Late in 2016, my stepfather of 40+ years began showing signs of confusion and decline following the deaths of several loved ones. Phone calls and visits were difficult due to the cognitive struggles, and then there were more serious issues such as him forgetting food cooking on the stovetop.
His medical issues continued and warranted a trip to the emergency department in January 2017 to rule out a possible stroke or neurological issues. I will never forget the doctor telling me that my dad, who was 85 at the time, had not suffered a stroke but instead was on a powerful and potentially deadly “cocktail” of medications for depression, anxiety, insomnia and pain and that he needed to be hospitalized to purge his body of the medications safely and while under observation.
Once he was discharged, we were able to convince him—with great persuasion and indeed pleading—to move to Raleigh to an independent living facility about two miles from my home.
It provided great comfort knowing that I would be with him consistently to help care for him, but as wonderful as the time was together before his passing, there were challenges as we shifted roles in our relationship.
My dad was a career pharmacist, so he did not relish the idea of me checking behind him on his medications or asking questions. He was a strong and virile man, so taking his car keys when it became obvious several months later that he was suffering from Alzheimer’s was excruciating. And he was a private and proud man, who fought through a 20-year battle with prostate cancer until it robbed him of his strength and life in January 2019.
I learned so much from him in his time of living and his time of dying. My hope is that each of you is as fortunate as I was to serve in the caregiver role for an aging parent. If you are so lucky, I share with you these suggestions:
- Accompany your parent to his/her doctor appointments and trips to the pharmacy. In our case, my dad was under the care of multiple physicians from his hometown and in Raleigh, and as a result, he used multiple pharmacies. It is important for the caregiver to be with the parent and to ask questions and help process all of the information shared. Encourage the physicians to discontinue all medications possible, as the more drugs a parent is taking, the more potential there is for contraindications and problems. And if at all possible, only use one pharmacy and develop a good relationship with the pharmacy team. They can be invaluable to your parent and you.
- Be the patient advocate during hospital stays and especially at discharge. Hospital stays can be so confusing for older adults, especially when the admission lasts for days and involves multiple diagnostic tests. The patients often get sundown syndrome and become very confused. It is critical that caregivers are there to look after the patient’s/parent’s best interests, especially when the nurse or discharge planner provide instructions prior to going home.
- Review their medications regularly, and help them fill their medication trays weekly. As I mentioned previously, my dad was a pharmacist, and while he did recognize some aspects of his mental decline, he held on to the idea that he could fill his pill organizer without fail. He could not. Schedule the same time of the week if possible to fill the medication tray, and make a routine around it such as dinner or lunch so that it is not the main focus of the visit.
- When the time comes, take over the medication management or hire a nurse to assist. When you recognize that your parent is getting more confused or taking the wrong medications at the wrong times, take over control immediately. It is easier said that done for most, but by forcing the issue, you will protect your parent from potential falls, hospitalizations or worse. You may have to hire a part-time nurse to assist with medication management if there are no other options.
- Assist your parent with cleaning out their medicine cabinets monthly or at least quarterly. Medication regimens change frequently with older adults—whether it is a completely different prescription or a dosage change, so it is important to clean out the medicine trays and medicine cabinets frequently. Then dispose of the medicines promptly and properly. Many older parents do not want to discard of unused or even expired medications because they are on a fixed income and think they might need them later. But by disposing of the medications, you are protecting them from medication mistakes or misuse, and you are also preventing possible diversion of the medications.
I had to remind my dad many times over those two years that my motivations and interests were simply to keep him safe and living independently as long as we possibly could. And I feel so fortunate that he was able to do just that until the very end.