Introducing a medication to a resistant parent?

jmack8

Just a bit of background. My mom was recently diagnosed with dementia. She is a difficult medical patient and refuses (so far) the MRI and the neuropsych eval that would allow a full diagnosis of Alzheimers but I think we all suspect highly that that is her eventual diagnosis.

She has a challenging and stubborn personality in the best of times and right now she's also extremely anxious and fearful and is suffering from delusions and paranoia. However, as the weeks have progressed (it has been 5 weeks since she first no longer recognized her husband) she has calmed significantly.

Still, we think she needs some kind of meds to be calmer and less anxious. The doctor has recommended Zoloft. BUT she's very much against any kind of medication at all, and specifically she has resisted suggestions that she is anxious (even though that's pretty much her defining characteristic right now!)

We're trying to figure out how to introduce this medication to her routine. I feel like if we do it wrong, we could set ourselves up for further upset. At the same time, I think she'll feel much better! So we want to try!

Any excellent strategies for introducing meds to dementia patients? Again, she's not logical and she's VERY suspicious. I thought maybe we could switch out her stool softener (since Zoloft has a side effect of diarrhea) and just switch out the meds bottles. She might be none the wiser. Or she might be suspicious.

But even if we are successful in that switch, we're Kaiser patients and the nurse will run down her list of meds at the start of each doctor appointment for whatever reason, allowing for an opportunity for her to hear about the Zoloft for the first time in that context.

Now she does forget things! But it seems like there is some permanence or remembrance around a topic that persists even if she can't remember the particulars. So for example when we took her keys, she was laser focused on driving and keys for several days but it morphed to anxiety about driving in other ways. She doesn't remember why she isn't driving but she remembers that she's super mad about it! I DON'T want to provoke a similar reaction!

Any ideas or strategies you guys can think of?

H1235

I think switching it out with the stool softener is a good idea. I’m not sure what a Kaiser patient means. If she is going to be upset about it, it seems like you could talk with the office and go over the med list before the appointment or something. If it’s a doctors office they should want to help you with what is in her best interest. Do you have DPOA? Good luck

jmack8

Kaiser is an insurance company and it is kind of a whole huge thing. It means that every doctor that my mom sees can see all the notes and meds and tests that have been ordered by all the other doctors. And most of the time that's nice and I love it but it doesn't work well with dementia patients! Because when she sees the cardiologist, that nurse will also see all her meds but won't know per se not to say anything!

Also, her PCP, also part of the Kaiser network, seems to really not appreciate the need for discretion. I hand delivered several letters to the doctor prior to her appointments while we were getting her diagnosed and the doctor had the audacity to hand those notes to me in front of her. Which I really didn't appreciate. By contrast, the geriatrics department seems to really GET IT when it comes to patients with dementia.

M1

Sertraline(zoloft), citalopram(Celexa), and escitalopram (Lexapro) all have pretty good track records here. There are liquid formulations you could put in drinks or soups that she wouldn't have to even know about, if you can figure out the med list issue. Generally the approach would be to start with one of these and then add an atypical antipsychotic like Seroquel or Risperdal if she remains agitated or becomes paranoid or delusional.

II personally think it's pointless to try to reason with her at all about what she takes, her capacity to make decisions is gone. Like pediatric or veterinary medicine, you have to rely on your own best judgment here. I would take the approach of doing what's practical to get it in her system and see how she responds.

H1235

That is frustrating. I would be very upset if the doctor handed me a note I wrote them in front of mom. Will she be able to recognize Zoloft for what it is when they list it? Could you just say Zoloft is for your cholesterol and give them a look. Does she wear hearing aids? Could you loose them on doctors appointment days. Maybe it’s time to have another discussion with the doctor. If he is not going to support you then maybe it’s time for a new doctor that will. I think we are headed for this kind of trouble with my mom.

jmack8

We're going to try talking to her about the new meds today. She got an alert on her phone that the meds are available. We've actually already picked them up! But she has a bone health class today and we told her we'd get them during her class. My dad and I worked out that we'd tell her that one of the meds is Zoloft. "It is sometimes for anxiety but for you it is to help you feel rested." We'll see how that goes. The doctor also prescribed gabapentin (sp?) and I told my dad to tell her that she doesn't have to take that one every day or ever. It is just there in case she gets really stressed. We'll see how it goes!