medications

LisaLH

Hi everyone,

I'm reaching out for advice, experience, etc. My step father is in a memory care facility with somewhere middle to late stage 6 Alz. He has to have total assistance in his daily dressing and bathroom needs. He is double incontinent. He can feed himself. He can actually read the names on the doors of each resident, but doesn't communicate in sentences that make any sense.

Now my question is when does all the medication stop or at least decrease? He does not take any Alz meds or cholesterol meds but is till on 17 other meds and 2 eye drops. 4 diabetic, 4 blood pressure, 3 mood/behavior, 1 edema, 2 allergy(otc), 1 sleep(otc), 1 probiotic(otc), 1 pain(otc) the 2 eyedrops, plus syringes and test strips. Lets be honest, he is dying, he would be so mad at me for letting him live like this.

I am his POA for everything but really don't know what decisions to make. I feel they just keep trying to scare me into another med because he might have a stroke or something. Is there an answer?

harshedbuzz

@LisaLH

That sounds very like where dad was when we decided to take a more palliative approach to dad's care. Right down to the intact ability to decode but not really comprehend written English-- he used to call out street signs loudly when I drove him places. Not that they meant anything to him in relation to where he was or could recall any personal history with the area.

His MCF had a geriatric specialist who became his PCP and reviewed his meds with us. We prioritized his emotional well-being, physical comfort and breathing. We eliminated all of his supplements. We ditched his statin and BP medication. He lost weight in later stages and his BP was lower than it had been when initially prescribed. We eliminated his metformin which caused him GI distress. Dad was a T2D not insulin dependent. His allergies were mostly seasonal; once in the MCF he didn't really go outside so we stopped those.

We kept the meds for his COPD and for mood/anxiety. I would have considered stopping his antipsychotic medication if he got to a point where he no longer needed it. We continued the ADT for his prostate cancer. It was only a shot twice a year and we had a goal to avoid bone metastases that could have led to a broken hip or pelvis and loss of ambulation.

I would encourage you to revisit the meds with his PCP-- ideally with a geriatric specialist who understands dementia.

HB

LisaLH

@harshedbuzz

He currently is seeing the MC doctor. I'm not sure I could take him to a doctor. He gets very agitated and acts out anytime he has to leave the facility. I/They can't even get him to go on field trips. I wonder if there is a geriatric pcp that would come to the facility? I'm going to ask the director there and see. Thank you for your advice.

M1

You can always ask the facility about a Hospice evaluation--not much to lose, if they turn him down you can ask again later. I think you are on the right track to stop anything and everything that is not absolutely necessary. Regarding the diabetes: tight control doesn't matter. Ditto with blood pressure; both of those regimens could probably be simplified,. The probiotic could certainly go, as likely could the OTC allergy meds. The mood/behavior meds may be needed, but some of those can serve double duty as sleep aids too (such as Seroquel/quetiapine), meaning that the OTC sleep med could also go. Edema? Those meds are usually diuretics, which double as blood pressure meds but are very difficult for old folks to take. If his legs aren't terribly uncomfortable and he's not short of breath, that's another one that's potentially dispensable. eye drops? for glaucoma? May also not be worth the effort. Good for you for being proactive about this.