Low Risk (Score: 0)

Your loved one is probably safe and able to continue in the current living
situation if the following are true:

• Taking medications properly – correct timing and dosage
• Not on pain medications or other medicines that alter awareness
• Talking with the doctor about medication issues or problems
• Has insurance or the finances to cover the cost of medications
• Not drinking alcohol while taking medications

If your loved one is alert, is not confused, and is able to manage self care,
medication management should not be an area of concern. If you notice unusual
behavior, or that things are changing around the house, consider talking with the
doctor or pharmacist about the changes. It’s possible that medications need
to be adjusted, even though your loved one is using them as prescribed.
Alternatively, there may be a conflict between multiple prescriptions or
interactions with foods. It’s a good idea to bring a list of your loved
one’s medications and dosages to every doctor’s appointment to give an
overview of their pharmaceutical regimen. Additionally, it’s best to fill all
prescriptions at one pharmacy. This way they can watch for possible drug
interactions. If you’re worried that your loved one is not taking medications
as directed, you might want to ask the doctor for a visit from a home health nurse.
These home health professionals can offer ideas on how to better manage
medications.

Medium Risk (Score: 1)

Your loved one may be OK to continue in the current living situation, but
occasional assistance may be needed. Look out for these in your loved one,
especially any changes from usual behavior:

• Forgetfulness
• Loss of balance or difficulty walking
• Slurred speech
• Increasing emotional behavior
• Changes in mental health such as depression, increased confusion,
  disorientation
• Inability to tell you what medications he is taking
• Not filling prescriptions
• Prescriptions which run out before they should
• Stockpiling medications
• Financial concerns about medications

If you notice unexplained changes in your loved one’s behavior or moods,
you may want to ask which medications they are taking. Ask to look at the bottles
for the correct dosage and medication schedule. Ask your loved one to describe why
they are taking the pill. Throw away any old or outdated prescriptions.

Depression and stockpiling medications could be a sign that your loved one is
having suicidal thoughts. Older adults have the highest rate of suicide, especially
older adult men.

Although a move may not be necessary, frequent check-ins and a consultation with
the physician is a good idea. A home health nurse can help set up a medication
dispenser that organizes pills a week at a time. For each of the seven days of the
week, these boxes typically have a compartment for morning, lunch, evening and
night. Placing each pill in its appropriate compartment(s) for the day can
eliminate confusion. If it’s not possible to have a home health nurse assist
with this, perhaps a family member or friend can help stock the box once a week.
Paying attention to medicines weekly will alert you to those prescriptions that are
running low so you can start having them filled.

Older adults who are generally healthy but have trouble taking medications often
do well in an assisted living community or adult foster home. These settings offer
low-level assistance such as this and are particularly good with medication
reminders.

High Risk (Score: 2–7)

It appears that your loved one has several areas of concern. Since the
consequences of medication problems are major, it may not be safe to continue in
the current living situation, or additional assistance may be needed. If living
alone, consider a move to an environment with more support and supervision if your
loved one is:

• Experiencing severe depression
• Expressing suicidal thoughts
• Having significant side effects from drug interactions
• Taking pain medications
• Taking medications that alter awareness
• Unable or unwilling to take medications as directed
• Drinks more than one glass of alcohol per day

If your loved one is not taking medications properly, it may be due to financial
concerns. They may also be unable to obtain or manage medications. Poor vision may
cause problems identifying the correct pills. If taking prescriptions that alter
awareness—such as pain medicines, sleeping pills or drugs that make them
dizzy or drowsy—they may not be able to monitor how much medication is being
taken. If your loved one drinks regularly, they may also have trouble
self-monitoring medication use. In addition, they could run the risk of dangerous
or life threatening problems if any medicines should not be taken with alcohol.

Talk with the physician or pharmacist if you suspect any medication problems.
Sometimes a change to another drug can help greatly. Ask the doctor to prescribe a
visit from a home health nurse for help with medication management if you believe
your loved one needs it.

If your loved one seems depressed, is isolated, and importantly, if they are
talking about suicide or stockpiling medications, you need to seek professional
help right away. It’s important that you know that older adults have the
highest rate of suicide—especially older adult men.

If your loved one is at risk for physical or mental harm due to medications,
24-hour access to help may be needed. You might strongly consider a temporary or
permanent move to a relative’s home, or to a care facility that can provide
medication assistance. Assisted living communities or adult foster homes are good
options health is generally good, otherwise. A residential care facility may be
more appropriate if they also suffer from Alzheimer’s, dementia or some other
memory disorder. A skilled nursing care center may be best if there are complex
medical problems that require access to 24-hour nursing care. Hospice services can
also be of assistance if your loved one is in the last few months of
life.