eight children and numerous grandchildren so he always had company; however, he lived alone.   Amongst other visits, I would stop by once weekly to help him with his weekly pill box.  He didn’t take much, some blood pressure and cholesterol medication and maybe a little pain medication now and again. 

After a few years he began missing a day of medication now and again.  No big deal, it was just surprising, because Dad was usually not the forgetful type.  Then, one afternoon I stopped by and most of the pill box was still full from the previous week.  A couple of the pills were gone, but there was no pattern to be seen.  I asked Dad what was going on and he said he was irritated and agitated and didn’t know why he had to take all these pills. 

Soon after that visit we had a doctor’s appointment where Dad tried to discuss how he felt.  The doctor gave Dad and anti-depressant medication to help him with his agitation and generalized anxiety.  As we know, these medications work well; however, they need to be taken on a regular basis and also may make a patient feel a little out-of-sorts for the first 7-10 days of therapy.  Dad took it for a couple days, didn’t like how it made him feel, and wouldn’t take it again. 

This cycle went around and around for 6 or 8 months.  Dad was becoming acutely disoriented, rapidly confused and increasingly agitated.  Eventually my brothers, sisters and I began taking turns staying over at his house.    I wish I could say I was the completely compassionate son and was totally understanding of his situation.  I found myself becoming frustrated and angry with Dad for getting so agitated over the littlest of things.

What we didn’t know at the time is that Dad would be diagnosed, two weeks before he passed away, with lung cancer, from his work with asbestos on airplanes back in the 40’s.  The cancer had spread to his brain and was affecting his entire thought process.  Dad reluctantly agreed to give up his car and move into a room in our house.  I was amazed at how calm and relaxed he would become when my wife would sit and listen to his stories for hours at a time. 

Dad passed away two months after he moved in with us.  It was quick and the Hospice team was here to help all of us (brothers, sisters, in-laws, grandkids etc.) deal with the process.  We were very fortunate to have our kids live with their Grandpa for those two months.

So the issue is, how do you help someone adhere to a medication regimen when they are becoming increasingly confused and agitated?

It is even more difficult when the person is living on their own and has been for several years.  To be honest, I don’t have a good solution to this situation.  I have lots of ideas; however, they all involve plenty of time, communication and resources. 

In my opinion, the best action to take is to make a plan before you become confused.  Pick a family member who understands your medications and who agrees to manage your medications for you if and when you are no longer able to do so.

The next important step is to create your plan on how you will be taken care of in the event you are no longer able to take care of yourself.  Do you have children who will volunteer to come over and stay with you?  Would you rather be in a facility of some kind that takes care of your needs and manages your medications for you?  Make some appointments and visit a few of the local facilities to see how they feel and find out how much they cost. 

These decisions are much easier to discuss when you are of sound mind and body.  Gather your family together, address the issue, and make sure everyone is on the same page about how you will be taken care of in the event you are unable to take care of yourself.

Steve