My mom is in an assisted living. She is 91 and in pain for a host of issues and has anxiety. The Psychologist prescribed an SSRI. I know they have a host of side affects and neither my mother nor I want her on any SSRI at this age. If she was younger yes, but not at 91. I feel there are other drugs that could be prescribed. Can I as her Medical POA say no to the SSRI? Can I ask the pharmacist not to fill the prescription?
Having said the above with all the emphasis at my command... If you (or anybody else) are not happy about a practitioner's prescription or recommended treatment of any sort, the thing to do is talk to the practitioner.
Your mother is suffering pain and anxiety. The relationship between pain and anxiety is close - one feeds the other, and your poor mother is the victim. SSRIs do have side effects, this is true, but I imagine her psychologist has taken the potential risks into account and has concluded that the potential benefit of relieving your mother's anxiety outweighs those risks.
Her age has no relevance at all. Why would it become okay for her to live with pain and anxiety because she's 91?
But the psychologist, or any other prescribing practitioner whose patient she is, can tell you far more about this as it applies to your mother than we can. You as MPOA have concerns, questions and reservations - so talk to the psychologist about them, ideally with your mother, and decide together what's best.
A few years ago, my sister and BIL had a PCP who, in addition to his MD, also had PhD in pharmacology, and he provided excellent care, but unfortunately is no longer available. He was also trained in acupuncture.
Then mom had a stroke, which resulted in a diagnosis of vascular dementia. My mom's level of anxiety skyrocketed. She wept, wrung her hands and seemed to be in a near- constant state of dread and fear.
We consented to a trial of Lexapro, an SSRI. I was concerned about side effects, as are you, in part because mom had tried Zoloft once and it hadn't gone well. (In retrospect, I think she read the package insert and developed side effects listed there due to suggestibility).
Lexapro was a lifesaver for mom and for us. As her brain deteriorated, another antidepressant, Remeron, was added and she tolerated that as well.
I think of dementia as having a "broken brain". The chemicals that maintain good mental health are sometimes in short supply and need supplementing. Not sure why you wouldn't give this therapeutic medication a try.
And if I hadn't happened to have had SIL on speed dial? I might well have been chewing my nails off for fear I was poisoning my mother!
Have you discussed your concerns with the person who is doing the prescribing? In general, psychologists don't have prescribing priveleges; many work with an MD or Advanced Practise Nurse to do the writing of the prescription.
I find that, in general, doctors are willing to let you follow their thought process in why they are chosing a certain med, or class of meds for a particular issue. So for example, a straight anti-anxiety med might be prescribed for a younger person in this sitation, but they often lead to falls in an elder, making an SSRI with antianxiety properties a better choice.
I am curious why you don't want your mom on an SSRI. Is it due to a heart issues, as CM describes?
She assessed my LO, and we immediately met to discuss her proposed recommendations.
When I asked that a VERY SMALL DOSE of medication(s) be tried, the PA immediately agreed with me, and that was what was done.
I did not feel that her age, 91 at the time, was the most important factor in her treatment.
Before Covid, she was seen every 3 or 4 months, and now, having been vaccinated, she will be seen again. She is also carefully monitored by the staff in her memory care unit.
I have contacted the PA many times with questions about my LO’s behavioral and affective issues. If you are able to do so, you might have the chance of addressing and clarifying your concerns faster than attempting to have to evoke your POA.
Hope this works out well for your mother.
I was surprised to read that a Psycholgist was allowed to prescribe medication since they aren't Medical Doctors. But seems the states of Louisiana, New Mexico, Illinois, Iowa, and Idaho allow it if they have the training.
My mother is 94 and I'd be willing to try ANYTHING to help her relax a bit and get rid of the pain she feels in her legs on a daily basis! Any meds can be discontinued if need be.
I remember when my mother got a small partial plate at the dentist when she was in her late 80s. I brought her some Polident and a denture bath to soak it in every evening. After reading the insert inside the package, she decided she wouldn't use the Polident cleaner at all because it could easily poison her. So she stopped using the partial plate entirely.
Anxiety is an ugly thing and only worsens when left untreated. Whether she approves the recommended meds or not, it's a good idea to get her pain and anxiety treated, one way or another.
Good luck!
I would disagree with you on this one. Elderly people are over-prescribed psychiatric drugs to an obscene degree. Like they're being used as guinea pigs to see what these psychotropic drugs will do. It's ten times worse when an elder is in a long-term care facility.
It's always better to start off small. Like maybe trying an as-needed benzo like lorazepam to treat the anxiety episodes as they arise. Not start off with a mind-altering psychotropic drug.
You start a campfire with some kindling and matches. Not with a flame- thrower.
All too often care facilities will drug up their residents to make caring for them easier. If your mom has anxiety, ask her doctor to prescribe an anti-anxiety drug like lorazepam that can be given to her as needed. It works really well for most people and doesn't come with all the side effects of psychotropic drugs.
Say no to the SSRI and yes to an as-needed anti-anxiety drug like lorazepam or xanax.
Is it possible that she could be consuming food or drink to make anxiety worse? Coffee or wheat? Does her anxiety start a few hours after her no or low protein breakfast? The first place effected by low BS\glucose is in the brain. Some ppl get mad, some angry, foggy, tired or some anxious. I have seen a pattern in my seniors with all 3 and have seen improvements by eliminating, substituting and keeping glucose levels even as possible. Enter small protein snack ever 2 hrs or before.
And last, if the doc is not hearing either of you on this, Hospice is always an option if she qualifies. Hospice does not mean she is actively dying, but at 91 there is failure to thrive. It is never too early for HOV if someone cannot be helped by docs with their pain and anxiety. I am a huge advocate for peaceful quality of time left rather than quantity of time, months or years left. That is just what they do. And I know my suggestion of HOV is biased, I have endured anxiety & panic attacks my entire life and there is nothing more exhausting. Not to mention the years of countless ?SRI meds docs said would work for my anxiety and did not. I could have enjoyed my 20s and 30’s had I just been given an anti anxiety med. There is no reason why she should not be given the smallest dose on a PRN basis & that goes for her pain too... best wishes for your dear Mom💕
You and mom if she’s capable have every right to understand and agree with treatment but don’t go in with an advasrial approach, skeptical sure but start by just making it clear you want to understand the thinking, the choices and why this is the plan rather than refusing the plan right off the bat. Hopefully this will also establish a relationship that will put you in the loop from now on. Good luck!
What Are Palliative Care and Hospice Care? | National Institute on Aging (nih.gov)
Who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life. Palliative care can be provided along with curative treatment and does not depend on prognosis.
A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.
Wishing you good luck. If your Mom is in distress something should be done. See if you can make an appointment with her psychologist, taking your POA papers with you, and tell her you are very worried, and why.
I add my query as to why you took mom in to see a doc and then don't choose to follow the treatment. I mean, you definitely have that RIGHT, but what a waste of time.
Personally, seeing my mom's anxiety ramping up, up, up over the past year, I WISH she would get something for anxiety. But she is now a high fall risk and no dr will give her anything for pain or anxiety. At 91, it frustrates me that they will not help her out. She faked a few too many falls and that made her a 'risk' even though she truly had not 'fallen'. Geriatric patients can be hard to work with!
Go BACK to the dr or find another one. Doctors are not mind readers, and they kind of have a 'list' they run through. Many elderly patients are notorious for not being very forthcoming with their issues and the poor doc is left guessing and playing guinea pig, b/c a patient won't be truthful, or expect the doc to just 'know'. And believe me, they DON'T. 2 of my kids are Drs and they are awesome in their own fields, but have them look at a sore throat--I can dx strep better than they can. I'm definitely better at psych things than they are.
I suggest you get rid of the Zoloft, however it's spelled.
For RLS (restless legs syndrome)....just add Nutritional Yeast to his food....he's depleted in his B vitamins.
I have RLS, and learned from Dr Eric Berg on YT, that I was low on the B's....hence, I developed RLS.
Since I've added the Nutritional Yeast to my food, I'm no longer suffering and losing sleep due to the constant need to move and shuffle my legs around to stop the incessant tickling, itching sensation, and the crawlies that keep one on the move all night, every night!
I also recommend for those elders interested in improving their overall health to give up all sugar, and bread, unless the bread is made from nut flours.
Start watching Dr Eric Berg...he's literally saving lives by teaching good nutrition, rather than just eating what tastes good....Stop the sugar and bread, and start feeling great! Add good oils like Extra-Virgin Olive Oil and Organic, Unrefined, Virgin Coconut Oil to the hot food....Good health is essential to a happier and healthier life!
And all people need to Repent of our sins, and Trust our Eternal souls to our Maker and Creator, Jesus Christ. We will live in eternity forever, but, will it be Heaven or Hell? Choose Christ for Heaven forever, and to not choose or reject Jesus guarantees Hell, Forever.
It's up to each one of us to decide our Eternal destiny.
God's love to all, and Shalom! 💜🕊💜
AS A RETIRED NURSE AND A CAREGIVER, I SAY THAT YOUR MOM, AT 91, DOES NOT NEED AN SSRI TO ADD TO HER BUCKET LIST OF MEDICAL PROBLEMS. IF SHE WAS SUFFERING FROM A UTI, THEN I WOULD SAY, OF COURSE TREAT HER WITH THE APPROPRIATE ANTIBIOTIC AND FLUIDS. SINCE YOU HAVE HER POA YOU DO HAVE THE RIGHT & RESPONSIBILITY TO CONSULT WITH THE PHARMACIST.
All meds have side effects and you need to decide if the benefits out weigh the side effects.
MY 96 yr old Dad is in his own home with 24 7 Caregiver Care and has Nurses and a Nurse Practioner visit him.
I have told them more than once regarding different Rx's that I don't feel comfortable with him taking and he doesn't take them nor do I have them filled.
It is totally up to you and your mom.
One of the bad things about Old Folks Homes are any time a person is the least causing them what they consider trouble, they get the Dr at the Living Facility to prescribe a Rx.
Mout all Seniors are on way too many meds.
Do what you think is right but besides a gut feeling, ask the Pharmacist and look up on line the benefits and side effects.
Also, ask the Pharmacists what would be a good option with less side effects.
The POA for healthcare needs to know the legality of making this decision to 'not' pick up a prescription or somehow insuring that the person it is intended for gets it. This advice seems to put the POA for healthcare in a very precarious legal position. Be careful what you write, be careful what you do. Being a POA for healthcare is a tremendous legal responsibility. It is important that the POA get everything in writing to 'back-up' their decisions. And, know in advance what you are legally obligated to do.
The only way the POS for healthcare can make decisions is if the medical provider deems the person incompetent to make their own healthcare decisions.
Even with benzos, my own dad suffered agitation in his first year or two of ALZ.
The MD prescribed a benzo, I cannot remember which one and that helped a whole lot. The MD said use it very limitedly, as you can get addicted.
I said hes a 92 yo man. So what if he gets addicted, isnt comfort better for him? The MD said the other issue was how it effected balance. That resonated with me more.
But as people get into ALZ,shoudlnt anything that provides comfort be OK? I knwo this sounds cold, but ALZ is basically terminal.