Getting medications under control

How it went for me

My mom was meticulous about medications. After years as my dad's caregiver, she wrote down every medication, every dose, and the time she took it.

When she landed in the hospital, every nurse and doctor asked what she was taking. We had the answer, in her handwriting. It helped again at skilled nursing and with her nurse practitioner.

Most families don't have a log like that. This guide is how to build one, without taking over.

Jan, founder

This week, ask your parent:

“Can we put every pill you take on the kitchen table?”

Prescriptions, over-the-counter pills, vitamins, drops, creams, inhalers. Check the purse, the car and the bathroom drawer too. More than 4 in 10 adults 65 and older take five or more prescription drugs, before you count anything else (CDC).

For each one, write down:

• The name and dose (like "10 mg")
• When and how they take it (with food, at bedtime)
• What it's for, in their words ("blood pressure," "for my knees")
• Who prescribed it, and which pharmacy fills it
• Anything they've stopped taking, and why

Put allergies at the top. Keep copies on the fridge, in their wallet, and on your phone.

• The pharmacy's name, address, phone number and hours
• How they get prescriptions: at the counter, drive-through, delivery, or mail
• Whether they use more than one (a local pharmacy plus mail order is common)
• Which prescriptions refill automatically, and who calls in the rest
• Whether the pharmacy is "preferred" in their drug plan, which can cost less. Call the number on their card to check.

Many parents like picking up prescriptions in person. That's fine. Just know that's how it works, so a missed pickup doesn't become a missed week of pills.

Use one pharmacy if you can. When everything goes through one place, the pharmacist can catch two drugs that don't mix, even from two different doctors.

Don't forget what isn't a prescription. For my mom it was fiber pills, gas pills and vitamins, and it adds up. Keep a list of exactly what they use (brand, strength, size) and where it comes from, down to the aisle.

Questions to bring:

• Is each of these still needed?
• Do any of these work against each other?
• Could any of these cause dizziness, confusion or falls?
• Is there anything here older adults should avoid?
• Is there a simpler schedule, with fewer pills or fewer times a day?

The fourth question has a real answer: the Beers Criteria, the American Geriatrics Society's list of medications that may carry more risk than benefit after 65 (HealthInAging.org). Being on it doesn't mean stop. It means ask.

Ask their pharmacy which of these they offer. Blister packs and refill sync are often free.

Keep them in charge. Let them fill the organizer while you check it, or the other way around. Doing it for them can feel like taking something away.

• Count what's left a week before any trip.
• Ask about an early refill. Many plans approve one for travel.
• Ask about 90-day supplies for long-term medications. Fewer refills, fewer chances to run short.
• Pack medications in a carry-on, in their original bottles, with a copy of the list.

After anything new (a prescription, a dose change, an over-the-counter pill), call the prescriber or pharmacist if your parent seems:

• Dizzy or unsteady, or has a fall
• More confused, foggy or sleepy than usual
• Off their appetite, or has new stomach trouble
• Not themselves, in a way you can't quite name

It's easy to blame age. Ask about the medication first.

After every hospital stay, get a new list. Medications often change at discharge. Get the updated list in writing, compare it to yours, and ask about every difference. This is where my mom's log helped most.

For trouble breathing, swelling in the face or throat, or a suspected overdose, call 911. For questions about an accidental double dose, call Poison Control at 1-800-222-1222.

1. 1Ask why. Side effects, cost, too many pills, a friend's advice, or their beliefs about health. Each has a different fix.
2. 2Tell the doctor what they actually take. A doctor can't adjust a dose they don't know was cut in half.
3. 3Ask about a lower dose. Doctors generally start older adults low and raise the dose slowly (HealthInAging.org). A parent who reacts strongly may do fine on less.
4. 4Ask before splitting. Extended-release pills shouldn't be cut (ASHP SafeMedication). The pharmacist may have a smaller dose instead.
5. 5Put herbs and remedies on the list. Teas, herbal formulas, supplements. Some interact with prescriptions (NCCIH).
6. 6Let the pharmacist be the neutral voice. "Let's ask the pharmacist" lands better than "you're wrong."

More on all three from the PAN Foundation. And ask the doctor or pharmacist about a generic or a cheaper drug that does the same job.

When the pharmacy says "not covered"

That's usually the start of a process. Your parent or their doctor can ask the plan for a coverage decision or an exception. The plan has 72 hours to answer, or 24 if waiting could harm their health (CMS).

1. 1Ask the pharmacist exactly why it was denied.
2. 2Call the doctor's office. They file the paperwork.
3. 3Ask the doctor about a covered drug that works just as well in the meantime.

Just switched plans? They can usually get a one-time 30-day supply of a drug they already take during their first 90 days on the new plan (Medicare Interactive).

Use a drug take-back site. Many pharmacies have a drop-off kiosk. If there isn't one nearby, mix pills with coffee grounds or cat litter, seal them in a bag, and throw them out. Only flush medicines on the FDA's flush list (FDA).

Get The Parent File

The Parent File has a medications page built for this: name, dose, when, what it's for, and who prescribed it. Free, plus one email a week with one thing to handle.