Dementia patient refuses to take medication: what to try first

When a dementia patient refuses to take medication, stop and don't force it. Wait 20 or 30 minutes, then try again with a calmer setup: one pill at a time, her favorite drink, no debate. If she keeps refusing for more than a day or two, call her pharmacist and her doctor. Many refusals come from something they can fix, like a pill that's too big, too many doses or a side effect.

Pills are one of the few daily fights with a clock attached. Some doses really do matter, so it's easy to push harder than you would over a shower. Pushing is usually what turns a "no" into a standoff.

Why a dementia patient refuses to take medication

She isn't refusing to make your evening harder. From her side, someone is handing her a fistful of things she doesn't recognize and telling her to swallow them. The Alzheimer's Society lists three common reasons: the medicine is hard to swallow, it tastes unpleasant, or it causes side effects such as nausea. Caregivers describe a few more:

• She doesn't remember why she takes it, or she's sure she already took it.
• She thinks it's poison or that you're trying to drug her. The National Institute on Aging lists paranoia and delusions among the symptoms of the moderate stage.
• There are too many pills at once. Eight pills in a palm looks like a lot to anyone.
• The timing is bad. Late afternoon and evening are often her worst hours.
• She's being told, not asked, and she's tired of being told things.

Watch what happens right before she refuses. Does she gag on one particular tablet? Push away only the evening pills? Refuse only from you? The pattern usually points to the fix.

What to do tonight when she says no

The Alzheimer's Association's advice is short: if she refuses, stop, and try again later. Here's what that looks like in practice.

1. Back off without comment. Put the pills away, out of sight, and talk about something else.
2. Try again in 20 or 30 minutes. A person who refused at 8:00 may take the same pill at 8:30 without a second thought.
3. Change the setup. Sit down next to her instead of standing over her. Offer one pill at a time with a full glass of something she likes. Check with the pharmacist that the drink is fine with her medicines, since some must be taken with or without food.
4. Make it part of a routine. The Alzheimer's Association suggests tying doses to meals or bedtime. Same chair, same cup, same time.
5. Let her hold it. Put the pill in her hand, or in a small cup she can tip into her mouth herself.
6. Try a different person. Some parents take pills from a spouse, an aide or a grandchild long after they stop taking them from you.
7. Write it down. Note which pill, what time and what she said. That log is what the pharmacist and doctor will need.

Take Carol, whose mom spat out her evening pills almost every night. Carol noticed she swallowed the small ones and only fought the large tablet. Her mom's doctor moved two of the evening doses to breakfast, and the pharmacist found that the big one came in a liquid. The evening fight shrank to one pill.

What to say

Keep it light and matter-of-fact, as if this is the least interesting thing that will happen all day.

More lines to try:

• Offering a choice: "Do you want this one with water or with your coffee?"
• Giving her control: "Here, you hold it. Take it whenever you're ready."
• Using the doctor's name: "Dr. Patel wants you to have this one for your heart. It's the little white one."
• Answering a fear of poison: "That's fair to wonder. Look, it's from your pharmacy, with your name on it. I'll sit with you."
• When she says she already took it: "You might have. Let me check the box." Then show her the pill organizer.

Skip anything that sounds like a lecture: "You have to," "You'll end up in the hospital," "We've been over this." She can't hold onto the reasoning, so she only hears the pressure. If she's frightened that someone is drugging her, our guide to hallucinations and paranoia in dementia covers how to respond to the fear itself.

How to get a dementia patient to take pills: ask the pharmacist

Her pharmacist is the most underused person on the care team. Bring the full list, or the bottles themselves, and ask:

The National Institute on Aging suggests asking about a liquid form if swallowing is hard. The Alzheimer's Society notes that some dementia drugs and painkillers come as a patch or an oral solution. Whether her medicines do is a question only her pharmacist or doctor can answer. The NIA also recommends a weekly pill organizer and a written list of every medicine, vitamin and supplement, with the time and the reason for each.

Ask the doctor which medicines matter most if a dose is missed and which can wait a few hours or be skipped. Don't stop any medicine on your own. The NIA is clear that she shouldn't stop a medication without checking with her health care provider first.

Hiding medication in food: ask before you crush or hide anything

Many caregivers end up wondering about applesauce. Ask first, every time.

Crushing isn't safe for every pill. The Alzheimer's Association says no pill or tablet should be crushed without first asking the doctor or pharmacist, because crushing can make some medications ineffective or unsafe. The NIA adds that some pills must be taken whole to work properly. A pill that's fine to crush still might not mix well with every food.

Hiding medicine so she doesn't know she's taking it is a separate question. It's often called covert medication. The Alzheimer's Society says it can affect how the medicine is absorbed and should only be done with written approval from her doctor or pharmacist. It also raises real ethical and legal questions. Is she still able to make this decision herself? Who can decide for her? Who holds her health care power of attorney? If she later tastes it, will she stop trusting her food? Have that conversation with her doctor, and ask for the decision to go in her chart.

If her refusals have you wondering whether a small fib is ever all right, our guide on therapeutic lying in dementia care explains where the line usually sits.

When to call the doctor

Call the same week if she's been refusing a medicine her doctor called important, or missing doses for more than a couple of days. The doctor may change the timing, switch the form, or decide some medicines can stop.

A sudden change is different. MedlinePlus describes delirium as sudden, severe confusion, and lists infections like UTIs and some medicines among the causes. A parent who took her pills fine last week and now fights every dose may be ill or reacting to a medicine.

Lock up the medicines, too. The Alzheimer's Association recommends a locked drawer or cabinet to prevent an accidental overdose, and throwing out expired medicines and ones she no longer takes. If getting her to the doctor at all is the problem, see what to do when a parent refuses to see a doctor.

Questions caregivers ask

What happens when a dementia patient refuses medication?

It depends on the medicine. Missing one dose of some is minor. Missing others can be serious within a day or two. That's why it's worth asking her doctor now, before the next refusal, which ones you have to get in and which can wait.

Can I put her pills in applesauce?

Only after the pharmacist or doctor says that pill is safe to crush or open and mix with food. Ask about each pill separately. Some need to stay whole to work properly.

Can a person with dementia legally refuse medication?

It depends on whether she can still understand the decision, and her doctor is the person to judge that. If she can't, the decision usually moves to her doctor and whoever holds her health care power of attorney. Rules differ by state, so if there's a real dispute, talk to an elder-law attorney.