Inpatient doctors prescribe antipsychotics against our wishes as POAs

jwilsonmichigan

We know from my father-in-law Logan's behavior when there's some health issue that needs addresses. He's had Sundowner symptoms now for the last 2-3 years. We have a home care aid Maddie that comes to his house twice a day to fix meals, do housework, grocery shopping, and provide company for Logan. Maddie was his wife's caregiver also for the past 4 years, but his wife passed  in Oct 2021.

Between Maddie and us, we know when it's more than a little Sundowner behavior.  We have cameras in the house, and can see him up a lot in the middle of the night, and after a few nights of not sleeping well, he gets increasingly agitated and combative, until he's arguing and fighting with us about everything, storming around the house, yelling, throwing things around, threatening to call his lawyer, wanting to throw us out of the house.

A lot of times it's a uti infection. 2 years ago, it was bladder cancer, which was treated and is undetectable. Then this past year, he started having terrible gout attacks in his left hand sending pain up his arm, so bad he would call us in a panic it hurt so bad. The 1st time, we thought it was heart attack symptoms he was complaining so much. They ended up treating it with a steroid Prednisone. He had been on gout medicine Allopurinol a few years ago, but stopped it because of some other drug interactions and declining kidney function. 

The gout attacks kept happening about once a month. For a uit or these severe gout attacks, they wanted us to bring Logan into the hospital. Each time he was admitted, he developed what we've been told is hospital dilerium. His mental state was already affected by being sick/in pain and loss of sleep. When admitted to the hospital, his Sundowner symptoms became alot worse. He became very angry and fought with the doctors and nurses, and needed to be sedated abd sometimes restrained for his safety. Sometimes they gave him Ativan and sometimes Seroquel or Zyprexa. These medications were usually needed to be administered later in the evening. We would go up to the hospital to sit with him and try and calm him down, but he would get angry and combative with us too, wanting to get dressed, out of bed and come home with us. If he continued being Restless and aggressive, he might get another dose later that night or early the next morning. After a few days of this treatment, he was so groggy he would sleep all day. And they would continue a regularly scheduled bedtime dose every day. Eventually after talking with the doctors extensively every day, we would explain that Logan's baseline behavior was completely independent living. He was still driving his truck at that time, going grocery shopping, to church, to the cemetery, and to visit friends.

As Logan's wife's health declined the last year of her life, we noticed Logan's mental faculties were beginning to noticeably decline. He was losing things all the time. It was difficult to explain things to him. He didn't like wearing his glasses or hearing aides anymore, and his speech was getting mixed up and Hardee to understand. He didn't pass his drivers exam in 2022. The examiner could tell he wasn't completely clear headed, and he couldn't write his address and phone number anymore.

Still, Logan would gradually return to his normal baseline after a short hospital stay, when the doctors finally understood that on e ogan's immediate health issue that brought him in was cleared up, he started sleeping better on his own and didn't need any behavioral or anti aggression medication. He was still taking Melatonin and Trazodone at home to help him fall asleep.

Last November, Logan has a fall and fractured a vertebrae. He was in the hospital for over 3 weeks recuperating. At that time, he was still struggling to get back to his baseline, not sleeping well and still in pain. He had to move into a senior assisted living facility. During that hospital stay, he was never taken off the Zyprexa. He was getting it as needed. We were talking withhis inpatient doctors (always a different inpatient team it seems), and assumed he would discontinue the Zyprexa when released. The discharge doctor changed the Zyprexa order to nightly when he went to the senior center. Logan struggled at the senior center. They had a difficult time with him. Struggling with recovering from his back injury. They tried inpatient, and after release at the senior center, to start physical therapy. But Logan was too sleepy all the time. So tired he was hardly eating anything. And he was having terrible diarrhea. He ended up back in the hospital because we thought with the diarrhea, and not sleeping or eating, that there must be something wrong still. He was dehydrated,  but it was the nightly Zyprexa making him tired all the time.

So this last hospital stay, Logan had only been at the senior center about a month. Going back in the hospital, they found out he had Covid. Then it took them about 5 days to collect a stool sample to figure out why he was having such terrible diarrhea. I had to sit up with him all night one day and walk him myself to a bedside commode to catch a stool sample full of diarrhea, to finally find out that he had Salmonella poisoning as well. The senior center didn't think he hot it there, they blamed the hospital. And the doctors were saying Logan was a fall risk, so they wouldn't let him out of bed to go to the bathroom. So when Logan felt the need to pee or poop, he would suddenly be very awake and argue with the techs, nurses and room sitters - for hours, until he would have explosive diarrhea everywhere, on him, all over the bed, maybe spilling onto the floor.

It's taken me spending several mornings and evenings with Logan showing the staff the symptoms of his behavior. He will be just waking up  or have just fallen asleep, when he will sit up and try to say somehow that he's going to pee the bed or make a mess. He's really hard to understand unless you realize what's going on. He will throw all his covers off, take off his diaper and hospital gown and try and crawl out of bed. He's pretty strong 

It wasn't until about the middle of the 2nd week that I was reading the notes on his patient portal, and talking to the home aid that overheard a nurse - they had been giving Logan Haldol, then tried Zyprexa, then Seroquel  in increasing dosages, changing from one to the next when one medicine wasn't stopping his Restless aggressive behavior. We talk with staff every day and it says on his white board to call us if he's Restless or aggressive and we will come in and see if we can calm him down. I did a couple times, because I had called to check o. Him and they said he wasn't sleeping. Most nights they just medicated him. They never called me. I've thrown fits about it, anout changing meds without asking us, his POAs. And stopping the Trazodone. And changing the Seroquel from as needed to every night. And using antipsychotics, instead of maybe Ativan. Using the antipsychotics like a chemical restraint. He gets Restless and angry, and they medicate him. No med changes they've made have made the aggressive behavior go away. Sometimes if I come in and sit with him, he sleeps all night without needing extra meds. And his normal bedtime is 7pm. But they don't give him his night meds till about 9:30 or 10. And if he's still up at midnight or 1, he gets another dose. And so for a couple weeks now, he's been sleeping till 3pm. Can't get physical therapy. His doctor thinks he has advancing dementia  I've talked to him many times the last month about his broke back, moving to senior living center, refusing to go to the bathroom in bed, and a history of hospital dilerium. But he insists that they often have to medicate Logan at night because he gets so violent he sent one of their staff to the emergency room with injuries on her arm. That there's no time to call me in this situations because he's going to hurt someone. 

Then I'll go in the next day and find out, they had somebody new on staff that night. A nurse or tech is sitter that knows nothing about Logan's history or behaviors. Only that they're getting calls about him grabbing people abd swinging at them. He is 89yrs old. He's practically deaf. He has Alzheimer's and can't understand most things you try and tell him. And he doesn't understand what they're doing to him when they come in his room, and he's mad because he wants to get out of bed, and has to use the bathroom.  I think it's unreasonable that any staff taking care of him or needing to be in his room, wouldn't know enough about the patient that he's confused, feels threatened, gets angry. And you should be able to talk to him calmly and keep him from getting out of bed, and call for help if needed. And not have to dope him up with antipsychotic medicines. That it's been documented in his records many times over the past several years don't really prevent the aggressive behavior, and make him too groggy. And they are FDA black labeled as dangerous to elderly dementia patients. Abd Logan and his family/POAs were not told about these risks and given a choice as to whether they would be used. And we are 15 min from the hospital and have said we would come in and sit with Logsn any time of night or day. But they never  call us. His primary care doctor and I reviewed his medication list and made changes taking jim off Zyprexa the day he was admitted. It was at that video visit that she thought he needed to go back in the hospital, but not be taking antipsychotics.

Is there any way going forward, that I can talk with the geriatric department at his hospital or perhaps another one in the area, to agree on certain methods of treating Logan before he gets admitted again next time?

Michael Ellenbogen

I am so sorry this has happened to you and this is what scares the sh-- out of me form ending up in a hospital or AL. They just don’t care about you but just want their money and not willing to do the real work to make things better for the individual. So sad.

ChicagoGal

I had a very similar experience with my Mom - when she was admitted to a hospital last December.  They took her off Trazadone, put her on Olazapine and Haldol and had her restrained (hands and legs) because they claimed she kicked and spat at the staff.  After a couple of days she was completely doped up but they kept on giving her the antipsychotics.  So I demanded that she be discharged and was barely able to get her home (because of her inability by now to even walk).  I understand that hospitals do not have the staff to "baby sit" individual patients but this whole experience was frightening.  I have promised myself to do everything I can not to admit her into a hospital again.  I have been planning to write a letter to the CEO and the Head of hospital operations - but the ongoing caregiving responsibilities are keeping me spinning.

harshedbuzz

jwilsonmichigan wrote:

Is there any way going forward, that I can talk with the geriatric department at his hospital or perhaps another one in the area, to agree on certain methods of treating Logan before he gets admitted again next time?

Probably not. It's fairly common for the elderly-- especially those with dementia-- to develop hospital psychosis which can result in the patient becoming a risk to staff. The best way to avoid this is for a family member to remain with their LO 24/7 to facilitate ease their LO's anxiety and to advocate for them. Sitting home with the offer to come if called doesn't cut it. 

My family had to do this with one of my aunts. It was exhausting but effective.

HB

jfkoc

Sad but true, a hospital is not a place that a person with dementia can be alone. You will need to have someone with him basically 24/7 and the person with him needs to know how to communicate with him as a person with dementia.

Also sad but true, if he has Alzhimer's (diagnosed following all protocal), things will likely get worse. Then you can add in the grief he if carrying. One more add, his age.

There is little for Logan to not be upset about so in answer to  your question I would talk with Logan's neurologist, I would find a facility that is well trained in dementia treatment and then be prepared for some 24/7 care if he is admitted again.

Would you please tell us more about the Senior Center.

Right now be assured you are looking under every rock and doing a great job for Logan. Things may just need a tweek.

Judith

Quilting brings calm

You are going to need to stay with him 24/7 in the hospital and for as long as it takes after release back to the assisted living center.    That could take a few weeks each time.   Part of his agitation is the recent back and forth between the hospital and the AL.   

ALs these days don’t have enough staff on the night shifts to allow people to leave their residents, go to the front office, look up emergency numbers, call, and then wait there to let people into buildings locked for the night.  My parents’ AL is only required to have two night staff members for 50 residents. Those staff members don’t have to be nurses - just resident assistants. 

Brandy2460

Do you have Durable Power of Attorney? 

You may be able to have a psych aval to get the meds right.

Marta

When my husband’s behavior became unmanageable during an acute hospital admission, he was placed in a canopied bed with flexible netting on the sides, to protect him and others. Nevertheless, I stayed at his bedside.