Q. My mother is 83 and has early onset of Alzheimer’s disease and also has been diagnosed with a bi-polar disorder. She lives alone and refuses to take her medication. I am frustrated that I cannot change her mind or behavior. When she is on medication she feels and acts better. Do you have some suggestions on what to do? Also, to what extent am I vulnerable to the disease? M.K.
The timing of your question is perfect since November is National Alzheimer’s Disease Awareness month, as designated by President Reagan in 1983. At that time, less than 2 million Americans had Alzheimer’s; today, the number of people with the disease has soared to nearly 5.4 million.
Here’s a little background information.
Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills. Eventually the disease destroys one’s ability to carry out simple tasks. It is the most common cause of dementia in older adults. While dementia is more common as people grow older, it is not a normal part of aging, although age is the greatest risk factor. Unfortunately the disease worsens over time.
Alzheimer’s is the sixth leading cause of death in the U.S. with no known cause or cure. Some estimate that among older people, the disease may rank third behind heart disease and cancer. One can live on average eight years after the symptoms are noticeable and survive four to 20 years, depending on one’s age and health conditions.
It is easy to get concerned when you forget where you placed your keys or miss a bill payment and think, “Hope this is not the beginning of Alzheimer’s disease.”
Here are some early signs of the disease as published by the National Institute on Aging:
• Making poor judgments and decisions a lot of the time.
• Having problems paying monthly bills or solving simple math problems.
• Not knowing the date or time of year.
• Difficulty having a conversation.
• Often misplacing things and not being able to find them.
And here some possible signs of normal aging:
• Making a bad decision on occasion.
• Missing a monthly bill payment.
• Sometimes forgetting a word or two.
• Occasionally losing some things, including your keys.
Let’s get back to your question about your mother refusing to take her medication. This is a common concern expressed by family members and caregivers.
I asked Deborah Cherry, executive vice president of the Alzheimer’s Association, Greater Los Angeles, Los Angeles, about her views regarding your question.
She writes, “When people with Alzheimer’s disease and related disorders behave in ways that the caregiver may interpret as challenging, we need to recognize that all behavior is a form of communication. Ask yourself what your mother is trying to communicate to you. Also, it is important to recognize any new behaviors. What did your mother do prior to the onset of the disease? Since she had a long-term mental disorder, bi-polar disease, was she always resistant to taking her medications? If so, perhaps they always made her feel sluggish or uncomfortable. Her mental health provider may know some of her history of compliance or non-compliance with medical regimes. If this is a new behavior, then it’s important to explore its cause.”
Anne-Marie Botek, a caregiver on AgingCare.com writes about three reasons a dementia patient typically refuses medication: “It tastes bad; it upsets my stomach and makes me tired; and I just don’t feel like it.” Let’s talk about the latter. Similar to Cherry, Botek recommends trying to find out what is triggering the resistant behavior before trying to fix it.
For example, some Alzheimer’s patients get distressed seeing a bottle filled with pills. If you think this is the case, just take out the pills that are needed and keep the bottle out of sight. If you think the size of the pills is the problem, check with her physician or pharmacist if the pills come in liquid form of if they can be crushed and taken with food. If the taste of the pill is the culprit, combine the pill with food that tastes good to her.
Next week we’ll talk about some additional tips, one’s vulnerability to the disease and the Global XPRIZE Competition that has set the goal to eradicate the disease.