Most persons living with dementia are able to manage their own medication in the early stages of their condition, but may find it more difficult to do so as their dementia progresses. Consuming the wrong combination, dosage or forgetting to take their medicine on time may put them at serious risk. It is, thus, important that both persons living with dementia as well as their caregivers are equipped with the basic skills for effective medication management.
Medication Management General Tips
Missing Medications
If a person living with dementia forgets to take their medication, it should be administered as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped. The dose should not be doubled to make up for the missed dose. Caregivers and care professionals should take note of missed or irregular doses and share this information with the medical team working with the person living with dementia.
Being Transparent With the Medical Team About the Consumption of Medications or Other Products
Caregivers, care professionals, and the person living with dementia should be transparent with all doctor(s) and pharmacist(s) looking after the person living with dementia about whether the person is taking:
- Any medications or supplements that have been previously prescribed
- Those that have been prescribed by other doctors, including traditional medicines
- Herbal preparations, supplements, or nutritional products.
These include:
- Medications prescribed to address the person’s dementia and those for other purposes
- Medications prescribed in different forms, including pills, injections, inhalants, and topical medications and creams (those applied on the skin), etc.
There needs to be transparency between these teams to avoid harmful conflicts in medications. See the section below on the Patient’s Medication List for more information on keeping track of medications.
Pay Attention to and Follow Medication Administration Instructions
Pay attention to and follow special instructions given by the doctor or pharmacist who gives the medications. Examples of instructions include:
- The number of times a day to consume the medication, the dosage during each consumption, and how long the prescription lasts for
- Whether the person needs to consume the medication before or after food
- What food to avoid while taking the medication
- How to administer the medication
Look Out for Side Effects
Look out for any possible side effects of medications taken, especially when they take newly prescribed medicine. The person living with dementia may have difficulty finding the words to alert others to side effects they are experiencing. Be mindful to report them to the doctor right away.
Drowsiness
Take note of medications that may cause drowsiness, as this may increase the risk of falling, especially in persons older in age.
Pay Attention to Special Storage Instructions
Know Your Meds: About Storage and Expiry
Source: Ministry of Health
This short video details the steps patients and caregivers can take to store their medication properly, and how to spot medication that have expired or should no longer be used.
It is important to store medication in a cool and dry place, away from direct light and heat. Some medication may require refrigerated storage conditions. If a person living with dementia moves to different locations during the day, such as to a day care centre or for different community activities, arrangements will have to be made such that the medications are kept in suitable conditions.
Administer as per the Doctor’s Instruction
Do not stop using any medication without first consulting the doctor or pharmacist. If you have any doubts, contact the doctor or pharmacist for clarification. Follow the advice of medical professionals. Caregivers and persons living with dementia should not make decisions on their own about their medication prescription. Medication takes time to take effect, so it is important to follow the prescription even if effects are not seen for some time. In addition, effects differ from person to person, so even if other persons respond differently, caregivers and the person taking it should not independently decide to change their dosage.
Coordinating Medication Assistance
The person living with dementia may be cared for by different caregivers and care professionals, and may require medication reminders or assistance from these different persons. It is important that the caregivers and care professionals are all on the same page about what the person’s medication prescriptions are, and are prepared to provide assistance if needed.
Medication Records: The Patient’s Medication List
This list facilitates communication between different healthcare professionals and contains vital information healthcare professionals can use when seeing persons living with dementia for the first time. It also helps to have one ready in the event of a serious drug interaction or overdose.
The PML should include:
- Two identifiers eg. name and NRIC number
- Chronic medical conditions
- Any drug or food allergies and a description of the allergic reaction
- The names of all medications/supplements/vitamins prescribed (brand name and active ingredient), strength, dosing instructions, and reason for use
- Date last updated
Bring the updated list for each visit to the clinic, hospital, or pharmacy, and show it to the healthcare professional. It also helps to add a picture of the medication and its bottle for easy identification to the list.
You may download a template of the Patient’s Medication List provided by the Ministry of Health here.
Remembering to Take Medications
Regularly forgetting to take dosages of medicine on time can lessen the medication’s effectiveness. It is important that caregivers and care professionals find ways to ensure that persons living with dementia take their medication in a timely and consistent manner.
Keeping track of the medication that needs to be taken at different times of day can be a struggle for both caregivers and persons living with dementia, especially when there is a mix of medicine that needs to be taken before and after meals throughout the day. This is even more challenging for a person living with dementia.
However, with some simple reminders and other medication management tools, medication can be managed effectively. Doing so can help people living with early-stage dementia continue to take their medication independently.
There are various methods that can be used to do this. Some of these methods allow the person living with dementia to maintain their independence in the early stages of dementia.
Use Pill Boxes
Know Your Meds: How to Pack A Pill Box
Source: Ministry of Health
This short video details the steps patients and caregivers can take when packing a pill box, as well as mistakes to avoid.
One of the simplest ways for keeping track of medication in pill form is the use of pill boxes. By placing each dose into a different compartment, it is easier for the person taking the medicine to identify and consume it at the correct times. By labelling each compartment, it also becomes easier to tell the time of day that each dose should be taken. This solution has the added benefit of making it easy to tell at a glance if a dosage has been missed.
Another solution is to use automatic pill dispensers. Such dispensers may have alarms that remind the user when it is time to take medications, and automatically dispenses medicine for that time of the day. There are a range of devices that offer slightly different functions at different price points that can be suited to the differing needs.
Set Reminders
If there are not too many different medicines to take, and if the person living with dementia needs only a simple reminder to take their medication at the correct time, using a phone to set alarms with simple descriptions can be an appropriate solution. Placing a daily schedule next to a digital clock can make it easier for the person living with dementia to tell which medications they should be taking.
Use a Timetable
Persons living with dementia and those caring for them can use a timetable to take note of when medications have to be taken. This is especially helpful if there are many types of medications to take. It can also be helpful when caregivers hand over caregiving duties to others when they are unavailable, or if the person living with dementia receives medication assistance services from home care personnel or centre-based care staff.
Medication Management Services
Some persons living with dementia and caregivers may require additional medication management services.
Some reasons for needing medication management services include:
- Progressing dementia: In later stages, persons living with dementia may no longer be able to take their medication independently.
- Living arrangements: Some persons living with dementia may live alone, or may not have family or caregivers around at certain times of the day when medication needs to be administered.
- Type of medication: Some medications may be more difficult to administer independently, especially at later stages of dementia, such as injections, inhalers, nebulisers, etc.
- Multiple medications and consumption timings: Having many medications to take at multiple times of the day may be difficult to coordinate.
There are medication-related services available for persons living with dementia by both public and private service providers. These services make it easier to manage medications. Services include:
- Medication packing
- Administering medication if clients and/or caregivers are unable to do so
- Medication supervision
- Medication reminders
- Monitoring of medication compliance and proper taking of medication
- Collection of medication from the pharmacy
- Other services: Some other services are listed in the “Additional Resources” section below.
How to Get Medication Management Services
Here are some ways to engage these services:
- Get a referral from a hospital, polyclinic or GP who is familiar with the conditions and needs of the person living with dementia.
- You can visit an AIC Link location near you for advice on care services and schemes.
- You may also use the online Care Services Recommender to find service providers near you.
The average price of the service is about $20 per hour before means-test subsidy. If caregivers and persons living with dementia require financial assistance for the service, they may speak to a service provider or the medical social worker in the hospital or polyclinic.
Additional Resources
HealthHub services: Check medication prescriptions and request prescription refills online
The HealthHub website and mobile application allows patients to check their past medication prescriptions and request medication prescription refills online.
You will need to use SingPass to access these services on the HealthHub website or mobile application.
PILBOX & MDS by SingHealth Polyclinic
SingHealth Polyclinics (SHP) Pharmacy provides both Prescription In Locker Box (PILBOX) and Medication Delivery Service (MDS).
PILBOX allows patients or their caregivers to collect prescription refills any time without queueing.
It is currently available at
1. SHP-Bedok
2. SHP-Marine Parade
3. SHP-Sengkang
4. SHP-Punggol
5. SHP-Tampines
The Medication Delivery Service (MDS) allows patients or their caregivers to have prescription refills delivered to their preferred address, without having to physically turn up at the polyclinic.
This delivery service is currently available in all SHP pharmacies.
ConviDose™ by National Healthcare Group (NHG) Pharmacy
ConviDose™ is a multi-dose packaging compliance service by NHG Pharmacy that helps patients and caregivers arrange their medicines.
The right amount of medicines are packed into each sachet according to the time medications should be taken.
ConviDose™ is an easy-to-follow system which allows patients or caregivers to manage medicines easily and spot any missed doses.
Currently, ConviDose™ service is available from the following polyclinics:
1. Ang Mo Kio Polyclinic
2. Geylang Polyclinic
3. Hougang Polyclinic
4. Kallang Polyclinic
5. Toa Payoh Polyclinic
6. Woodlands Polyclinic
7. Yishun Polyclinic
NHG Pharmacy ConviDose™ Service
Source: NHG Pharmacy
ConviDose™ is a service that helps you arrange your medicines. It is an easy-to-follow system that allows you or your caregiver to manage medicines easily.
‘Ask-a-Pharmacist’ by NHG Pharmacy
‘Ask-a-Pharmacist’ by NHG Pharmacy allows patients and caregivers to direct questions to a patient care pharmacist regarding their medications or any drug-related concerns or issues.
Patients and caregivers can post questions at their website .
If you need immediate advice, consult a doctor, or call an NHG Pharmacist via the NHG Polyclinics contact centre at 6355 3000.
‘Know Your Meds’ by Ministry of Health
‘Know Your Meds’ by the Ministry of Health (MOH) is a series of videos and infographics aimed at teaching patients and caregivers the basic skills to effectively manage their medication.
The skills covered in the series are:
1. Know About Medication Label
2. Know How to Remember to Take Your Meds
3. Know If You Have Enough Medication
4. Know About Storage and Expiry
5. Know How to Create a Medication List
6. Know How to Pack A Pill Box
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Read Next
- Teo, J., & Tan, C. (2021, March 5). Budget debate: Central national pharmacy being set up to deliver medications to patients’ homes. The Straits Times. https://www.straitstimes.com/singapore/politics/budget-debate-central-national-pharmacy-being-set-up-to-deliver-medications-to.
- Speech By Dr Koh Poh Koon, Senior Minister Of State For Health, At The Ministry Of Health Committee Of Supply Debate 2021, On Friday 5 March 2021. Ministry of Health. (2021, March 5). https://www.moh.gov.sg/news-highlights/details/speech-by-dr-koh-poh-koon-senior-minister-of-state-for-health-at-the-ministry-of-health-committee-of-supply-debate-2021-on-friday-5-march-2021.
