Managing Medication at Home

By their eighties a lot of people are taking eight or ten different things, several times a day, some with food and some without. It is a genuinely difficult administrative task, and it is being handed to the person least well placed to manage it.

Medication problems are a common cause of avoidable hospital admissions in older people, and many of them come down to organisation rather than anything clinical.

Start with a review, not a system

The instinct is to buy a pill organiser. The better first step is to find out whether everything in the cupboard should still be there.

Ask the GP practice for a structured medication review, or ask the community pharmacist to go through the list with you. It is free, people taking several medicines are a priority for one, and it is one of the most useful appointments you can arrange. Prescriptions accumulate over years, often started for reasons that no longer apply, and nobody looks at the whole list unless somebody asks.

This matters beyond tidiness. Taking five or more medicines is associated with a higher risk of falls, and some combinations cause dizziness, drowsiness or confusion that then gets attributed to age.

Take everything with you, including anything bought over the counter and any supplements, because interactions are the point.

Then simplify

With the list as short as it is going to be, ask two questions.

Can anything be taken at the same time as something else? Four medication times a day is much harder than two. Pharmacists can often suggest consolidation for the GP to approve.

Can any of it be a different form? Liquids, patches or dispersible versions where swallowing is difficult, or larger print on labels.

Practical systems

A dosette box or blister pack. Pharmacies can dispense medication pre-sorted into a weekly pack with days and times. Some do it free where there is an assessed need. This is the single most effective change for someone getting muddled, because it makes a missed dose visible at a glance rather than something you have to remember.

A simple pill organiser filled weekly by a family member works well where someone is managing but occasionally loses track.

A written list on the fridge. What, when, what it is for. Useful for your parent, essential for anyone else who comes into the house, and helpful for paramedics in an emergency.

Alarms. A phone alarm, a talking clock, or a pill box with a timer. Habit-stacking works better than technology for most people: tablets live next to the kettle, taken with the first cup of tea.

Repeat prescriptions on automatic order and delivery. Many pharmacies offer this, and families often do not ask. It removes the recurring failure point of somebody having to remember to reorder and then get to the chemist.

Warning signs to look for

Tablets left in the box at the end of the week, or the box empty too early. Multiple part-used packets of the same thing. Medication that expired years ago. New drowsiness, dizziness, confusion or unsteadiness, particularly after a prescription change. Not collecting repeats. And your parent being vague or defensive about whether they have taken them today.

A good indicator: count what should have been used since the last collection against what is left.

Where a carer fits

Worth understanding the distinction, because it matters practically and it is what any provider will ask you about.

Prompting is reminding someone to take medication they manage themselves.

Assisting is helping physically, opening the packet or handing them a glass.

Administering is a carer giving the medication, which requires appropriate training and proper written recording.

Be clear about which is needed when arranging care, and make sure it is written into the care plan along with what to do about a missed dose. Anyone administering medication should be recording it, which protects your parent and the carer equally.

A carer is also usually the first person to notice that something is not working: new drowsiness, a rash, or a change after a prescription review.

After a hospital stay

This is the highest-risk moment for medication problems.

Things get stopped, started and changed on a ward, and the discharge letter often reaches the GP after your parent gets home. Go through what came home against what they were taking before, and if anything looks contradictory, ring the pharmacist. They are the most accessible expert on this and they do not need an appointment. Our guide to care at home after a hospital discharge covers the rest of the first few weeks.

A few questions families often ask

What if my parent refuses to take something?

Find out why first, because it is often a side effect they have not mentioned. Never hide medication in food without proper advice. There are circumstances where that is appropriate, and they require a clinical decision, not a family one.

Can a carer collect prescriptions?

Usually yes, with arrangements in place. Agree it in advance with the pharmacy and the carer.

What if my parent has been doubling up by accident?

Tell the GP or pharmacist promptly, and move to a dosette box or blister pack so each dose is set out in advance.

Who do I ring with a medication question?

The community pharmacist, first. Free, immediate and expert, with no appointment needed.

If medication is the thing that is not working

It is frequently the specific task that tips a family into arranging help, and often a short visit each morning is all that is needed.

Call 01225 63 77 19, request a callback, or read how Gladys works first.