The Heartbeat
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Why Mom doesn't take her pills

Did your mom teach you to “do what the doctor says”? If she’s not following doctor’s orders for medications now, you’re probably feeling confused. And concerned.

It’s common for patients not to take pills as directed. Some typical reasons:

• “It’s too costly.” One quarter of new prescriptions are never filled because of cost. Make sure the drug is on the insurance plan formulary. Or ask about generics. Find a discount pharmacy, or consider mail order.
• “I don’t have symptoms.” Many illnesses lack noticeable symptoms. High blood pressure and high cholesterol, for example. These prescriptions often go unfilled. Many people don’t finish their antibiotics for similar reasons: the symptoms went away. Ask the doctor or pharmacist to review with your loved one why a medication is necessary.
• “It made things worse.” Consult with the doctor or pharmacist. Reducing the dose or changing from morning to evening may fix the problem. Or taking a different medication may be advised.
• “It was too complicated.” Some drugs require multiple doses in a day. Others are restrictive (“30 minutes before eating”). Ask the doctor or pharmacist about alternatives.
• “I can’t get the bottle open” or “I can’t read the label.” Arthritic hands and poor eyesight can make it difficult to follow directions. Ask the pharmacist for large type on the label and a NON-child-proof container.
• “Why bother?” Hopelessness and depression are common reasons why people don’t take their medications. If you suspect depression, ask the doctor to do an evaluation.  
• “It won’t do anything.” Perhaps your loved one has an entirely different interpretation of what is wrong with their health. Ask to learn more.
• “I forgot.” Simple memory lapses are a fact of aging. It may be time for an automated pill dispenser or pills that are pre-packaged into morning, noon and night time doses.

Should Dad still be driving?

Did a recent visit with your parents reveal new dents in the car? Did a drive together result in a hair-raising ride? If so, it could be that it’s time to reassess your loved one’s ability to drive safely. Safe driving is not dictated by age. Plenty of middle-aged people are terrible drivers. And there are people in their 90s who are still superb drivers. But age, undeniably, makes driving more challenging.

Signs that a problem may be brewing

• Two or more tickets in the past two years. Running a stop sign, going the wrong way on a one-way street, and poor parking are the most common.
• Two or more accidents in the past two years. Older adults have more accidents involving left-hand turns. Even little “fender benders” are noteworthy. Parking lot crunches and sideswipes, for instance, indicate a driver error.
• Dementia. Alzheimer’s and other forms of dementia impair judgment and often depth or spatial perception. If your loved one is in the early stages, it may or may not be safe to drive for a while longer. Talk with the doctor.
• Medications. Many drugs—prescription and over-the-counter—slow reflexes and thinking processes. Not good for driving.
• Poor vision and hearing. Common problems include not seeing pedestrians, stop signs, or lane lines. Night vision declines for everyone starting in middle age, but gets worse as we get older.
• Stiffness in the neck and shoulders. Lack of flexibility can result in not turning one’s head around completely when backing up, changing lanes, or merging with traffic.

To get an assessment

• Download the Drivers 65 Plus self-assessment brochure from the American Automobile Association. This is a 15-question, self-rating survey your loved one can complete at home. It includes tips for addressing identified problems.
• Talk privately with the doctor and see if they will recommend an evaluation by an occupational therapist to address any underlying medical issues.
• Consider a driving skills evaluation. Driving schools have certified evaluators. You can also contact the American Automobile Association for a local list of evaluators.

The four stages of hope

Is life with a terminal illness hopeless? Not at all. Seriously ill individuals thrive on hope, just like the rest of us. It gives us a sense of purpose.

According to hospice expert Cathleen Fanslow-Brunjes, hope in serious illness typically has four main stages:

• Hope for a cure. “I’m not going to let this stop me.”
• Hope for treatment. “I think the radiation is really working!”
• Hope for prolongation of life. “I want to go to the family reunion.”
• Hope for a peaceful death. “I’m hoping for no pain in my final days.”

The four stages often align with disease progression. But it’s not uncommon for a person to move back and forth among them.

Knowing the four stages, you can better support your family member in sustaining his or her hope. Listen carefully for comments that indicate hope.

Many families are concerned about “realistic hope.” Find out what your loved one is hoping for and ask the doctor if it is feasible. If so, then all of you can work toward this shared goal.

If the hope is not realistic, it may signal the need for a change in care goals. But it does not mean your loved one must be without hope! Instead, it means you need to talk together with the doctor and come up with a more achievable project or purpose.

Dr. David Casarett, a hospice physician, wrote an insightful book about this topic called “Last Acts.” It specifically looks at the many ways his patients chose to find meaning in their last few months, weeks, and days.

Hope is always available. We just need help knowing how to look for it.