Facility to help sort out meds for Dementia for mom

virgil_sf

Mom has been in AL for a month now.  After a few days in, she was doing 'ok', but she has gotten worse.  Only sleeps from about 7pm - midnight, then they need someone in her room with her or she starts screaming and being very agitated.  We are trying different medicines (she is on Lamotrigine, Zoloft and Trazadone now).  Went to the neurologist this morning to see what else we might be able to do.  We are adding Depakote and Quetiapine/Seroquel to her list of meds now.  Hoping that helps.  She is pretty 'ok' in the mornings according to the caregivers, afternoons starts getting worse(Sun Downers).  This is all pretty much the same as when she was home(we had care givers 24x7), though we could usually get her to go back to sleep until 5am or so.  The AL facility said the neuro might recommend she go into a facility for them to work out her meds.  Says it could take 1-2 weeks and that they have had folks in the facility do that before.  Does anyone have experience with that?  Feeling nervous, scared, frustrated.  If anyone has any experience on more of a 'skilled nursing'/'rehabilitation' place that might offer in patient for 1-2 weeks to figure out her meds, let me know.  She is in Phoenix.  When she had a serious hospital incident(she had internal bleeding, caused by a different med used to treat her cancer) she went to rehab Vi Grayhawk.  Basically skilled nursing.  It wasn't cheap, but worked really well.  I was going to call to see if they did that.  I know Psychiatric Hospitals do it, but I am not a fan of doing that.  

jfkoc

Finding the correct cocktail is difficult.

I ran possible drug interactions on the list you gave and found 2 major interactions. I used drugs.com. Please check out the interactions on that site or another online.

harshedbuzz

virgil_sf wrote: 


 I know Psychiatric Hospitals do it, but I am not a fan of doing that.  

Why would you not want your mom to be admitted to the place with the most experience and most highly qualified individuals to manage these powerful psychoactive medications in the context of dementia? Skilled nursing tends not to have the people on staff she needs 24/7 nor dementia trained caregivers. 

Am I missing something?

towhee

Skilled care would be able to do slightly more medical monitoring than AL/MC but they are not usually a place to go for medication adjustment. I am not a fan of psychiatric hospitals either but sometimes they are necessary. Since University of Arizona has a geriatric dept, you might be able to find a geriatric psychiatric facility which is best if you decide to go that route.

But in any case, you need a geriatric psychiatrist on your team. Someone who works with these medications frequently will be more aware of possible side effects and drug interactions. Medications matter. If your neurologist is also a psychiatrist, fine, but make sure.

IMO while the facility's goal is to to get your LO to sleep because she might disturb other residents and take too much staff time, and for her health, your goal is to see that this happens with the least amount of harm to your LO. 

There was a good article posted recently about medications and dementia from the UCSF. I'll try to find it for you. In the meantime, this is some general advice to consider.

You want the right medication(s) at the right dose (lowest effective) at the right time. Start with lowest dose, gradually increase. If at all possible, change only one medication at the time. (If you change more than one medication you don't know where side effects are coming from or which medication is effective) The fewer medications, the fewer interactions and possibly fewer side effects.

Seroquel and Depakote can both cause significant sedation, especially in the first couple of days (not always, but can) If you decide to give both of these, especially without taking your LO off any other medications I would make sure your LO is monitored for at least 48 hours. Make sure that someone is available to take her vitals and especially to help her walk if she is still doing so.

I agree with jfkoc, make a list of all her medications, OTC ones included, put down what symptoms they are supposed to address and run them all thru a drug interaction checker. drugs.com or another. You can also ask a pharmacist to do a review.

Hope things get better.

May flowers

If you do a psych hospital, be sure and stay on top of what all they are giving her and why. They kept adding on to my FIL’s med list until he was a zombie, 8 or so meds… instead of trying one and if it didn’t work, try another…

After his surgery we worked with a neurologist to wean him off all of them (a really rough period of withdrawal) at home. We have tried some of them again one at a time, but they were making his agitation and sundowners much worse. We eventually ended up with one that calmed him, but doesn’t knock him out.

M1

Virgil, a skilled nursing facility can Not do the medication management she may need, period. That's just not in their wheelhouse, especially with the current understaffing issues. I'm no fan of geri psych units either, personal experience was awful, but that's probably going to be your only option. As mayflowers said, you'll need to watch them like a hawk and be very assertive.

virgil_sf

Thanks everyone, I appreciate the feedback.  I honestly wasn't sure if a skilled nursing facility did this, I hadn't even called and asked.  I just happened to have a good experience at a skilled nursing facility several years ago.  I will check out the drug interactions, I have done that online with some of her other meds in the past.  I'll update this post as to where we end up so someone might benefit.

dayn2nite2

She is going to have to go to a geriatric psychiatric unit or a regular psych unit.  SNF is inappropriate for this.