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Avatar universal

Multiple prescriptions for elderly pt

My 77 yr old mother with back pain,depression and anxiety is currently taking oxy contin 10 mg three times a day, hydrocodone 5/250 three times a day,(possibly more,she is very defensive on this issue),tizanidine 4mg three times a day,ambien 10 mg at hs and was recently prescribed klonopin twice a day,She sets her clock to get up at 2 am to take her oxy contin and frequently has to take a hydrocodone an hour or so later "to get back to sleep".She complains of dizziness, "chills" requiring her to go to bed to get warm,tingling in her hands,muscle spasms, a sensation of a "black cloud" coming over her,excessive worrying ,anorexia,insomia despite the ambien (but insists she must take it and became very angry when I questioned the doctor prescribing the klonopin if that would take the place of the ambien at bedtime or should be taken in conjunction with it,she's taking it along with it),and nausea.She has had two severe falls in the past year,has become very forgetful,somewhat paranoid(I have always been her main caretaker when she's ill and she now distrusts me,especially in talking with her doctor about how many CNS depressant medications she's on),her weight has dropped sharply,she is unsteady on her feet , she has stopped most activity she used to enjoy (such as a church social group and spending time with her grandchildren) ,and cries frequently. She has been thoroughly checked for physical reasons for all of these things and her only medical problems are hypertension which is under fair control on medication,and spinal stenosis causing the chronic back pain.She has a past history of alcohol and valium (drinking two six packs each evening and then taking a valium"so she could sleep",but according to her this was not abuse or an addiction.She lives alone and continues to drive with the above medications and symptoms.My sisters think this is her personal choice and there is nothing we can do and that I am just overreacting and need to just leave her to it.This is not acceptable to me as I feel she has become dangerous to herself (and others on the road) but she gets angry when I try to talk with her about this, and my sisters are not even willing to broach the topic based on how she treats me for weeks after I try.Are they right,do I just need to shut up and quit trying(I miss my mother and my children miss their grandmother,this woman bears very little resemblance to her),are these changes due to normal aging as they say or a result of the drugs and depression as I think.(She  will not take any antidepressant medication,she has tried several and stopped them just when they seemed to be effective d/t "side effects".. which are the same complaints listed above that she has had for two years now.She claims an intolerance to NSAIDS in any form as well,(including the transdermal),and tylenol "does nothing for me") Her doctors just continue to write another prescription(to be fair she is very persistent in telling them what meds she "needs") and I truly feel like a lone voice of reason.I'm at my wit's end but felt the need to ask an objective party before I just give up.She is seeing a psychiatrist (on referral from her pain mngmt MD),according to her he does not feel she needs an antidepressant,and is working with her on cognitive therapies,(progressive relaxation and visualization),which she alternately makes fun of and claims to be trying. Is there anything else I can do or do I just watch her self destruct?
12 Responses
518031 tn?1295578974
You are in a diffacult position.. if your mom is mentally compatent theres really not much you can do. Legally her docotor is nit allowed to talk to you about her treatment. Now if you could get your mom to agree for you to go with her and talk with the doctor that might work. I understand you are concerned but if her pain specialist and phsicarist is working together then they know what meds they are giving her. Wish i could have been more help give it some time there will be people alot smarter then me on here in a bit and maybe one of them will answere . Good luck to you and your mom
547368 tn?1440545385
Hello Bunky,

First let me welcome you to our community. I am very glad that you have found us. I do know where you are coming from and how alone you feel in your concerns. My Mother is 76 (lives with me part time) with some of the same problems that you describe with your Mom. My Father is 80 (Mom divorced him when I was 12) and live with me full time. I have years of professional experience in geriatrics but nothing prepared me for the time that my parents reached that stage of their lives.

Is your Mom seeing a Gerontologist?  They are the true specialists in the issues of aging. The next best in an Internal Medicine Physician. If you Mom is not seeing either one of those I would encourage you to get her a referral for her to be seen by a Gerontologist. Family Practice Physicians do not have the expertise to treat a complicated geriatric patient.

You need to be as involved as you are comfortable being. If you think you should be questioning her care and medications than do so. When she is gone it will be too late and you will forever blame yourself. That is how I judge when I step in, or when I shake the tree. Is it something that I feel may be life threatening and that I have any control over? If I can answer yes to those questions than I act. Your siblings are right to a degree. You Mom is her own person with rights that no one can take from her unless she is proved incompetent in a court of law. It is a very fine line on how much you can control at this point. You cannot stop your mother from taking medications that her physicians prescribe for her, even if you disagree with them. However you can try to get her seen by another provider that can evaluate her current medications and physical and mental health.

It sounds like Mom has had some issue with alcohol and medications in the past. These or any issues that an individual had in the past will often magnify as they age. In geriatric ppl it in not uncommon that many of their friends and spouse are gone and even undesirable behaviors will be more prominent. Their circle of friends and their social climate is very different from what it was 20 years ago. They no longer have anyone (or a very few) to impress or any need to control their undesirable behaviors.

Your Mom may be defensive about her pain medications because not only do they relieve her pain but possibly they bring her some comfort. She may be afraid you will be instrumental in taking them form her. The setting her her clock to "wake up" to take sleep or pain medications is out of the norm. I am a CP sufferer as are our other members. Most of us, probably none of us do that. I am so happy to sleep I would never set a clock to wake me, even if it (and it does) mean that I wake with more pain.

Because her of "sharp" weight loss I would be concerned that there may be something going on medically that has not yet been diagnosed. If there is nothing medically active than because it was a sudden and "sharp" weight loss it need to be investigated. My Mom is on the Fentanyl Patch and also takes hydrocodone for several pain issues. It certainly decreased her mental acuity. Recently the strength of the Patch was decreased. Her pain is still controlled and now she more mentally astute; with that her sharp tongue has returned as has her boistrious denial of her limitations. She is a handful.

So again I encourage you to have your Mom evaluated by a gerontologist. Express your concerns regardless of you siblings silence. Good luck to you. If you have any questions please feel free to ask. You may also send me a PM (personal message) and I will be happy to offer any assistance I can. Rather your Mom realizes it she is very blessed to have such a concerned daughter. I admire your courage to become actively involved with your Mom's care. I have discovered that having aging parents has been more challenging than having children. But I feel very lucky to still have both of them. If I (and you) didn't care so much we wouldn't be so concerned. Please keep in touch and let us know how you and she is doing.
Take Care, Tuck  
547368 tn?1440545385
I wanted to add that your Mom's "chills" is fairly normal in the elderly as their circulation is not what it use to be. Both my parents would be happy to have the thermostat at 85+.  My Mother is always freezing and complains of the chills very frequently. She has insomnia, also not uncommon in the elderly. And situational depression is also a common factor. Our senior citizens are forced to face many life changing crisis by the simple (or not so simple) fact that they are ageing.

The "dizziness" can be related to poor circulation in addition to all the medications she is taking. Have they checked her B/P in a laying and sitting position and than monitored it as she stands up? Orthostatic hypo-tension can cause dizziness. I would recommend you request that it be checked if they have not done so.

It sounds as though her physical complaints have been investigated. It is not "rare" that elderly patients have many of those same complaints. That does not mean they should not be monitored closely.

Jollyman is correct. Your hands are tied by legal factors. HIPPA protects your mother's privacy. My mother has signed a wavier allowing me access to her physician and medical records. I know there are days she regrets that decision. Nothing stops you from talking to her physician. He/she would probably value your information and input. He/she just can't give you any real answers.

Again best of luck and please keep in touch.  
518031 tn?1295578974
I just read what Tuck wrote about your mom setting a clock to get up and take a pain med..like Tuck i would never set a clock to do that..if i am lucky enough to be asleep at 2 or 3 in the morning then there is no way on this green earth am i setting a clock.. pain will wake me up too soon as it is.. sorry i missed that when i first read your post that is something i think you should be very concerned about.. as far as i know most chronic pain sufferers are happy to sleep whenevr possible
356518 tn?1322267242
Welcome to our community, we are very glad to have you here.
Tuck and jollyman have given you some execellent advice.
I agree your mom is afraid of you taking her pain mediaction away and if you sit down and speak with her and explain your not trying to take her pain control away that your just trying to make sure she is safe and is being treated well medically.
As we all know here our pain medications are very important as they help give us a normal life and when someone tries to threaten that we may get defensive.
It is no different than a diabeitic that needs their insulin we need our medications.
I think if you see that she understands you know she has chronic pain and that she needs her meds and you understand you will get a different approach from her as to her medical treatment.
You do have to try and do all you can because then if you do not you will always wonder if you had stepped in would it had made a difference.
Just be sure she knows you understand she is in pain and needs her medications and then go from there.
The doctor may be telling her to set her clock to take her meds, I have had a doctor tell me this befoer but as Tuck says I value what little sleep I get and I refuse to set a clock to take medications.
Talk to her and let her know she does not need to be afraid and that you understand and only want to help.
Let us know how it goes and if you need anything please let us know.
760259 tn?1236130991
Good afternoon,

It sounds like you have quite a situation here.  Tuck and Jollyman have offered some very good advice.  I am only 24 so I didn't have much experience with my grandparents' health issues before they passed away a few years ago, and my parents haven't made it that far yet.  I won't get in to what the last two posts went over, don't want to steal their thunder!  I do know that my grandmother also took Oxy for her pain, but also know that she never set the alarm to wake up in the middle of the night to take it.  The only time I have ever taken my meds in the middle of the night was after I had surgery to place a titanium nail in my leg after I broke it, and that was only because the pain was bad enough to wake me up.  I'm with Tuck, it is hard enough for me to sleep that I couldn't imagine waking myself up in the middle of the night for anything!  

I can tell you than the 10mg Immediate Release form of Ambien is only cited for short term use (7-10 days).  I am in the military and they have no problem giving that stuff to you for months or years and long as you still get any amount of sleep at all with it.  Depending on how long she has been taking it, she has probably built up a pretty hefty tolerance to it.  That was the case with me.  I was finally lucky enough to get my insurance to pay for Ambien CR, which you can take as long as your Dr. prescribes.  Long story short, I had a tolerance built up to Ambien from the IR version I had taken for 5 months, and the CR wasn't putting me asleep, so my doc also put me on Klonopin, 2 per day.  I take one right before bed and the Ambien works very well now.  She should try taking her Klonopin shortly before she takes the Ambien, otherwise she might consider having a sleep study done to see if there is a problem that isn't being treated.

As for the Hydrocodone, that is very dependent on how long she's been taking it in addition to her age.  I have seen it recommended many times on here in a situation such as this that you consider taking her medications away from her and dispensing the proper dose to her so that she doesn't take more than she's supposed to, although I'm sure she won't appreciate that very much.  I have friends whose grandparents live alone and take multiple medications and the families ended up finding out that they were taking the wrong meds at the wrong times of the day.  You may also mention that you intend on speaking with her doctor about your concerns with all this.  If the meds she is taking are truly not enough for her pain, then she needs to talk to her doctor about being on something a little stronger/longer acting so that she doesn't have to take as much and doesn't feel the need to wake herself up at 2 AM to take meds.  I've not been prescribed any muscle relaxers, so I can't really comment on that.  Again, I do not have a lot of experience with the senior population, so I apologize for being so long winded.  I mainly just thought I would share my recent ambien experience with you.  Good Luck with all of this and keep us updated.

Turbo
760259 tn?1236130991
Sandee offered great advice too, I was just typing for 10 minutes so she posted while I was typing, otherwise I would have pointed that out.  Actually made me re think some things that I put in my own post but I think I've said enough for one thread.


Turbo
Avatar universal
Thank you so much for your thoughtful and helpful reply.I actually do have access by her waiver to my mother's medical records (and yes I too think she often regrets that) and have accompanied her often to her various Dr appointments when she was physically unable to drive herself or she wanted my support to talk with her doctor.As long as I agree with whatever she tells him/her my input is welcome.If I speak up,however gently,when what she tells the doctor is not what she tells me or what I observe(she wants to be the "good patient") she gets mad at me and the doctor for even turning his attention to me,then she makes sure she has another ride to the next appointment or drives herself.I was instrumental in getting her to the pain specialist and insisting on incremental increases until she got as much pain relief as was possible without being to the point of non-functioning,so she should know I don't want to take her pain meds away,I just question when they add another med to the mix if she shouldn't back off one of the others,but she becomes very upset at the thought"Dr so and so said I would have to take ambien for the rest of my life"(That was many years ago and long before she was on all these other meds.),so she shouts me and the doctor down,the doctor shrugs and gives her another prescription.My fear is that with taking one on top of the other until she gets to sleep is she going to stop breathing from the cumulative cns depressant effect especially being her age and not clearing these meds as well or is the next fall going to be the one that breaks her hip? I do feel that she is also treating emotional pain with these meds (the "comfort" you mentioned)but they have increased her emotional pain byisolating her and making her unpleasant to be around so that only the most persistent of us still visit. One sister has never been real close with her and the other cares but lives an hour away and gets treated to mom's best behavior when she does visit and doesn't get the true picture.Mom says I'm the one she can be honest with,and the one she feels most comforted by(as long as I agree with her) and agrees that she acts differently around them."I put on a brave face for them"This makes me wonder sometimes if I'm being a good daughter or a"patsy".I have children still at home and sometimes I feel that mom's demands on my time and emotional energy is taking away from them,not to mention they no longer want to go to grandmom's with me "Can I just stay in the car?".Oh, I also work a full time job with mandatory overtime,and do have chronic pain issues from two ruptured disks myself.Plus I was a late to motherhood mom who is going through menopause complete with hotflashes and sleep disturbances with a moody teenager and a tween going through the throes of puberty. I won't stop visiting or trying to help her,she's my mother and I am glad I still have her,or some semblance of her.I guess I'm just still thinking if I could just find the right words,I could talk her back to herself and off of some of these meds that I feel are partially responsible for her "disappearance".I sometimes feel I'm grieving the loss of my mom while she"s still alive.Thanks again for your input...at least I don't feel so alone,especially your comment that you were not prepared for this even with your experience.
547368 tn?1440545385
I so agree with every word you wrote. I too wonder if I am just trying to get my mother back. I know I have been grieving for the mother she once was. I know in my head that that woman is gone forever. It breaks me heart.

And my Mom did the same think, putting on a face for my siblings. Unfortunately one of the best things that happened to the siblings is when my Mom had to have open heart surgery. My only sister who lives 600 miles away came home. My two brothers who live within a half mile on each side of Mom were forced to see Mom in her true light. So now we are all pretty much on the same page. But until several months ago I felt like the outcast. I was over reacting and etc. My younger sister is caring for Mom in Mom's home 4-5 weeks and than returns to her home for 14-20 days and than comes back again. When she leaves my oldest brother or I bring Mom into our homes. My brother will not be able to do participate in her care April through November due to his construction management job. But finally it is a blessing to have us all working together as a family in harmony. I hope that for you.    

You may want to ask a pharmacist about your Mom's medications, especially the CNS respiratory depressant effects. They are the true specialists in that area. I think if she takes her meds correctly she is not is serious danger, but at 77 anything can happen.

I know how you feel about giving so much time and energy to your Mom. In my situation it is both of my parents. I ask myself the same thing. I know I take a lot of time and energy from my children, husband and now my grandchildren. As I am sure you feel, they deserve more of me, more of my energy and quality time instead of finding me emotionally and physically exhausted. But what is the alternative? There are many like you and I out there. I think we are called the sandwich generation.

Please keep in touch. I think it helps to chat with someone who is also there. Feel free to send me a PM any time. Good luck and rest when you can. I'll be thinking of you.
Tuck
Avatar universal
ur in a bad way..in my opinion that the pain m shouldn't be giving her all these pain meds to her being on klonpin anyways!!  they took me off of klonopin and put me on xanax..for the simple fact that i,d been on the klonopin 13 yrs..and there long 1/2 life it carries is up to 72-100 hrs..the shorter acting xanax is only 11 hrs  big difft..when being mixed with all the pain meds..her respiration must be very good for her to be on all these pain meds??..i noticed pain docs seem to not to care as much when it comes to older people..its like the risks have all the sudden went away for some reasons??..they dont think that older folks will be abusing them..my father is 71 hes on methadone and xanax as im too..but they have him on a lager dose then me..i dont want to say the wrong things here,.but im realy surprised that the state would let her drive if they knees all this she wouldnt be..and as far as ur kin folks,cant  get into that one..but this is ur mother,, being on these meds at 77 isint a real good thing..just cuz of the things with our heath that we cant see can arise..from what's being done or not being done..i know thats hard to understand..when ur 77 ur pains are for real..im 46 and mine are real bad i couldnt imagine 77.....I WISH  YOU THE BEST WITH UR KIN....GOOD JUCK TOO YOU ALL GOD BLESS YOU ALL...JAMES
547368 tn?1440545385
James,

I so agree with your driving concern. Unfortunately the state cannot stop you from driving until it is proven you are a danger on the road. At least that is a fact in my state.

True story. When I was at the DMV a very elderly man came to take his eyes test required to renew his liscense that expired in several weeks. He shook so bah he could not hold the eye testing machine to his eyes. He could not understand what he was being told to do. He was obviously very impaired. The counter person told him (six-seven times) to bring a note from his doctor telling them he could drive and the results of an eye exam. He than walked out of the DMV with a walker, almost falling. I felt very sorry for this impaired very elderly man but I felt sorrier for the ppl that had to meet him on the road. Had he walked out of a bar in that condition he would have been stopped.

I was aghast that they didn't pull his liscense until he could prove he could drive. The counter person explained that she could do nothing to stop him from driving until his liscense expired and he was unable to pass an eye test or in that situation if his doctor would not agree to his driving. Sad but true!
356518 tn?1322267242
I posted a topic on this long ago. Driving while taking presciption medications is dangerous and we all know someone or have seen someone driving and they have no clue they are impaired form the medications they are taking.
It is too easy not to realize your  a daily basis. I know most of us have been taking our meds for sometime and know how they effect us but new pain management pts need to cease driving all together until they know how they react to their medications.
I have many times left my car in the garage and gotten a driver to drive me around when I am feeling unsure of my reaction response from my medications. I know my own body and how the meds react and I know when I should leave the driving up to someone else.
There are no test the law can use roadside to test one for presciption drugs other then looking at the pupil and getting blood test but the police have a sense about thses things and no one wants to have to deal with a dui. I am not sure what amounts of medications are at the legal limit but I am sure that if you are caught and tested and are a PM pt that one would most likely fail therefore causing all kinds of problems both legal and with your PM doctor. So its best to be safe for yourself and your family and others on the roads:)
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