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My mother has moderate dementia & COPD. Until recently, she remained stable on a Ventolin inhaler administered with a spacer so that timing wasn't a big issue. Unfortunately, despite 4 time per day usage, that no longer works for her & she wheezed like some old steam engine. The doctor has tried Advair, Dulera & Spiriva, all of which have worked well but my mother adamantly refuses to allow refill of either script because of the monthly price... $300 range for the Advair or Spiriva & $1000 (!!) for the Dulera. I convinced her doc to prescribe a nebulized Albuterol solution thinking the longer administration time would open her up better, get the medicine deeper into her lungs & keep the shortness of breath at bay longer than just a pocket inhaler. I had explained the nebulizer to her & she agreed that she would do it & she was very pleased with the $4/mo pricing at Walmart. Now, of course, that I have everything arranged & purchased the nebulizer machine, she refuses to use the nebulizer for more than a minute or two so she's not even coming close to getting a full treatment. It's just a matter of time before the inadequate treatments catch up with her & she'll become significantly short of breath but no amount of talking, explaining, begging or even threatening will get her to complete a full treatment OR take even a partial one more than twice a day. Of course, when she becomes short of breath, that's all I hear about..."I feel so bad."..."I'm so short of breath"..."I don't understand why I'm so short of breath all of the sudden", etc. When I try to explain why, she becomes angry & denies everything I tell her as being untrue. The longer I try to convince her otherwise the angrier, NASTIER & more adamant she becomes. Any ideas on how I can get her to comply with the nebulizer?

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you are going to have to take charge my mother had copd for years and was on 3 different inhaler and only a nebuliser when she had chest infection as dr said makes them laz about taking med properly. she did nit have dementia. howevery I now look after mother I law who has vascular dementia and cannot even rember ho to wipe her self correctly or flush loo so don't think its you mothers falt. any medication my mil takes is given by us as correct time.Mil has lived with us for 2.5 yrs
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A mental health specialist would know strategies to play around this. It is challenging where to draw a line between respecting her wishes as an individual and protecting her from self-neglect (the confusion caused by the dementia make individuals with the condition to have short-memory loss or to have their own 'logic', so it is the challenging part for us to go beyond and play the detectives to unveil their logic. It doesn't help -and it won't work- if you try to bring her to reality). I'm afraid if this continues, health care authorities could take those decisions for her, even when she refuses. Has she appointed a PoA or and advocate that speaks for her well-being before a stranger is appointed? I'll leave it with you.
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Does she have a mouthpiece or a mask? For the lazy, the mask may be a better choice.. set her in frount of the TV and let it run. You really dont need a 20 minute treatment, in the hospital we often just run it for 10 minutes of so, but our flows are higher. The mouthpiece is much more effective, but take what you can get... Good luck
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Maybe cream up her hands and legs while she is doing the treatment. When my kids were little I would wait until they feel asleep to give them their last treatment of the day.
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My MIL doesn't do the treatments unless we say something to her.I keep explaining that she should do them 4 times a day but she thinks she doesn't need them. I keep telling her before she gets up to walk a bit that it would help to do this but still she fights it because its too loud and too long. I feel your pain...
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This gets tricky - what are her rights and what is she simply incapable of doing? It seems to me that she may be rebelling against being told what to do. Is there a way to back off for a little while?

When she get's short of breath, you can say nicely, just let me know if you'd like any help setting up your nebulizer. The suggestion of using a mask is a good one if this is possible for her. You could do some digging there. But unless she is cognitively impaired to the point that she needs complete intervention, you may find that she will respond better to a more relaxed approach, leaving the responsibility of feeling better in her hands - with your standing offer to help. If this is too dangerous for her situation, then ask the doctor for some suggestions for people like her. Please keep us updated.
Carol
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Good move in using the albuterol vs. the advair, Dulera & Spiriva. $4 is much easier on the wallet than the copay for the brand name drugs. I liked the idea of distracting her while doing the nebulizer treatments from Patrice2oz! Hang in there!!
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My husband has the same two chronic and fatal conditions. Stop trying to convince her as you are only going to make yourself ill. Remembering to take breaths, inhale and hold it (with medication) is a big chore for people with dementia and COPD. You can only do your best, and either illness will be fatal or she will develop fatal pneumonia. Been there, done that and I pray.
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I didn't know we could have commercials on this site!
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How do you keep person with dementia/Alzheimer's from going to bathroom 20times a hour? She has no urinary tract infections. It's obsessive compulsive behavior. First has to go bathroom. Than washing of hands every 5minutes. She does not have to go to bathroom. Does not have to wear depends.
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Don't know if a Pulsox meter might help. When you put it on her finger, she might be able to see and understand the need to take her medications.
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I have the same history and same behaviors with my Mom. She is unable to even figure out how to take a deep breath and coordinate it with a puff on an inhaler. She uses a nebulizer with a mask and since an admission to hospital in March for a COPD flare up, she has caregivers in with her for 6 hours per day. She does have the pulse ox machine too, and the C.G.has set up a chart where she records the O2 level before and after the nebs so she can see the difference. She must take 2 nebs tx before bed after C.G. leaves at 4 pm...1 is albuterol and the other is a steroidal tx to keep her 'tuned up'. But frequently she misses and when I phone and remind her she is 'too tired' and doesn't see why she has to when her oxygen level number has been good all day. I try to explain how it's only good BECAUSE she gets all the treatments when the C.G.s are there, but it won't sink in. But she can have blue lips and be audibly wheezing to where I can can hear her on the telephone, and she designs wheezing at all and says she is fine. Yet she complains of being so tired all the time. There is no teaching or explaining....but our doc did think the mask was a good alterative as well as the pulse ox machine. My Mom has never been one to focus on her own health care if SHE must do something regularly. She loves to go to the doc and she loves for others to have to do things to her or for her....but she 'has too much house work to do' or 'too much to worry about to add that to my list today' or she is 'just too tired to bother'. So doctor says keep caregivers and we are working towards an official declaration of incompetence and then, as her money is running out, it will be a memory care placement for her cause we'll come to where we have to sell the house to have money. Most of the cash is now gone. We have an RV left to sell...and the house and car....that's it. Medicaid.....here we come..... She is 89 and her daddy...my grandpa...lived to be 101. He DID have much better health, but in the end, fell down the basement stairs and got pneumonia after a fractured hip. He was actually 68 when my mom was born and he had another child...her brother....4 years after that. He kept a huge garden right up to the end, and at age 90, was on his roof fixing shingles when family ordered him to hire someone! I don't think she is going to fare this well.....but both parents are outliving their money!!
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Haidee...I am Mom's healthcare & financial POA. She lives in my home & I care for her 24/7/365. I agree that me getting bent about her refusing treatments isn't doing anything but ruining my own health. I have hypothyroidism & I haven't had a stable bloodtest since September 2014 due to the stress of dealing with her so, in the past few days, I've adopted an attitude that I'll offer. If she refuses, I'm just "letting it go" for my own sake. If she gets acutely short of breath & will do one then...great.

We are at that stage in dementia where I'm not right about anything, she'll argue in circles with me & she just gets more obstinate & angry the more I try to reason with her. Today was a case in point. She walks with a cane, has super-severe osteoporosis, has chronic back pain from old compression fractures of her vertebrae & can't make it 1/3 of the way across Walmart without wheezing like a steam engine. But she insisted today that she was capable of push mowing my large lawn....in 103 degree heat. When I mentioned her health issues, she told me that I had no clue what I was talking about & she didn't have those problems. You also need to know that it takes ME 2.5 hrs to push mow it! So, since I wasn't gonna change her mind, I told her that if she could pull the cord to start it, she could mow. She couldn't even BEGIN to pull it...thank God...and, to my surprise, she gave up the idea without asking me to start it for her. Had she asked, I was going to feign not being able to start it either.

But, anyway, as I said, I'm at the point of self-preservation & I'm just gonna agree with her & let her do whatever she wants within reason. If her refusals result in her being hospitalized then I'll look at taking that opportunity to say that her care is beyond my abilities at home & force facility placement by refusing to bring her back home.
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First, as to the expense of the inhalers, contact the manufacturers and see if they have a program of assisting patients to pay, sometimes by discounting the medicine. Some counties also have prescription discount cards; one in our area gives out the cards for free. The problem is that many drugstores won't accept them. Still, it's worth a try.

Second, for whatever reason my father also disliked using a nebulizer. I used to suggest pretending that he was a sage Native American smoking his wisdom pipe.

Third, I don't know if this would be an equivalent substitute given her conditions, but perhaps she might be amenable to using a spirometer. My father used to make a game of it. Once you get started, it's easy to get caught up in trying to beat your own record.

If you try it, she might even decide to use one as well just to "one up" you.

And the next time she decides to mow the lawn, in whatever weather, tell you you're going out to gas it up and check the oil, but remove the spark plug. That should be very discouraging.
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Another thought re: those with dementia not wanting to use the nebulizer. Dementia can cause a great deal of anxiety over noise and chaos in the mind. If your parent happens to be hard of hearing, don't do the treatments with hearing aids in. My Mom pulls her aids out and lets them hang over her ears while doing the treatment because she cannot stand the noise of the machine . That seems to make a big difference for her. If she turns that machine on with her hearing aids in, she about jumps out of her skin and is immediately set off into a rant of bad words, cussing and complaining about how the noise upsets her. So with or without hearing problems, it may be the noise that creates the resistance to the machine.
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My mom is the same way with her nebulzer. She will only use it for perhaps a minute or so. Nagging only makes the situation worse. I like the idea of using a face mask and trying distraction to help your mom complete her treatment. Maybe use the time to clean under her nails and lotion on her hands.
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