Medicines: keeping the list, the brown bag review, pill organizers, and delivery

One list, everywhere

The National Institute on Aging's first tip is the simplest: write down every medicine, including over-the-counter pills, vitamins, and supplements. For each one: the name, the dose, when it is taken, who prescribed it, and what it is for. Keep one copy at home by the medicines, one in a wallet, and one on your phone. Show it to every clinician, including the dentist and the physical therapist. Update it the day anything changes, and date the list.

In CarePair, the vault is a good home for the current list, and the care circle can all see the same version.

The brown bag review

Put every bottle, tube, inhaler, patch, and supplement in a bag and bring it to the doctor or the pharmacist. Ask them to go through each one: Is this still needed? Is the dose right for their age and kidneys? Do any of these interact? Could any of them cause dizziness, confusion, or falls? Older adults often take medicines prescribed by several doctors who have never compared notes. A review once a year, and after every hospital stay, catches most problems. Only the prescriber changes a medicine; do not stop or skip anything on your own.

Ask about a free medication review

If the person has a Medicare drug plan and takes several medicines for more than one chronic condition, the plan may offer Medication Therapy Management at no cost: a full review with a pharmacist, a written summary, and a to-do list for the doctor. Call the number on the drug plan card and ask. Many pharmacies will also sit down with you for a review if you ask.

Questions to ask the pharmacist

• Can all prescriptions be synced to refill on the same day each month?
• Can you package them by dose and time, in blister packs or pouches, so nobody has to count?
• Do you deliver, and is there a charge?
• Which of these can be taken together, and which need food or an empty stomach?
• Can you switch to easy-open caps and large-print labels?
• What do we do with the medicines that were stopped?

Choosing an organizer

• A weekly box with one compartment per day: fine for someone who takes everything once a day and remembers to look.
• A box with morning, noon, evening, and bedtime rows: for more than one dose a day. Fill it on the same day each week; better yet, have the pharmacy do it.
• Pharmacy blister packs or dated pouches: no filling, no counting, easy to see what was missed. Ask for them.
• An automatic dispenser with an alarm and a lock: for someone with memory loss who takes too much or forgets. Some can text you when a dose is missed.
• For dementia, the person should not be filling the box, and the extra bottles should be somewhere they cannot reach.

Habits that prevent mistakes

• Tie doses to a routine: after breakfast, with the evening news.
• One pharmacy for everything, so one computer checks for interactions.
• Read the paper that comes with each new medicine, and keep it in a folder.
• Check expiration dates when you fill the box.
• After a hospital stay, rebuild the list from the discharge papers and bag the old bottles until the pharmacist has compared them.
• Never share prescriptions, and keep pain medicines locked.
• Dispose of old medicines at a pharmacy take-back or a police drop box, not in the trash or toilet, unless the label says otherwise.

When to call

New confusion, dizziness, a fall, unusual sleepiness, or a rash after a medicine change is a call to the prescriber the same day. Keep the list in hand when you call; the first question will be what they are taking.