Managing Medication for the Dementia Patient: The Details and the Big Picture
“The whole is more than the sum of its parts”: that’s a piece of wisdom that has been with us for two and a half millennia (it comes from Aristotle). No one feels the truth of this aphorism more than a caregiver who’s overseeing the medication of an Alzheimer’s patient.
If a person were just a loose collection of parts, you could treat each condition separately: meds for the pain of arthritis, meds to lower blood pressure, meds to help with agitation, meds for mood, meds for heart disease, meds for diabetes, meds for sleeping, perhaps meds to slow down memory loss.
But what if the pill that helps with mood causes insomnia? What if the medicine that helps with pain makes falls more likely? What if the prescription that calms anxiety accelerates memory loss? And with all these medicines, if the patient develops a new symptom, how can you tell which pill—or which combination of pills—is the likely cause?
Many of the drugs used to treat symptoms associated with dementia act on the brain and the nervous system. Dr. Donovan Maust, a psychiatrist at the University of Michigan, says that such drugs increase the risk of a fall, which every caregiver knows is a special danger for the aging.
In an ideal world, no doctor would prescribe a new pill without reviewing the patient’s entire medication schedule for interactions and assessing its effect on every other medical condition the patient has. But modern medicine is highly specialized. The price we sometimes pay for the intensive knowledge a doctor has about one system is the lack of integration of treatments.
This is why a geriatrician can be such an important member of your medical team. Geriatricians are doctors whose practice focuses on treating older patients. In a profession that’s increasingly hyper-focused on details, we need a doctor to look at the big picture. Geriatricians can help in many ways. For example, they can:
But even with a geriatrician on your team, you, as caregiver, have a vital role in managing medications. Start by making a list. Here is a template that includes the most important details: name of drug (don’t forget both names—generic and brand name), what it’s for, date started, prescribing doctor, color and shape of the pill, and dose and instructions.
Consider adding a column where you can keep notes. The National Institute on Aging lists some basics you should know about each prescription. For example, what positive effects should you look for, and when can you expect them to begin appearing? What side effects might a new med cause? If you see a side effect, should you call the doctor, ignore it, or treat it yourself—and if you should treat it, what is the proper treatment? What should you do if the patient misses a dose?
Good medication management and the help of a geriatrician can integrate complicated treatments for dementia, addressing not only each symptom separately, but the whole patient. But just as the whole is greater than the sum of its parts, the whole person is (infinitely!) greater than the sum of their symptoms. As a caregiver, you are the ultimate big-picture person. In addition to overseeing your loved one’s care, you know them intimately. You are the one who can spot changes when they’re still subtle, assess how bothersome a particular side-effect is to a patient, or simply sense that something isn’t right. You may not have the medical knowledge of the specialists you consult, but your intuition is of great value here, because it springs from your personal relationship with the patient. So as you navigate doctors, treatments, and medications, never underestimate the power of your perspective, for you see the patient as a whole person.