Seroquel not appropriate for rehab

LaurieRZ

In a previous post I mentiond my mom was put on Zoloft, but I wasn't seeing any benefit. She had an emergency admission to the hospital on Sunday due to increased confusion and they ended up adding Seroquel to her Zoloft. She discharged to rehab yesteday and I got a call from them telling me that Seroquel isn't really appropriate for rehab, because it can make them drowsy. I honestly didn't know what to say to that. They also put in her a regular rehab even though the knew she had dementia (I didn't know there was another option). They called to tell me they were concerned about her memory and considering putting her in the memory care part of the rehab. Has anyone else been told their LO shouldn't be on Seroquel while in rehab?

harshedbuzz

Laurie-

When my dad was very newly given a tentative Alzheimer's diagnosis in the hospital, he was transferred to a regular SNF/rehab having just started on 25mg of Seroquel at night on discharge. The rehab seemed nonplussed by the use of the medication and TBH, dad was so agitated they were probably grateful for it. The amount he was on did not sedate him and he participated quite well in his therapy.

FWIW, this facility did seem to cluster their LTC/SNF population in one wing and their post-hospital rehab people in the other. They did not have a separate dementia informed SNF or rehab at this facility. Of the 12 places I did tour, only one large CCRC had a distinct SNF for people with dementia. In my state, Medicaid does not fund MC so I suspect most of these residents were PWD who had been moved to a Medicaid bed from their MC unit when they ran out of funds or who had complex medical needs with dementia.

HB

Marta

So, question, is she actually sedated?

Facilities are under pressure from regulators to avoid antipsychotic medications. I see their point in that patients may not be able to participate fully in rehab. However, the dementia trumps that, and appropriate treatment for the dementia lies with the provider who prescribed the Seroquel.  The facility should discuss the issue with that provider. 

LaurieRZ

That's a good question. She doesn't act drowsy. She's very agreeable, which isn't her norm, so not sure if it's the Seroquel, progression of her Alheimer's or something else.

Marta wrote:

So, question, is she actually sedated?

Facilities are under pressure from regulators to avoid antipsychotic medications. I see their point in that patients may not be able to participate fully in rehab. However, the dementia trumps that, and appropriate treatment for the dementia lies with the provider who prescribed the Seroquel.  The facility should discuss the issue with that provider. 

M1

LAurie i guess the converse of this question is whether your moms dementia makes her inappropriate for rehab. If they have a MC wing maybe that's where she needs to be?

Jo C.

Hello Laurie, I can imagine that was a very startling bit of news to receive.  Did you notice that your mother was actually drowsy or "sedated" when you visited her?   It has not been my personal experience that Seroquel cannot be a med when in rehab.

From what you have written, I suspect that your mother may possibly not have been able to follow, cooperate with or retain  rehab instructions which would not be appropriate or covered for that level of care as those are some of the criteria for Skilled Care Rehab.  If her dementia has advanced to such a state as to cause such issues, then benefit from rehab attempts would be questionable to nil.

In my personal experience, extended family members who were receiving Seroquel and also Risperdal had no problem being admitted to various Skilled Care Rehabs and did well.  They were able to follow therapist directions, cooperate and progress with the therapy.

If your mother's dementia has progressed as the cause of why she cannot benefit from rehab due to inability to follow, cooperate, or gain benefit, that may be the answer to your question.

That your mother showed no benefit from  Zoloft and in fact had been hospitalized due to onset of increased confusion after the Zoloft began, was it assessed by the physician(s) that she possibly had or did not have a negative effect from that med? I do not know if your mother's dementia specialist saw and assessed her in the acute care setting.  You can look for the side effects of any med online.

If the dementia has indeed progressed, your mother may need to have and benefit from the special support a Memory Care Unit can provide.  You are a very caring and loving daughter who is trying her very best to do her best, she is blessed to have you at her side looking out for her with your advocacy and care.

Let us know how you and she are doing, we will be thinking of you.

J.

Malka

Laurie,

My FIL was in rehab with terrible delusions, but they were a no restraint rehab and that included chemical (their words) restraints.

Maybe you can get her moved.

LaurieRZ

The concern they mentioned is that she can't remember to use the call button. When I was there and they were were instructing her to use it if she needed to get up, I reminded them she has Alzheimer's and they seemed aware. They did end up moving her to the memory care unit while she does rehab. The people in the memory care unit have more advanced Alzheimer's. I feel like she's in this inbetween stage and doesn't completely belong in either area. I was there when they did PT with her and she definitely can follow instructions at the time, but I don't think she will remember what they said like "slow down when you walk". She's always been a fast walker and it's automatic for her.

She was on Zoloft for about 3 weeks before this happened, so I don't suspect? it has anything to do with her increased confusion. She was her normal self at 3:00 on Saturady and then didn't answer her phone when I called at 8:30 the next morning. By the time I got the police to come to her house and break in, she was still in bed (around 11:00) and confused, tired and cold. The hospital said she was a little dehydrated and had bacteria in her urine, but her mental status was out of proportion with her labs, so they didn't really know what caused the increased confusion. She had a CT and no stroke. Can Alzheimer's worsen overnight?

LaurieRZ

The concern they mentioned is that she can't remember to use the call button. When I was there and they were were instructing her to use it if she needed to get up, I reminded them she has Alzheimer's and they seemed aware. They did end up moving her to the memory care unit while she does rehab. The people in the memory care unit have more advanced Alzheimer's. I feel like she's in this inbetween stage and doesn't completely belong in either area. I was there when they did PT with her and she definitely can follow instructions, but I don't think she will remember what they said like "slow down when you walk". She's always been a fast walker and it's automatic for her.

She was on Zoloft for about 3 weeks before this happened, so I don't suspect? it has anything to do with her increased confusion. She was her normal self at 3:00 on Saturady and then didn't answer her phone when I called at 8:30 the next morning. By the time I got the police to come to her house and break in, she was still in bed (around 11:00) and confused, tired and cold. The hospital said she was a little dehydrated and had bacteria in her urine, but her mental status was out of proportion with her labs, so they didn't really know what caused the increased confusion. She had a CT and no stroke. Can Alzheimer's worsen overnight?

jfkoc

Dehydration and a UTI (which can be silent) can bring on some serious problems. Once treated you likely will see an improvement. 

Just being in the hospital can add confusion etc.

I am surprised these things were not explained to you.

Please let us know how your mother is tomorrow.