A diagnosis of dementia has a profound effect on caregivers who need to respond to challenges associated with progressive cognitive decline. Alzheimer's disease and related disorders can cause a person to act in unpredictable ways. Behaviors such as anxiety, aggression, agitation, suspiciousness, and wandering can be commonplace. While we know that the behaviors are caused by the disease, it doesn't make coping with them any easier. As a care provider for my mother with dementia, this was something that I was well aware of.

My husband and I were getting ready to drive my mother over 1200 miles to attend a large family reunion. In spite of the length of the trip, my mother was very anxious to attend because there was going to be a memorial service held for her younger sister during the reunion weekend. I was willing to make the trip because of its importance to my mother. However, I was suffering some pretrip anxiety. I knew that placing my mother in an unfamiliar environment, where her routine was going to be disrupted, was a recipe for disaster. Driving long distances, in tight quarters is not always conducive to tranquility!!

One evening my husband mentioned that his friend had given his mother a common over-the-counter drug for pain relief and insomnia before starting a long trip. His friend reported that his mother slept peacefully the entire trip. The promise of a trip where my mother would be comfortable and sleep was too tempting to resist. I quickly went out and purchased the recommended medication (a combination of ibuprofen which is a nonsteroidal anti-inflammatory drug and diphenhydramine citrate which is an antihistamine). As an expert in gerontological nursing, I knew a nonpharmacological approach would be better ... but the temptation of a peaceful trip was hard to resist. We gave my mother her first dose of the medication, and instead of sleeping peacefully, she experienced a paradoxical reaction where she became quite agitated and restless. To my horror, she never slept once while we were driving. Fortunately, we went back to using nonpharmacological approaches on the way back home and the return trip was uneventful.

This experience has sensitized me and made me very aware of the need to share information on prescription and over-the-counter medications with the caregivers of individuals with cognitive impairment. We need to ensure that they are knowledgeable about the benefits and risks associated with prescription and over-the-counter medications. We also need to ensure that they know the best practices associated with giving medications to older adults.

In this issue of Alzheimer's Care Today, the "Tips and Strategies" department is devoted to providing guidance on giving medications to older adults for caregivers and professionals. The Tips and Strategies department features a tear-out design that will let you give it to caregivers or to other interested individuals. My hope is that this information will help others avoid my conundrum of "I knew better ... So why did I do that?