When Progressive Confusion Challenges Medication Adherence

AUGUST 29, 2016
When I think of my dad, who died nearly 15 years ago, the words “practical” and “organized” come to mind.
He lived on his own for quite a few years after my mom passed away. However, he had 8 children and numerous grandchildren, so he always had company.
I’d stop by weekly to help him with his pillbox. He didn’t take many medications; just some blood pressure and cholesterol pills, and maybe a little pain medication now and again.
After a few years, he began missing a day of medication here and there. It was no big deal, but it was surprising because he wasn’t the forgetful type. Then, one afternoon I stopped by, most of the pillbox was still full from the previous week. A couple of the pills were gone, but there was no pattern to be seen.
I asked my dad what happened and he said he was irritated and agitated and didn’t know why he had to take all these pills. 
We made a doctor’s appointment where he tried to discuss how he felt. The prescriber gave him an antidepressant to help with his agitation and generalized anxiety. These medications work well, but 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 to 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 continued for 6 or 8 months. Dad was becoming acutely disoriented, rapidly confused, and increasingly agitated. Eventually, my siblings and I took turns staying over at his house. I wish I could say I was the compassionate son who was totally understanding of his situation, but I found myself becoming frustrated and angry at my dad for getting so agitated over the littlest things.
At the time, we didn’t know that 2 weeks before he’d die, he’d be diagnosed with lung cancer from his work with asbestos on airplanes back in the 1940s. 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’d become when my wife would sit and listen to his stories for hours at a time.
He died 2 months after he moved in with us. It was quick and the hospice team was there to help my entire family deal with the process. We were very fortunate to have our kids live with their grandpa for those 2 months.
The issue is, how do you help someone adhere to a medication regimen when they’re becoming increasingly confused and agitated? It’s even more difficult when the individual has been living on their own for several years. 
To be honest, I don’t have a good solution to this situation. Still, I believe the best action is to make a plan before you become confused. Pick a willing family member who understands your medications and will agree to manage them for you if and when you’re no longer able to.
Then, create a plan for how you’ll be taken care of in the event that you’re no longer able to do so 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? Make some appointments and visit a few local facilities to see how they feel and find out how much they cost.
These decisions are much easier to make when you’re of sound mind and body. Gather your family together, address the issue, and make sure everyone is on the same page about your future.

Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.
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