More than 7 million Americans are living with Alzheimer’s disease and other dementias. As dementia progresses, challenges often extend beyond memory loss to everyday activities that support health and quality of life, including medication management. Residents may no longer understand why medications are necessary, become overwhelmed by frequent med passes, struggle with swallowing, or refuse medications altogether. Medication adherence often becomes a daily challenge faced by caregivers.

When adherence declines, residents may experience worsening health outcomes, avoidable hospitalizations, behavioral changes, and reduced quality of life.

During Alzheimer’s & Brain Awareness Month, it is important to recognize the role pharmacists play in helping care teams in long-term care (LTC) and senior living settings develop safer, simpler, and more person-centered medication strategies for residents living with dementia.

Pharmacists serve as an important extension of the care team, working alongside the broader multidisciplinary team (MDT) to address common barriers to medication adherence. By leveraging their expertise, LTC and senior living providers can apply several key principles to help improve medication adherence, reduce medication burden, and support quality of life for residents living with dementia.

When to Consult the Pharmacist

As dementia progresses, changes in a resident’s physical, cognitive, and functional status can create new barriers to medication adherence and present opportunities to optimize the medication regimen.

Changes in a resident’s condition that should prompt the care team to consult the pharmacist for a comprehensive medication review include:

• • Falls
  • Increased confusion
  • Changes in behavior or mood
  • Excessive sedation
  • Difficulty swallowing (dysphagia)
  • Significant weight loss
  • Declining mobility or function
  • Frequent medication refusals
  • Hospitalization or other transitions of care

Once engaged, the pharmacist can work alongside the MDT to simplify therapy, reduce medication burden, address adverse effects, and better align treatment with the resident’s current needs and goals of care.

1. Start with the 4Ms

Senior care pharmacists begin by evaluating the resident’s full health profile, including medication therapy, using the 4Ms framework for age-friendly care:

• • What Matters: Knowing and acting on each person’s specific health goals and care preferences.
  • Medication: Using only medications that do not interfere with What Matters, Mentation, or Mobility.
  • Mentation: Preventing, identifying, treating, and managing dementia, depression, and delirium.
  • Mobility: Ensuring individuals move safely every day to maintain function and do What Matters.

This framework helps ensure medication-related decisions support not only clinical outcomes, but also the resident’s overall function, safety, and quality of life.

2. Simplify

Complex medication regimens can quickly become overwhelming for residents with dementia. Multiple med passes throughout the day and high pill burden can increase confusion and anxiety, contributing to medication refusals and additional strain for care staff. Pharmacists can help simplify regimens by identifying opportunities to:

• • Reduce dosing frequency
  • Consolidate medication administration times
  • Eliminate duplicate therapies
  • Consolidate medications into combination products when available
  • Transition to longer-acting formulations when appropriate

Even modest simplifications may improve adherence and create a less stressful med pass experience for both residents and staff.

3. Deprescribe

As dementia advances, goals of care often evolve. Some preventive medications intended to reduce long-term health risks may no longer provide meaningful benefit relative to the burden they place on the resident. In these situations, deprescribing conversations may be appropriate.

Pharmacists can work collaboratively with prescribers, nurses, residents, and family members to evaluate:

• • Whether medications continue to align with current goals of care
  • Whether adverse effects may be contributing to confusion, sedation, or falls
  • Whether medication burden is negatively impacting quality of life

Families sometimes struggle with deprescribing discussions because they fear care is being reduced. In reality, deprescribing often represents a thoughtful shift toward comfort, function, safety, and quality of life.

4. Assess Dosage Forms

Residents with dementia often struggle with tablets and capsules for both cognitive and physical reasons.

Crushing tablets and administering medications in applesauce or pudding is a common first-line approach. However, medications should not be crushed automatically. Certain medications, including extended-release, delayed-release, enteric-coated, and hazardous medications, may become unsafe or ineffective when crushed. Caregivers should always consult the pharmacist or an approved “Do Not Crush” list before altering a medication.

When crushing is not appropriate, pharmacists may recommend alternative dosage forms such as:

• • Liquid formulations
  • Transdermals, such as patches or gels
  • Oral disintegrating tablets
  • Suppositories
  • Other alternative dosage forms or compounded formulations when clinically appropriate

Assessing dosage forms is especially important for residents with dysphagia, as swallowing difficulties can increase the risk of choking, aspiration pneumonia, and esophageal injury.

Supporting Adherence Through Person-Centered Care

Optimizing medication adherence for residents living with dementia requires a coordinated, resident-centered approach across the MDT.

Successful strategies require flexibility, a holistic view of the resident’s needs and goals, thoughtful conversations with families, and a willingness to adapt care plans as the resident’s needs change.

During Alzheimer’s & Brain Awareness Month, pharmacists remain an important partner in helping care teams and families navigate these complex challenges. Through an age-friendly and person-centered approach to medication management, pharmacists help improve not only adherence, but comfort, dignity, and quality of life for residents living with dementia.