On med management…

A recent conversation with friends of mine was a critical reminder about the importance of prescription management.

His 80-something year old mother had been living independently.  She wound up in the hospital due to an infection.  A neighbor found her on the floor, unconscious.  After a lengthy hospital stay and no conclusive diagnosis, she was transferred to a nursing home for short-term rehab.  She declined quickly, both mentally and physically.  My friends decided to bring her home to live with them.  He quit his job to take care of her.

Initially, weak and very confused, she was taking enough prescriptions to knock out an elephant.  After considerable research and local medical consult, she has weaned off everything but meds for her blood sugar.  She is her snarky self again (sooo reminds me of my mother) and is readying to teach a painting class at a nearby senior center.

From the book –

After a short hospital stay (from a fall), Mom was discharged to a nursing home for follow-up rehab.  At some point while still in the hospital, she was asked if she was a smoker.  This information was added to her chart.  Upon discharge, rather than inquiring how much she smoked or asking if we thought it was necessary, she was given a nicotine patch and prescription.  She weighed less than ninety pounds and only smoked about four cigarettes a day.  Even the lowest patch was too high a dosage.  We were not informed.

On the afternoon of her discharge from the hospital, my cell phone rang.

“Your mother has been taken to Rockville Hospital.”

“Hospital?  No!  She was just discharged from Hartford Hospital.  She’s at Vernon Manor for a week of rehab.”

“This is Vernon Manor.  Your mother had a fall.”

She’d been admitted to the nursing home that afternoon and was there no more than two hours before she decided to get out of bed (without assistance) and fell again.  It wasn’t a bad fall, but they wanted to be sure.

When I arrived, she was still in the emergency area, surrounded by curtains and fitted with a neck brace.  The brace was too large for her tiny frame and she looked a bit like a Pez candy dispenser.  She recognized me, but other than that, wasn’t making much sense.

“Mom, why didn’t you ring for someone before getting out of bed?”

“I wanted a cigarette.”

She hadn’t smoked all week while in the hospital and thinking it was a good time to help her quit, we’d tossed her pack.  “You don’t have any cigarettes.”

“I was going to smoke one with Joey.  He has some.”

I sat down hard.  Joey (my brother) had been gone for two years.  Yes, he too had been a smoker.  “Mom, you know Joey is dead, right?”

“Yes.”

“Well, how was he going to give you a cigarette?”

“He’s here.”

“Where?”  I looked around.

“Right there and he looks pretty good.”

“Ma, what are you talking about?”

She pointed above her, telling me he’d put on a bit of weight and it looked good on his face.  His hair had also grown back.  “Whatever shampoo he’s using makes it shiny.”  My heart pounded and yes, I had goose bumps.  It was eerie to be standing beside her bed, while she looked directly at my dead brother, who possibly stood (or floated) across from me.

She rambled on for the next few hours (sometimes to me, sometimes to Joey) while we waited for x-ray results of her head and neck.  I sat and held her hand and even said, “Hey” to my brother.  Eventually, she was discharged and they allowed me to drive her back to the nursing home, where I tucked her in for the night.

Before leaving, I spoke to the nurse in charge and asked what medications she was taking.  Up to this point, it had mostly been breathing treatments and vitamins, along with a low dose of an anti-depressant.  The nurse brought out her chart and the one noticeable difference was a nicotine patch.

We discussed the past few hours and she agreed.  Even the lowest dose was too much.  It would account for the hallucinations and extreme behavior.  The patch was removed and the prescription discontinued.  The next day she was more coherent and in less than two weeks was discharged.  Joey will have to smoke alone.

And here’s a good read from ‘A Place for Mom’ – http://www.aplaceformom.com/blog/common-but-surprising-cause-of-dementia-symptoms/

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About hereisakiss

Daughter Writer Art's Educator
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4 Responses to On med management…

  1. NotHereNow says:

    Bodies and systems change so much as they age. My charge was originally on a ton of blood pressure meds most at their most extreme dosages. The she was in a chair, always half asleep. Now she is on just two, and is alert and is more the person I recall from the old days. Lucky we had a gerontologist who recognized that what was once essential was now problematic, and who very slowly corrected the situation@!!!

    • hereisakiss says:

      Sounds exactly like what my friends just went through. My friend’s mom is not 100%, but she is again enjoying life and participating in it as well. Far from the woman they originally moved into their home.

  2. Priscilla Herrington says:

    Oh Elizabeth, I’m so glad you’re writing about this! I’ve heard and read about so many cases of elderly patients appearing to be senile after yet another prescription was ordered…. The other big one is food. My grandmother, about 96, was living alone. She had meals on wheels but didn’t eat them because she didn’t like them. Two sisters who lived across the street, retired nurses, checked in on her every day and laid out her meds for her. A cousin, another retired nurse, took her shopping a couple of times a week. Grandmother loaded up on those prepared vanilla pudding cups – easy to eat and she liked them. What Flora didn’t realize was that the pudding was about all Grandmother was eating, except for when Flora took her out to eat. Grandmother had a fall at home and was aditted to the hospital. There was nothing wrong, medically, but they didn’t want to discharge her home alone since there had been previous falls. Flora was able to get Grandmother into a good nursing home in the next town to hers (important, since her minister and friends were able to get to visit her there, and she had connections with some of the other residents) For the first few weeks she was silent, scared probably, and we didn’t expect her to last very long. And then I went to visit her and she wasn’t in her room. It turned out, she had been moved (in with a far more congenial roommate) but she wasn’t in that room either! She was down in the lounge, laughing and talking with her friends! We had a lovely visit, and she told me about all the activities she was participating in, the trips they occasionally took – she seemed like the grandmother I remembered from years earlier! And then I realized why: I asked her about the food. “Not so good,” she said, “except for breakfast. You know I always liked my breakfasts!” When I aked her what she had eaten that day, she listed bacon, sausages, eggs, toast, oatmeal with a banana, a half a grapefruit, coffee and a donut!!! At 96 I don’t think all that cholesterol was a concern, but the protein was, quite literally, a life saver! She had a little more than a year there. She was always cheerful when we visited, and both the staff and the other residents seemed to like her a lot. She simply got weaker and finally slipped away one night – aged 98. I wish we had realized earlier that she wasn’t eating properly – mostly sugar and carbs. She had stopped using her gas stove – afraid she would either leave it on or get burned while cooking. She was throwing out the meals on wheels stuff but apparently no one noticed.

    Never trust anyone who has not brought a book with them. (Lemony Snicket)

    Date: Mon, 5 Nov 2012 13:58:12 +0000 To: priscillaherrington@hotmail.com

    • hereisakiss says:

      Priscilla, and thank you for writing. What a wonderful story about your grandmother. Absolutely, food is another big issue (my dad loved those pudding cups also) at several different levels. To cook or not to cook being a big one! Probably a good thing your grandmother realized she shouldn’t use the stove. Regarding what to eat or not…this is probably one of the only things many seniors still feel like they have control over. A person can choose to eat a pudding cup (and it tastes good) and they can choose not to eat a home-delivered meal. I am guessing there is a feeling of control, when so much else is out of their control. Does that make sense? PS…Love Snicket!

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