Medications are miraculous.
This is undeniable. When used appropriately, they can protect us from and relieve us of pain, illness, anxiety, and a long list of symptoms.
SIDEBAR: I’ll stay away from recreational drugs for this piece. I’m a goodie-goodie who does not partake (no judgement – honest) and Mom is not smoking weed or throwing back gummies – at least not as far as I know.
I've been the beneficiary of life-saving prescription drugs and am certain that most of us have used medicines to get better from various ailments at some point in our lives. Whether for a common, short-term sickness like strep throat, or a potentially life-threatening, chronic illnesses like diabetes, we all appreciate the physical, mental, and emotional relief prescription drugs can provide.
However, a return to perfect health is not always guaranteed.
Good, reliable, proven medications can, unfortunately, also cause menacing, long-lasting effects on older adults. I’ve experienced the impact medications can have on the dementia mind first hand multiple times. It has been disturbing. I’ve watched my Mom – on several occasions -- go from being one of the sweetest people I know to becoming a stranger who is aggressive, paranoid, delusional, and suffering from hallucinations.
I’m no coward, but I openly confess to being terrified when a change to Mom’s medication is mentioned. It has become blatantly obvious to me that certain prescription drugs affect her memory, mood, and ability to think and remember. The same was true for my Dad. While their specific behaviours and the drugs prescriber were unique, the overall changes in personality and cognition were similar.
My understanding is that there are several reasons why older adults and those living with dementia may be more susceptible to negative outcomes when prescription and some over-the-counter drugs are taken. These include:
weaking of the blood-brain barrier which allows oxygen and nutrients to cross and nourish the brain but, as the barrier thins, drugs can reach the brain and affect cognitive function
simultaneous use of multiple medications (polypharmacy), often occurs as we age in order to manage multiple illnesses and ailments, can interact to cause problems
slower metabolism of drugs that can make the individual more sensitive to medications that should be helpful but instead cause adverse side effects
As a caregiver, it's tortuous to know that while medications can heal physical ailments, they may also cause short-term – and possibly permanent – changes to those we love. These can be significant changes to how the person feels, thinks, and feels. As advocates for those living with dementia, it is our responsibility to help point out concerns to the health team when changes in medicine are being recommended.
We have, for the most part, been fortunate. I find the care teams patient, compassionate and thoughtful. In some cases, recommendations for Mom’s medications have been changed after I’ve provided some history and discussed concerns with physicians. Similarily. physicians have been firm about not making changes to Mom's medications when I’ve asked them to consider doing so.
Lessons Learned
Ask questions about potential impacts when a change in medication is being suggested. There could be serious, unintended, permanent consequences and there are no do overs.
When a new medication, especially antibiotics, pain relievers or sleep aids, are being prescribed, ask if they are absolutely necessary and what the risks are for cognitive impairment are.
When a new medication is prescribed, watch for and note of new, negative behaviours. Add them to the medical history you keep for future reference and report them to your care team.
Remember that you are the expert advocating for the person you care for. You know their behaviours best. Your observations and input should be respected and integrated into care decisions.
NOTE: There are lots of articles exploring the impact medications have on older adults. Stuck in a brain fog? Look in your medicine cabinet by Matthew Solan of Harvard Health Publishing did a great job summarizing common elements for this topic. Consider reading his article for more in depth information than the quick overview provided above.