Dealing with Dementia: How Pharmacists Can Offer Support During National Memory Screening Week
When people talk about their family member with dementia, one word is used by almost everyone—cruel. It’s a cruel disease that sneaks up and slowly steals their loved one’s mind, personality and joy of life. As dementia progresses, it’s frightening for the person affected and the family members struggling to take care of them, especially since so few are prepared for what lies ahead.
National Memory Screening Week is scheduled for the first week of November. Even if you don’t plan to offer memory screening, this is a great opportunity to reach out to the family members taking care of their loved ones with Alzheimer’s or other forms of dementia. This group is often overlooked yet desperately needs information from a trusted professional. Compounding pharmacists can dedicate a one-day event to support those dealing with dementia.
Compounding Benefits Caregivers and Patients
Family caregivers may have information about home-based services and day programs for loved ones with dementia. Chances are, however, that they don’t know how pharmacists can help with medication management or simplify the regimen for those who resist taking medication due to difficulty swallowing, confusion, or irritation. Compounding makes it easier for caregivers and patients by combining medications, providing topical and transdermal options, and adding flavor to make medications more palatable.
Compounding pharmacists should never assume that caregivers understand every detail regarding the medications prescribed for their loved one. Make sure they know that the medications currently available only have the potential to slow the decline of cognition and function.1
- Cholinesterase inhibitors—donepezil, galantamine, rivastigmine and tacrine—are used in the mild to moderate stages. By blocking the breakdown of acetylcholine, they improve cholinergic neurotransmission.
- NMDA receptor antagonist—memantine—is used to delay decline in the moderate to severe stages of dementia. A generic product released in July 2015 makes it more affordable for patients without insurance.2
Two new drugs in clinical trials—solanezumab and aducanumab—may inhibit progression of the underlying disease.3 However, a report in July 2015 said that aducanumab fell short of clinical significance on efficacy and may be more toxic than expected. Keep this disappointing announcement in mind when you communicate with caregivers.
- Pharmacists need to balance the hope of new medications with the reality that they may not be approved in time to help.
- Recent news headlines have mentioned that vitamin D deficiency, type 2 diabetes, and obesity may increase the risk of dementia. Pharmacists should be prepared to discuss science-based options.
Medication Review: Tell family caregivers that a medication review is free, then encourage them to participate by emphasizing that:
- Older people taking anticholinergic medications, including nonprescription diphenhydramine in sleep aids, have a higher risk of dementia.4
- Their loved one may take multiple medications, such as calcium channel blockers, muscle relaxants, antihistamines, and NSAIDs. A review will identify combinations of medications that increase the risk of adverse effects.
Coping With Behavioral and Emotional Issues
Loss of memory and diminishing cognitive ability are hard for family members to experience, but at least they’re expected. Even if they know about the behavioral and emotional symptoms, caregivers seldom expect the severe reality and don’t know what to do when their loved one carries on a lively conversation with people who exist only in their head.
Helping caregivers deal with psychological problems isn’t a routine part of pharmacy-based outreach, but providing straightforward information—and having a list of mental health resources—may be the most valuable part of an event to support caregivers.5 The mental health problems found in individuals with dementia include anxiety, fear, depression, anger, irritation, and aggression. Behavioral changes primarily occur in the middle stage of dementia. During this time caregivers can expect sleep issues, night hallucinations, wandering, and difficulty eating and walking.
Roles of compounding pharmacists:
- Track prescriptions for antipsychotics and benzodiazepines, which should be avoided or used cautiously. Benzodiazepines are associated with increased confusion, falls, and memory impairment; antipsychotics increase the risk of sudden death.
- Develop individualized doses of meds that should be used with caution such as amitriptyline. Even though amitriptyline is effective and may slow memory deterioration, it has anticholinergic activity.6
- As dementia progresses, it gets harder for caregivers to administer medications. Talk to them about adding flavor, combining multiple meds into one dose, and topical or transdermal options.
Creating a “Support for Caregivers” Event
Creating a “Support for Caregivers” day doesn’t have to break the budget, but it does take time to assemble the information you need and you’ll need to advertise to ensure success.
Tips for your event:
- Have health care professionals on hand to answer questions. Coordinate with geriatric specialists, staff from local assisted living facilities, or social workers from local health care facilities.
- Provide a table of information with handouts about dementia basics and a list of local resources. Collect pamphlets from local hospitals, long-term care facilities or the nearest Agency on Aging.
- Offer financial info for medications including state subsidies and enrollment in Medicare Part D.
- Family members have questions about non-medical issues such as durable power of attorney and living will. Ask an attorney or staff from long-term care facilities specializing in medical documents to participate or contribute pamphlets.
- Provide healthy snacks and beverages. Local grocery or health food stores and suppliers of products you carry may donate items.
- Depending on the space you can use, there are many options for information. Possibilities include nutrition, personal care tips and products, and simple home safety. Highlight any products sold in your pharmacy.
Compounding Pharmacists Can Fill Gap in Support for Caregivers
Organizing a “Support for Caregivers” event provides an immeasurable value in the community. Almost half of all family caregivers reported that they don’t have access to a support system. On average, there’s a 2-year delay between symptom onset and getting a diagnosis. About 40 percent of caregivers said the delay was caused by lack of knowledge about the disease.7 When compounding pharmacists reach out to the community, they significantly help those dealing with dementia.
Pharmaceutica North America provides bulk APIs and compounding kits that meet the diverse needs of patients with dementia. Please contact us to discuss how our quality compounding products can serve your pharmacy.
- “Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer’s Disease: A Systematic Review and Meta-Analysis,” 2014, http://www.ncbi.nlm.nih.gov/PnRx!23456/24662102 ↩
- “Generic Namenda Alzheimer’s Drug Now Available,” July 2015, http://www.pharmacytimes.com/product-news/generic-namenda-alzheimers-drug-now-available ↩
- “New Drugs May Help Slow Decline, Progression in Alzheimer’s Disease in Alzheimer’s Disease,” July 2015, http://www.pharmacist.com/new-drugs-may-help-slow-decline-progression-alzheimer-disease ↩
- “Cumulative Use of Strong Anticholinergic Medications and Incident Dementia,” March 2015, http://archinte.jamanetwork.com/article.aspx?articleid=2091745 ↩
- “Managing Behavioral and Psychological Symptoms of Dementia,” 2013, http://www.alz.org/documents_custom/hcp_MD_BPSD.pdf ↩
- “Amitriptyline-Mediated Cognitive Enhancement in Aged 3xTg Alzheimer’s Disease Mice is Associated with Neurogenesis and Neurotrophic Activity,” June 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124550/ ↩
- “Investigating Caregiver Attitudes and Needs,” March 2006, http://nationalmemoryscreening.org/downloads/survey_full_report.pdf ↩