OverSixty January 2023 Issue

6 NEWS ISSUE 3 | JANUARY 2023 | OVERSIXTY.COM.AU Better medication management for dementia carers Beware button batteries LOUISE WATERSON NEWS W hile caring for a loved one with de- mentia can be a rewarding role, as the condition worsens, getting them to take their medication can be a daily struggle. Added to this, the medication regimens for dementia are increasingly expanding, so the stakes for ensuring the correct doses are taken are even higher. Failure to take just one dose correctly can result in behavioural instability, confu- sion and worse. “The disease trajectory can last for many years andwhilemany people can continue to operate independently, most will eventually need help with daily activities,” says medica- tion expert Gerard Stevens, AM. “Managing medication is a crucial part of that. However, the person with dementia may feel reluctant to hand over control, sensing a loss of inde- pendence that can result in anxiety and low- ered self-esteem.” According to Dementia Australia, in 2022 an estimated 487,500 Australians live with dementia, while as many as 1.6 million peo- ple are involved in the care of someone with dementia. “For carers, assisting with medication can be a time-consuming and difficult task with many feeling challenged by their changing roles,” says Stevens. “Families may be un- certain about when and how to take over medication management, especially as the disease progresses, and it has the potential to lead to conflict.” While a person with dementia is more likely to support their carers with taking their medication during the early stages of the dis- ease, this is likely to wear off as the disease progresses. Here are six medication tips to help carers: 1. Review and simplify medication. As dementia is a progressive condition, doing regular medication reviews will ensure the regimen is as accurate – and beneficial – as possible.This should only be done in consul- tation with the person’s medical team. 2. Establish a routine. To avoid resistance as much as possible, establish a routine that flows easily with the person’s daily routine LISA FIELDS NEWS M oments after three-year-old Mio acci- dentally swallowed a button battery from his family’s selfie stick in September 2016, he ran crying to his mother, Minttu, to tell her. Alarmed, Minttu took him straight to the nearest hospital. An X-ray showed the battery had lodged in Mio’s oesophagus, but the hospital didn’t have the right tools to remove it. By the time doctors at a second hospital got the battery out, seven hours had passed, and it had severely damaged the boy’s oesophagus and burned a hole in his trachea. He required 20 reconstructive surgeries to his oesophagus – and for a few months had to be fed through a tube. Now 10, Mio’s oesophagus must be monitored for scar-tissue buildup, which could impact his ability to eat comfortably. “So many people have told me that they never realised just how dangerous those bat- teries are,” says Minttu. This event is not a remote occurrence. It happens to other children surprisingly often and now government regulators are taking action to prevent button battery injuries. Tucked away in many everyday items – including TV remote controls, car key fobs, hearing aids, musical greeting cards, and fitness watches – button batteries go largely unnoticed, but we should not ignore them. Round and flat, the silvery coin-like bat- teries can be particularly fascinating to pre- schoolers, who may be tempted to pop them into their mouths. “They are tiny, shiny, and similar in size to some sweets, making them very attractive to young children,” says Delia Rickard, deputy chair of the Australian Competition & Con- sumer Commission. “If swallowed, a button battery can get stuck in a child’s throat and cause a chemical reaction that burns through tissue, causing death or serious injury.” In Australia, three children have died since 2017 and one child per month is seriously injured. According to the Australian Medi- cal Association, as many as 20 children each week present to an emergency department with a button battery-related injury. One of the main issues is that these batter- ies are easy to access. While items marketed to children have compartments that screw shut, many everyday devices – including LED lights, calculators, and glucometers – do not. Without those, children can pry batter- ies free, or batteries can fall out. Many adults leave used batteries lying around, wrongly assuming that they aren’t harmful. Difficult to diagnose One reason young children sustain but- ton-battery injuries is their narrow oesoph- agi. If an older child or adult swallows a but- ton battery, it’s less likely to become lodged; it can then pass freely into and through the person’s digestive system. When a button battery does get caught in “Have you tried turning it off and on again?” and if possible, is something that they enjoy. 3. Support effective communication. Be sure to inform the patient about what the medication is for, and choose your words to reflect their level of impairment. 4. Set up aWebster-pak® system. This medi- cation dose administration aid is designed to make managing medication simple and safe. Set up in conjunction with a patient’s phar- macist, their weeklymedication is set out in a blister pack, so the carer has a clear reminder of whether the dose has been taken or not. Find out more at www.webstercare.com.au. 5. Employ stress reduction techniques. When taking or administering medication becomes stressful, use breathing techniques, listen to calming music, or even ask for assis- tance from a friend or neighbour. 6. Seek further help. Resistance to taking medication is common among people with dementia, but help is available. Discuss op- tions with your health team and pharmacist. For example, some medications can be dis- pensed in liquid formwhich is easier for peo- ple who have difficulty swallowing tablets. the oesophagus, it presses against delicate tissue while also coming in contact with saliva. The liquid activates the battery’s cur- rent and forms hydroxide, which burns the oesophagus and causes tissue damage. All button batteries contain lithium, al- kaline, silver oxide, or zinc. In recent years, more devices require the lithium kind. These batteries’ bigger size – often 20millimetres or larger – and the fact they releasemore energy makes themmore dangerous if swallowed. The immediate signs of a stuck battery are coughing, vomiting, wheezing, drooling and difficulty swallowing, but because these are things children commonly do, it can be difficult to pinpoint that the child is reacting to a battery. “There are no symptoms that are exclus- ive to swallowing a button battery,” says Dr Madhavan Ramaswamy, a clinical fellow on the tracheal team at Great Ormond Street Hospital for Children in London. “And when the kids are of non-verbal age, they may be crying, they may be in discomfort, but they can’t actually tell you there’s something hurt- ing in their throat or that it’s burning.” Ideally, a button battery needs to be re- moved within two hours of ingestion to pre- vent serious, long-term harm. “If a button battery goes through the oe- sophageal wall, then very soon it damages the trachea or one of the big arteries, like the aor- ta,” says Dr Lissy de Ridder, a paediatric gas- troenterologist. “If it burns a hole in the aorta, then a childmay quickly bleed to death.” If there is any suspicion that a child has swallowed a button battery, get to an emer- gency department as quickly as possible, so doctors can take X-rays. Raising awareness Prompted by child injuries and fatalities, in last June Australia became the first country in the world to enact safety and information standards to reduce the risk of harm from button batteries. Battery manufacturers and suppliers are now required to use child-re- sistant packaging and warning labels, and must create secure compartments for prod- ucts containing button batteries. Widespread awareness of the hazards of button batteries is crucial to avoid further tragedies. As de Ridder says, “There are millions of batteries around the world already. Selling the new ones in a protected seal doesn’t do the job on its own.” The Battery Stewardship Council estimates there are currently 67 million button batteries in Australian households. Managing the care and medication of a loved one suffering from dementia can be challenging, but help is available through systems such as a Webster-pak (pictured). Parents and grandparents are urged to be aware of how dangerous these tiny cells can be to kids Photo: Getty Images NEWS NEWS