If you care for an older parent or relative, managing medicines will be part of your role as caregiver. Here are steps you can take to help ensure safe and effective medicine use.

Caregiving - managing medicines

It's important to know what each medicine is for and about possible side effects. You'll also need to work with all health care providers to keep track of the medicines your loved one takes.

If your loved one has vision or hearing loss, or loss of hand function, you'll also be the ears, eyes, and hands for that person. You'll be making sure they take the right dose of the right pill at the right time.

MAKE A CARE PLAN WITH PROVIDERS

Going to provider appointments with your loved one can help you stay on top of which medicines are prescribed and why they are needed.

Discuss the plan of care with each provider on a regular basis:

• Learn as much as you can about your loved one's health conditions.
• Bring a list of all prescribed medicines, and those bought without a prescription, including supplements and herbs, to each provider appointment. If possible, bring the pill bottles with you to show the provider. Talk with the provider to make sure the medicines are still needed.
• Find out what condition each medicine treats. Be sure you know what the dosage is and when it should be taken.
• Ask which medicines need to be given every day and which are used only for certain symptoms or problems (also called "prn use").
• Check to make sure the medicine is covered by your loved one's health insurance. If not, discuss other options with the provider.
• Write down any new instructions and make sure both you and your loved one understand them.

Be sure to ask the provider all of your questions about the medicines your loved one takes.

DON'T RUN OUT

Keep track of how many refills are left for each medicine. This should be on the medicine bottle label. Make sure you know when you need to see the provider next for a refill.

Plan ahead. Contact your loved one's pharmacy for refills up to a week before they are due to run out. Ask their provider which medicines they can get a 90 or 100 day supply for.

RISK OF MEDICINE INTERACTIONS

Many older adults take multiple medicines. This can lead to medicine or drug interactions. Be sure to talk with each provider about the medicines being taken. Some interactions can cause unwanted or serious side-effects. These are the different interactions that can occur:

• Medicine-medicine interactions - Older people are more likely to have more harmful reactions between different medicines. For example, some interactions can cause sleepiness or increase the risk of falls. Others may interfere with how well the medicines work.
• Medicine-alcohol interactions - Older people may be more affected by alcohol. Mixing alcohol and medicines may cause a loss of memory or coordination or cause irritability. It can also increase the risk of falls.
• Medicine-food interactions - Certain foods can cause some medicines not to work as well. For example, you should avoid taking the blood thinner (anticoagulant) warfarin (Coumadin, Jantoven) with foods high in vitamin K, such as kale. Talk to your provider If you can't avoid this.

Some medicines also may worsen certain health conditions in older adults. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen) may increase the chance of fluid buildup and worsen heart failure symptoms.

TALK WITH YOUR LOVED ONE'S PHARMACIST

Get to know your loved one's pharmacist. This person can help you keep track of the various medicines your loved one takes. They can also answer questions about side effects. Here are some tips for working with the pharmacist:

• Be sure to match the written prescription with the medicines you get from a pharmacy.
• Ask for large print on the prescription packaging. This will make it easier for your loved one to see.
• If there is medicine that can be split in two, the pharmacist can help you split tablets to give the correct dosage.
• If there are medicines that are difficult to swallow, ask the pharmacist for alternatives. They may be available in a liquid, suppository, or a skin patch.

Of course, it can be easier and less expensive to get long-term medicines by mail order. Just be sure to print out the list of medicine from the provider website before every provider appointment. Then compare that list with what your loved one is actually taking. Review any differences with your provider.

ORGANIZING MEDICINES

With many medicines to keep track of, it's important to learn certain tricks to help you keep them organized:

• Keep an up-to-date list of all medicines and supplements and any allergies. Bring all of your medicines or a complete list to every provider appointment and hospital visit.
• Keep all medicines in a safe place.
• Check the "expiration" or "use by" date of all medicines.
• Keep all the medicines in original bottles. Use weekly pill organizers to keep track of what needs to be taken each day.
• Devise a system to help you keep track of when to give each medicine during the day.

PLANNING AND ADMINISTERING THE MEDICINES PROPERLY

Simple steps that can help you to manage all medicines regularly include:

• Keep all medicines together in one place.
• Use meal times and bedtimes as reminders to take medicines.
• Use a watch alarm or notification on your mobile device for in-between medicines.
• Read the instruction sheets fully before giving medicine in the form of eye-drops, inhaled medicines, or injections.
• Be sure to dispose of any leftover medicines properly.

Aragaki D, Brophy C. Geriatric pain management. In: Pangarkar S, Pham QG, Eapen BC, eds. Pain Care Essentials and Innovations. Philadelphia, PA: Elsevier; 2021:chap 10.

Naples JG, Handler SM, Maher RL, Schmader KE, Hanlon JT. Geriatric pharmacotherapy and polypharmacy. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 101.

Preveill LA, Heflin MT, Cohen HJ. The aging patient. In: Wing EJ, Schiffman FJ, eds. Cecil Essentials of Medicine. 10th ed. Philadelphia, PA: Elsevier; 2022:chap 126.