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Medication challenges for the caregiver

by Isabel Fawcett

Medication management is one good reason some caregivers may want to consider finding and using agency care alternatives for loved ones. An elder's medications are vital to life and health. For caregivers who choose to be primary providers to elders there are complex issues to consider when supervising and administering prescribed medications.

For years, I had little to do with my mother's medication self-administration routines. Occasionally, I went to the pharmacy with her, or on her behalf to pick up her prescriptions. Life was simple back then. Caregiving errands were the order of the day.

Medication Issues: Insulin Injections

My only other involvement with hers medication routines occasionally allowed her a breather when I administered her insulin injections at the end of her day. My carer's heart understands that multiple daily self-injections are physically painful, and might be psychologically devastating whenever the patient stops to think about daily self-infliction of pain.

I was in my 30's back then--less mushy than I am today. Sometime between my 30's and 40's, I found it hard to watch, much less administer insulin injections to her. That was a time where I backed off simply because I'd become mentally queasy at witnessing or administering what I perceived to be needle torture. How I long for those simple days of intermittent caregiving once more. Isn't that ironic?

There was another good reason I volunteered to assist her occasionally with her daily insulin injections. I observed that she did not rotate injection sites as often as medically recommended for people with diabetes. The lack of regular site rotations might lead to undesirable physical complications in the long term. She continued to inject the sites on her body that were easier for her to reach, including her stomach and upper thighs. I occasionally chose to help her rotate to sites that otherwise forced her into contortions just to administer her insulin injections, like the back of her arm.

Full-Time Medication Administrator

Last year, I noticed she started skipping some daytime insulin injections. In no time, her glucose levels soared. The time had come for me to become her insulin injection supervisor. Initially, I administered the first insulin shot pre-breakfast before I left for work each morning. Then I realized that she would not have breakfast until noon, at the earliest, which meant that early morning insulin had nothing to work on in her system. Not good for a person with diabetes.

That led me to another caregiving adjustment to help tide her body over until she was ready to eat breakfast. A cup of yogurt, applesauce, and hot tea did the trick after her first injection each morning. Numerous caregiver modifications and years later, I chose to become a full-time in-home caregiver to her. My choice to be an in-home care provider, including administering multiple daily insulin injections makes me admire health care agency staff more than ever.

Medication Administration: Pillboxes

I discovered 7-day pill containers when my mother reached her late 70s. Each pill container held each day's pills. Pills are best loaded at the end, or, beginning of each new week for the week ahead. As her medical diagnoses and physical ailments became more complex through her 80's, more elaborate pillboxes helped. For example, the pillbox design with two containers per day allows separation of morning and evening pills. Pillboxes worked well until she started moving the next day's pills into the current day's container and adding new pills to the vacated container.

What pills had she taken and when, I wondered?

Medication Issues: Stay the Course

When administering prescriptions stick with routines. Changing logic midstream can confuse caregivers and loved ones. Consider yourself warned when your loved one's routines for self-administering medications suddenly shifts.

Administering Medication to Elders: Stay Organized

All prescriptions are not created equal. Some medicines are prescribed for once daily ingestion while others are taken once weekly. Some prescriptions start with a single dose, while others start as a double dose, decreasing over a period of time as medically indicated. Other prescriptions such as Vitamin D, may be on-again, off-again regimens which fluctuate weekly. Ask the doctor and pharmacist as many questions as needed to ensure that only required dosage is taken for prescribed periods. Some antibiotics have significantly reduced treatment effect if not taken consistently, discontinued prior to completing full course of treatment, or, if not taken at the same time daily. Read all inserts.

A hard-copy or electronic notebook dedicated to prescriptions is helpful. Each year's end, I buy a spiral calendar hard-copy notebook to annotate glucose readings, insulin doses and ticklers reminding me to administer once-weekly prescriptions, for example. The same notebook keeps track of prescription changes, doctor's instructions and more.

All of my mother's medications are in a container tray. The plastic tray has many compartments to hold securely locked pill bottles, syringes, alcohol swabs, prescription inhalers, glucose testing equipment and more.

Providing medication support is not for the fainthearted. An elder's life depends on the quality of care you and I provide. Caregivers who are not prepared, or, who do not have ample time to implement consistent routines, may want to defer to expert agency staff, including senior and assisted living centers and nursing home partners.