News & Views

Managing Medicine

It is a sad fact of life that as people need more personal care they usually need more medication.

The medical profession often refer to older people taking a mixture of medicines as having complex needs. The complexity arises not just from the range of conditions that have to be treat, but from the effect that one condition has an another and effects caused by mixing medicines. If we add in a range of side effects that can come with long term medication then we really do have a situation that is complex.

Worse still, the person in question may be suffering from early stage dementia. Perhaps not so absent minded that the person can no longer take any responsibility for themselves, but perhaps occasionally forgetting to take medication, or worse, forgetting they have already taken the medication and then taking a double dose by accident.

This is the world of the care professional. It is a balancing act in a complex environment. We have to allow the clients to take as much responsibility for their own care as they can, for as long as they can. However, someone who sees the reality of existence for a client they are caring for daily, will most likely have to make some difficult decisions from time to time.

As carers we face three distinct situations with respect to medicine and each has its own challenges which we can look at in turn.

1 - The client can look after their own medication

As a carer this is on the face of it the ideal situation - we only need look after the physical challenges. If we are not being asked to make any checks in this area it is easy to relax and take our eye off the ball.

However, the complexity mentioned above will almost certainly be present and we have to recognise that a side effect or combination effect may kick in at any time. This is a particular risk if dosages are being changed, or if a new course of drugs is being added to the mix.

It makes sense therefore to make a note of the medication the client is taking and to discuss occasionally how things are for them. Often this type of discussion will provide a warning of a problem before it occurs. For example, if a client suddenly becomes very listless or absent minded, this could be a sign that an alert to the GP should be considered.

In any event, continual vigilance is wise to make sure you are attuned to any changes in mental capacity that may indicate the client has early stage dementia

2 - The client has early stage dementia, but has not been diagnosed as such

This is by far the worst case scenario for all concerned. Worse still if the client is aggressively denying they have a problem. In this situation developing a trusting co-operative relationship with the client is vital.

With a good relationship the chances are you will be able to detect something is wrong before you are told. It is import to find a way to gently getting around to discussing the complexity of the medication and suggesting ways of dealing with it.

For example, do you remember the last time you had a bad cold or flu? Typically you would be taking medication every 4 to 6 hours. That only has to be mixed with a cycle of cough medicine to start to make it difficult to keep track of. You will appreciate then that you don't have to be suffering from dementia to have a problem keeping track of the cycles for 5 or 6 medicines.

So it is reasonable to suggest a chart, or record of some kind to tick off, or record the time when a medicine has been taken. This allows the client to keep a check on themselves and you to keep a check on them. You will then be able to see very clearly any deterioration in mental capacity in time to suggest medical intervention or closer supervision.

3 - The client has reduced mental capacity so the carer is responsible for medication

Sometimes the client has reduced mental capacity so they are forgetful, but still able to live independently with the aid of a carer. In such a case the carer may have the issuing of medicine as part of the care responsibilities.

In some ways this is the easiest situation as there is no doubt and the carer can fully take charge. However, being fully in charge also implies responsibility so that should be explained a bit.

If the carer is in charge of making sure the client takes the medication there is a risk that, if anything goes wrong, then the carer may be blamed in some way. It is therefore vitally important that the instruction for the issuing of the medication should come from a responsible doctor and not the client, or one of the client's family members.

If you are responsible for the client taking medication, then you should never take the risk of accepting instructions from anyone other than the responsible doctor. Ultimately it is the doctor who is responsible for the medical mix and managing the complexity implied by the mix.

The carer's responsibility is just to ensure the doctor's instructions are carried out.

In summary

The relationship between domestic care and medication can be very complex and challenging.

We can manage the risk by having an open working relationship with the client and ensuring the client does not deviate from the doctor's instructions.

It is ultimately the doctor's responsibility to define what medication is taken and when. It this the carer's responsibility to ensure the client follows the doctors instructions, or creates an alert if they cannot be followed for some reason.