On house calls, I ask to see the medications. What usually arrives is a shoebox. Prescriptions from three different doctors, a blister pack, some vitamins somebody read about, and one bottle nobody can explain.
This is normal. Medications accumulate the way paperwork does: every specialist adds one, and subtracting is nobody's job. But in dementia, a long list matters more, because some very common medications work against the brain we are trying to protect — and the person taking them can no longer tell us how they feel.
So here is one appointment worth booking. Call it a medication review; pharmacists and family doctors do them all the time. Before you go, put everything with a lid into one bag — prescriptions, vitamins, herbal remedies, sleep aids, eye drops, the ones in the drawer "just in case." Everything. Then hand over the bag and ask five questions.
The five questions
1. What is each of these for? If nobody in the room can say, that is a finding, not a failure.
2. Could any of these be making things worse? Memory, balance, bladder, appetite, daytime sleepiness. Some medications that are fine at sixty are a poor fit at eighty-five. You are not accusing anyone. You are asking the question the list needs.
3. Can anything be stopped? Fewer medications is often the safer direction, and doctors have a whole quiet discipline for this. It has a name — deprescribing — and asking for it out loud gives your doctor permission to use it.
4. How will we know each one is still earning its place? What should we see, by when, and when do we look at this list again?
5. If there's a medication for mood or behaviour on the list: what would we watch for, and what could we try alongside it or instead? These medications carry real warnings in dementia, and they deserve the longest conversation of the five.
The rule that outranks the appointment
If confusion, sleepiness, or falls change suddenly after a medication starts or changes dose — that is a phone call today, not a note for the next review. A sudden change is medical until proven otherwise.
This week
Here is your permission slip: you are allowed to question the list. Questioning the list is not questioning the doctor. It is how the list gets better — and you may be the only person who has seen all of it in one place.