Family Caregiver Strategies to Manage Medication Refusals: Results from a Cross-Sectional Survey

TL;DR

Family caregivers of dementia patients often use nonpharmacologic strategies to manage medication refusals, with mental health linked to less covert administration.

Contribution

Identifies specific nonpharmacologic strategies used by caregivers and their association with caregiver mental health and burden.

Findings

Common strategies include waiting and trying again later (79.4%) and covert administration (46.0%).

Higher caregiver mental health scores correlate with reduced covert medication administration.

The study highlights the need for interventions to support caregivers managing care-resistant behaviors.

Abstract

Family caregivers of persons living with dementia commonly navigate care-resistant behaviors when administering medications. Nonpharmacologic strategies are recommended to manage care-resistant behaviors, but the specific strategies used by family caregivers and their association with caregiver factors including burden, mental health, and perceived medication hassles is unknown. We conducted a survey of 63 family caregivers of persons living with dementia to determine the nonpharmacologic strategies used to manage medication-related care-resistant behaviors and their associations with caregiver factors like burden and mental health. We analyzed strategies descriptively and using univariate statistical tests (t-test and chi-square as appropriate) and used logistic regression to determine strength and direction of statistically significant associations. We found that common strategies included waiting and trying again later (79.4%), covertly administering medications (46.0%), and doing nothing/skipping the medication dose (25.4%). In multivariable regression modeling controlling for demographic factors, we found that higher caregiver mental health scores according to the PROMIS-10 was associated with a decreased likelihood (OR 0.64; 95%CI 0.44, 0.88; p = 0.01) of covertly administering medications. The lower likelihood of covert administration in higher mental health scores indicates the potential for caregiver mental health interventions to affect responses to care-resistant behaviors. Given the cross-sectional nature of our study, additional work is needed to determine the causal pathways between the identified care-resistant behaviors, the strategies used to manage them, and caregiver outcomes, and to test interventions to support caregiver management of medication-related care-resistant behaviors.