Sometimes a small change in routine can make a big difference. After long discussion, my mother-in-law started using a weekly pill organizer. This simple little box, and some common sense questions to her physician, made all the difference in the world.
My mother-in-law (we called her Bubbie) took twelve different prescription medications, three types of eye drops, two stool softeners and three vitamins. Some medications were taken once daily, some twice, some with meals and some before bedtime, for a total of 19 pills each day. Although she had
a number of chronic conditions which required medication, she lived independently, was an avid computer solitaire player and read 2-3 books per week.
Bubbie understood her conditions and the importance of medication compliance, so she was careful to take each medication exactly as directed on the prescription bottle. She managed her medications just fine, except it seemed more and more that her medications managed her.
One prescription bottle, scheduled for noon, said, “Take on an empty stomach.” Another pill due at noon said, “Take with food.” A medicine to be taken with breakfast called for two additional dosages six hours apart. Since breakfast at her senior residence was served at 8 AM, she took these pills at 8 AM, 2 PM and 8 PM. Another medication to be taken three times daily said “Take every eight hours.” Her doctor told her to take this “when you wake up.” Since she woke at 7, she took the first pill at 7 AM and subsequent pills at 3 PM and 11 PM. She went to sleep around 9 PM, so she would set her alarm for 11 PM. In order to be compliant, Bubbie was taking pills at 7 AM, 8 AM, noon (before lunch) and noon (after lunch), 2 PM, 3 PM, 5 pm (before dinner) and 5 PM (after dinner), 9 PM and 11 PM. She constantly focused on her next medication dosage; the responsibility was burdensome and depressing. Her medication schedule made her feel sickly and became an impediment to her going out and doing things (“I have to be home to take my medicines”). She became increasingly insular and self-absorbed.
When we suggested to Bubbie that she was being overly rigid with her schedule, she showed us the instructions on the prescription bottles. She wanted to be a “good patient” and was adamant that the schedule had to be followed to the letter. Plus, like many people her age, Bubbie would never dream of questioning the pharmacist or the physician.
I have long believed that bad events sometimes lead to surprisingly good outcomes, and so it happened with Bubbie. When an infection caused her to be hospitalized, my husband and I made an appointment with Bubbie’s physician to talk about her medication schedule.
We showed the doctor, who had prescribed most of the medications, what Bubbie’s daily routine looked like and how it impacted her quality of life. The doctor had never thought about the cumulative effect of taking multiple medications, or dreamed that someone would take directions so literally. “Isn’t there some way she can take her medications just four times daily?” we asked.
To our delight, the doctor grouped all 19 pills into four administrations, instead of the previous 10. “What about the instructions on the prescription bottles?” we asked. The doctors assured us that the adjustments would not reduce the medications’ effectiveness, and made notes in Bubbie’s chart to revise the instructions on future renewals. Although initially hesitant, Bubbie agreed to the adjusted, doctor-approved medication schedule. We found a weekly pill organizer with four sections per day, and Bubbie agreed to give it a try.
After that, I took over Bubbie’s prescription renewals and filling the weekly pill organzier. We knew the change in medication schedule made our life easier and hoped it would improve Bubbie’s life as well. We were not prepared for the changes we saw.
Bubbie was delighted to have the burden of refill management and pill sorting removed from her shoulders. With just four administrations daily and the pills already sorted for her, Bubbie began to see herself as less sickly and started going out more.
We asked ourselves what our take-aways were from this, as family members. Our first learning was that seemingly small changes can make a big difference in people’s lives. When Bubbie saw herself as less sick, she acted less sick. This has big implications. Studies show that people with positive perceptions of their health live longer than those with negative perceptions. We also realized that we needed to be active advocates for Bubbie with her medical team.
As for Bubbie, she was one happy camper. She continued to carefully manage her medications, but her medications no longer managed her.