Improving Medication Adherence for Assisted Living and Memory Care Residents with Dementia: Five Effective Strategies
By Candace Dufour, PharmD
Medication adherence is a cornerstone of effective healthcare and often a primary reason loved ones seek assisted living or memory care settings for their family member. Ensuring that individuals with cognitive impairments follow their prescribed medication regimens often poses unique challenges for caregivers—challenges that, as a consultant pharmacist, I see regularly in the communities I serve. However, with the right strategies and support from the multidisciplinary team, including long-term care (LTC) pharmacists, adherence can be significantly improved, enhancing the quality of life for residents, and easing burdens for caregivers.
Understanding the Importance of Medication Adherence
Medication adherence is critical for managing chronic conditions, preventing complications that lead to hospitalizations, and maintaining the health and well-being of residents with dementia. Yet, for community-dwelling older adults with Alzheimer’s disease, medication non-compliance can range from 17 to 100%.1 Studies highlight the complexity of medication adherence in dementia care and the need for tailored interventions that address the unique needs of these residents and their caregivers.2 Research has shown that caregiver support plays a vital role in influencing medication adherence among this population.3
Refining the Approach
Ensuring medication adherence among residents with dementia in assisted living and memory care communities is crucial for their well-being. However, residents, including those with cognitive impairments, have the right to refuse their medication. Residents decline medications for range of reasons, and they may express their refusal by a variety of verbal or behavioral expressions.
“When a resident with dementia is refusing medications, the first step should always be a comprehensive assessment,” says Shelley Stofer, a registered nurse with Guardian Pharmacy of the Heartland. This includes assessing for swallowing difficulties, a decline in cognition, or new physical ailments.
When traditional approaches, such as crushing tablets and administering them with applesauce or yogurt, have been tried and failed, the care team can look to the multidisciplinary healthcare team for more targeted strategies. Each of these strategies emphasize the importance of flexibility and personalized care in the medical management of individuals living with dementia.
Five Strategies for Success in Improving Medication Adherence
- Empower Medication Administration Staff with Dementia Care Training
“Educating community staff on the nuances of caring for individual with dementia is crucial,” says Stofer. This education should include understanding the behavioral and psychological symptoms of dementia, communication strategies, and the importance of a person-centered care approach. A key component of learning to care for individuals with dementia is understanding how dementia affects each resident in a unique way. When it comes to approaching residents with their medication, what works for one resident may not work for another.
Staff trained in dementia care are more likely to successfully navigate the complexities of medication administration, leading to better outcomes for residents with dementia.
- Deprescribe to as Few Medications as Possible
Polypharmacy is a significant concern in the elderly, especially those with dementia, due to the increased risk of adverse drug reactions and interactions.
“As their disease progresses, a resident’s medication needs will change,” offers Stofer. “Medication regimens, as a result, should be tailored to their current status. This is where the pharmacist’s expertise can come into play.”
LTC pharmacists can play a pivotal role in reviewing medication regimens and recommending the discontinuation of unnecessary medications, focusing on simplifying regimens without compromising efficacy.
- Tailor Dose Regimens to Personal Habits and Preferences
Recognizing and respecting each individual’s daily habits and preferences, and then personalizing their medication schedules to fit their routine, can significantly improve adherence. LTC pharmacists can offer invaluable insights into making these adjustments without compromising therapeutic effectiveness.
“A consistent daily routine is essential to the well-being of residents with dementia,” emphasizes Stofer. Predictable patterns of daily activities can provide a comforting structure, which helps to reduce anxiety and improve overall adherence to medication regimens.
For example, aligning medication administration times with a resident’s personal mealtime or bedtime routine can reduce the likelihood that they will refuse medication. Adjusting the time of day that staff approach them can often help improve a resident’s openness to receiving medications.
“Flexibility and patience are key to success,” notes Stofer. If initial medication administration attempts are unsuccessful, revisiting the resident with a different approach or at a different time can lead to better results.
“It’s all about being willing to change the plan and wait for the right moment,” Stofer adds. “If giving a medication doesn’t go well the first time, try coming back later and approaching the resident in a different way. Sometimes residents respond differently to a fresh face, so staff needs to be flexible and work as a team.”
- Consolidate All Drug Dosing Schedules as Much as Possible
Streamlining medication schedules to minimize the number of administration times each day can reduce the potential for refused or missed doses, alleviate the cognitive load on residents, and lessen the burdens on care staff. LTC pharmacists can assess a resident’s entire medication regimen and recommend adjustments that consolidate dosing schedules, often to only once or twice daily, without affecting medication efficacy or therapeutic outcomes.
- Reevaluate Medication Forms and Delivery Methods
“For residents who have difficulty swallowing or often refuse pills, alternative dosage forms should be considered,” adds Stofer.
Recognizing the challenges that traditional oral dosage forms, such as tablets and capsules, may pose for residents with dementia, LTC pharmacists can suggest alternative dosage forms, such as liquids or transdermal patches, which may be easier to administer and more acceptable to residents. Reassessing the medication form and delivery method can be a game-changer in improving adherence.
The Role of LTC Pharmacists in Supporting Staff and Residents
LTC pharmacists are key members of the healthcare team in assisted living and memory care communities. With their expertise, they can guide the implementation of the strategies outlined above to ensure they are tailored to meet the specific needs of each community and resident. They collaborate closely with staff to identify and resolve medication-related issues, providing routine, expert advice on medication management for individuals with cognitive impairments. Furthermore, when employed by the community, they can provide routine comprehensive medication regimen reviews. These reviews consider the whole resident, beyond just their immediate needs, allowing the pharmacist to act as a resident advocate to medical providers. This role is especially crucial for highlighting potential issues that may not be obvious during acute provider visits. By monitoring trends in vital signs and lab values, and not limiting the focus to the status of the resident “today,” the pharmacist is able to make holistic recommendations that prevent adverse drug events and enhance quality of life.
Conclusion
Improving medication adherence in residents with dementia requires a multifaceted approach that addresses the unique challenges posed by cognitive impairments. Empowering care staff with the necessary training and tailoring medication regimens to individual needs and preferences of residents are critical steps toward ensuring that residents receive the most effective and least intrusive treatment possible. Ultimately, these strategies support the overarching goal of improving health outcomes and quality of life for residents living with dementia, while also reducing burdens on caregivers.
Candace Dufour, Pharm.D., is a tenured clinical consultant pharmacist who is passionate about providing clinical services to long-term care communities and their residents and collaborating with other medical professionals. She received her doctorate in pharmacy from Shenandoah University and serves as the Director of Consulting Services for Southern Pharmacy Services, a member of the Guardian family of pharmacies.
Shelley Stofer, RN, BSN serves as a nurse account manager for Guardian Pharmacy of the Heartland in Springfield, Missouri. She has 11 years of experience caring for hospice patients, residents of long-term care communities, and older adults in the community setting.
References:
- Cotrell V, Wild K, Bader T. Medication management and adherence among cognitively impaired older adults. J Gerontol Soc Work.(2006) 47:31–46. doi: 10.1300/J083v47n03_03
- Arlt S, Lindner R, Rösler A, von Renteln-Kruse W. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging. 2008;25(12):1033-47. doi: 10.2165/0002512-200825120-00005. PMID: 19021302.
- El-Saifi N, Moyle W, Jones C, Alston-Knox C. Determinants of medication adherence in older people with dementia from the caregivers’ perspective. Int Psychogeriatr. 2019 Mar;31(3):331-339. doi: 10.1017/S1041610218000583. Epub 2018 May 11. PMID: 29747719.
