Stan Cohen – Senior Wellness

Archive for the ‘Medical’ Category

I have been following a post on one of my Linkedin groups and felt I needed to repost this excellent reply on the topic from Angil Tarach, director of the Visiting Angels:

Good Morning Lynn,

What caught my attention in your email was Morphine was used in your “mom’s last days”.  I am thinking your mom was on hospice?

Although we all know there is definite over use of drugs on the elderly it’s important to understand when drugs are appropriate or not.  As a nurse with over 30 years in senior care, and as a previous hospice nurse, there is a definite difference in what drugs may be given to a dying patient that wouldn’t be frequently given to a person that isn’t in the process of dying.  Not to say there is never a reason to give an elderly person who is not dying, those same drugs.

Morphine, Ativan and a few others are commonly used in hospice care for the comfort of the patient.  Morphine is not only used for pain, but is also used to relax respirations when someone is having difficulty breathing.  There can be a lot of anxiety in the dying process that Ativan helps tremendously.  Families of hospice patients worry about the drugs used, and are very concerned when their loved one sleeps a lot, especially when first placed on those drugs.  Many times the dying patient has been very uncomfortable, and has lacked appropriate rest and sleep, because of the discomfort.  Initially it may be the first time in awhile they are comfortable so they sleep a lot, because they can.  Most will resume more awake time as they get adequate rest, sleep, and comfort.  I have also heard from a lot of hospice patients and their families that they are worried about addiction.  This should never be a concern.  Generally patients who actually need pain management don’t get addicted, and when it’s at the end of life, I say, so what?

Although we all need to advocate for less use of drugs like antipsychotics on the elderly, there are some patients that benefit greatly from those drugs.  I just don’t want to see us push and advocate so hard on less drug use that it gets to the point where patients needing those drugs are not getting them, and suffering.  It can be easy to assume that anyone we see on these type of drugs shouldn’t be and are being overmedicated, when there are appropriate uses.  There is a lot of depression in the elderly, which actually may be undiagnosed.  The question is whether the depression is situational or of an organic brain disorder.  Two very separate issues.  Who wouldn’t be depressed sitting day after day in a nursing home with little activity and meaningful attention?  This has nothing to do with a chemical imbalance.  Situational depression needs to be addressed environmentally.  Brain disorders need to be addressed chemically.  You cannot fix situational depression with a drug, just as you can’t fix a chemical imbalance with therapy or environmental change.

I guess the best is to educate the elderly, and their families to find a geriatric specialist that is very conservative when ordering meds.  Pressure needs to be put on nursing home docs that find it easy to just prescribe before they look into the possible causes of behavior problems and depression.  I believe a lot of those issues can be resolved by how nursing home residents are worked with and treated.  There needs to be much more training for the staff of long term care facilities, and use of techniques that are effective.  Judy’s ranch is a perfect example.  They get to the root of the behavior and use effective techniques to reduce, and/or eliminate the behavior.  I think Judy’s techniques ought to be used in every long term care facility.  If they were, there would be a huge decrease in drug use.

There is a lot of financial benefit in drug use.  There needs to be advocacy against gifts and “perks” to doctors and hospitals from drug companies.  When I worked for the State of Michigan as an Infection control Coordinator I was in a state psychiatric hospital.  The numbers of drug reps that came in on a daily basis offering lunches, gifts, etc, was ridiculous!  Easily there were no less than 6 drug reps a day visiting.  These people are biased and push the advantages of the drug with little attention to appropriate use, and side effects.  Doctors get on a band wagon about a new drug and you see it being prescribed left and right, until a new and supposedly better drug is pushed enough.  I don’t know about any specific cases of docs being paid for prescribing a specific drug or from a specific drug company, but I will bet it happens more than anyone can imagine.

We need to put pressure on state surveyors.  There are regulations about chemical restraints, which I am sure differ by the state.  First, and I have always thought this is crazy, facilities are aware of when the surveyors come to visit.  Every facility I have ever worked in goes crazy trying to clean things up right before and the day the surveyors arrive.  I always said, if they did it right all the time, they wouldn’t have to worry and go crazy trying to get things right.  When they visit, they randomly choose charts and patients to survey.  Many times they ask the administration to pick out the charts.  So, of course the administration will pick out the patients and charts they are not worried about getting reviewed, and the surveyors don’t see the total picture of what is going on there.  Each year they seem to choose one issue they will focus on.  One year it may be falls, another it may be bed sores, etc.  If they looked at psychotropic drugs one year, it may be years before that issue is again on the radar.

As you can see there are many areas that need pressure and tightening up before we could see a decrease in the amount and type of drugs ordered for our vulnerable elderly.  It’s almost like there needs to be several groups, each focusing on pressuring a different group of people at the same time for anything to change.

I hope I have helped some of you with what I have shared here.  I hope it gives a clearer understanding of drug use, and the problems that contribute to overuse.

Have a beautiful Sunday!

Angil Tarach RN
Visiting Angels

2860 Carpenter RD. Suite 300
Ann Arbor, MI 48108
Ph. (734) 929-9201
Fax. (734) 929-9202

As caregivers, we need to be on the lookout for how medications are delivered.   Thanks to Diane Carbo of Aging Home Health Care,  the following suggestions make a few common  issues much easier to understand and cope with.

Safe Medication Procedures: Read the rest of this entry »

Linda Abbit
Tender Loving Eldercare

An unexpected emergency like this can be much less stressful for you as a family caregiver if you prepare a few things in advance. Emergency Kits traditionally include bandaids, ointment, gauze pads, scissors, etc. The Aging Parents Emergency Kit I created has different contents, but is something I could grab and be out the door with in no time flat. Kind of like the suitcase I packed when I was expecting my first baby!

Prepare a folder, envelope or accordion file with the copies of the vital information the hospital will need upon your parent’s arrival in the ER, including but not limited to: Read the rest of this entry »

Beth Parker-O’Brien
Caregiver Journey

As health care providers, we need information from you and your loved one about the state of the physical, cognitive and emotional health of the patient. Let’s look at your visit from 2 perspectives: The Doctor’s interview and The Patient/Caregiver questions.

Questions your doctor may have: Read the rest of this entry »


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