How to give medication to someone who refuses to take it?

My mum has started refusing to take her pills, spitting them out or hiding them under her tongue. I've tried insisting, and it only makes the situation worse. What can I do differently?

Refusing medication is one of the most stressful daily situations for a carer — not only because it involves the person's health, but also because insisting often leads to conflict. Refusal is rarely "stubbornness": it can be distrust, difficulty swallowing, confusion about what they are taking, or simply not understanding why they need that pill.

Why it happens

In more advanced stages of dementia, the person may no longer recognise pills as something familiar, may have difficulty swallowing (dysphagia), or may feel they are being forced to do something without understanding why. Understanding the cause helps choose the right strategy, instead of repeatedly insisting in the same way.

Practical strategies

• Use a weekly organiser box: with seven compartments, it makes management easier and reduces errors, both for the carer and for the person, if they still have some autonomy.
• Associate medication with meals: taking pills always at the same time, linked to breakfast, lunch, or dinner, creates a predictable routine that is easier to accept.
• Try the eMed.pt app: available in Portugal, it helps organise schedules, reminders, and medication history.
• Simplify the explanation: use short, direct phrases, such as "this is for your headache", instead of long medical explanations that cause confusion.
• Always approach from the front: never surprise the person from behind or the side — approach calmly from the front, to avoid startling them or making them feel threatened.
• If there is difficulty swallowing, speak to the doctor: only with medical or pharmaceutical authorisation should pills be crushed or dissolved, as not all medications allow this without losing effectiveness.

"I found out my dad refused the white pill because he thought it was 'poison'. We switched to the liquid form, with the doctor's permission, and the problem disappeared."

What NOT to do

• Never hide medication in food without first speaking to the doctor — it can be legally sensitive and, in some cases, alter how the drug works.
• Do not physically force or argue insistently — this increases agitation and distrust in the long term.
• Do not alter doses or schedules on your own to "compensate" for a missed dose.

When to seek professional help

If refusal is persistent, or if the medication is essential (for example, for heart conditions or diabetes), speak to the GP or pharmacist. There may be an alternative in liquid form, patch, or a single daily dose that is easier to accept. Never decide on your own to crush, dissolve, or stop a medication — any change to the form or dosing schedule should always be confirmed with a healthcare professional.