Medication Problems and the Elderly

September 12, 2011 § Leave a comment

At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches.  It was becoming harder to motivate herself, to get up in the mornings and accomplish the day’s tasks.  She confided to her daughter that she felt anxious and tired.  Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha’s and got her a prescription for Valium.  In doing so, the daughter’s doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.

Martha, in fact, was taking nine different medications as well as herbal supplements.  The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress.  If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.

Medication errors are common in the elderly.  Many seniors take on average 6-8 different prescriptions as well as over the counter drugs.  Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary.  Family members should be aware that elderly parents may tend to take the family’s advice over going to their own doctor.  Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.

Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications.  In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors.  This is called the “Beers List” after one of the research professionals.

Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State and one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:

Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.

“With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well,” says Dr. Fick.  “Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast.”

An on-line article on HealthSquare.com titled “Drugs and the Elderly,” talks about physical symptoms and medications.

Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory.  Too often, these alterations are overlooked, ignored, or chalked off to “old age” or senility.  Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom.  Nothing could be further from the truth.  Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first.  Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance.  And never dismiss the possibility that a real psychological problem has developed and may itself require medication.

There are many things family members can do to help monitor medications for their elderly parents:

  • make a list of medicines prescribed and all supplements and vitamins being taken;
  • give this list to the doctor and pharmacist and have one on hand for emergencies;
  • use the same pharmacy to fill all prescriptions — pharmacies have a record of your prescribed drugs and will verify your doctor’s instructions — they will also tell you if foods or over the counter supplements will interact with a prescription;
  • dispense pills in a daily pill organizer box;
  • have a family member be responsible to call or physically monitor the taking of medication.
Family members who live long distances from their elders have available to them new technology in medication monitoring.  Today there are alarms for pill boxes, watch alarms, medical alarm bands, and necklaces that ring a reminder.  Additionally there are also computerized pill boxes that ring a designated number if the pills have not been taken.  Finally, home health care agencies offer a variety of service options in helping families care for and properly dispense medication to their elder parents.
Overmedication or taking medication incorrectly may lead to early mental confusion and decline in health in seniors.  If medication problems were ranked as a disease in cause of death, it would be the fifth leading cause of death in the United States today.  For assistance with medications for your loved one, give Weekly Law a call.  815-570-2334.
Every day of every week, Weekly Law is here for you!
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Long Distance Caregivers Receive Help

September 3, 2011 § Leave a comment

Living in a different city or state — miles from aging parents — can be very difficult.  Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time-consuming and not nearly as effective as being available full time in person.

One of my clients spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions.  Family vacations were spent traveling the 500 miles to his parent’s home to personally take care of home maintenance and provide health care visits to their doctor.  During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time.  This alarming change in his parent’s condition concerned Mark that his parents’ care needs required more than frequent phone calls and vacation visits.  Running his business and handling his parent’s long distance care was now becoming very challenging.

According to a report by the Alzheimer’s Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for.  The report also states that 15 million days are missed from work each year because of long distance care giving.  Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years.  Long Distance Caregiver Project — Alzheimer’s Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator).

 The long distance caregiver is a new role that is thrust upon children and younger family members.  Families used to live closer together, with children residing and working near their parents.  But nowadays family members are more distant from each other.  Society, today, is recognizing this.  Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.

At my firm, we do Life Care Planning.  What this means is that, in addition to legal and financial advice on how to pay for long-term care, I have an Elder Care Coordinator on staff.  Elder Care Coordinators are care managers who assist caregivers, friends, or family members provide care for loved ones.  They evaluate and recommend care for the aged.  Care manager professionals are becoming extremely popular as the caretaker liaison between long distance family members and their aging elder loved ones.

Jacqueline Marcell — author of “Elder Rage, or Take My Father…Please!  How to Survive Caring for Aging Parents” (Impressive, 2000) — says, “The most important thing to do is to find a geriatric care manager in the area where your loved one lives.  She will have knowledge of all the services in the area and can be your eyes.”

Below is a partial list of what an Elder Care Coordinator might do for our clients:

  • Assess the level and type of care needed and develop a care plan
  • Take steps to start the care plan and keep it functioning
  • Make sure care is in a safe and disability-friendly environment
  • Resolve family conflicts and other issues with long-term care
  • Become an advocate for the care recipient and the caregiver
  • Manage care for a loved one for the out-of-town families
  • Conduct ongoing assessments to implement changes in care
  • Oversee and direct care provided at home
  • Coordinate the efforts of key support systems
  • Provide personal counseling
  • Help with Medicaid or VA benefit qualification and application
  • Provide placement in assisted living facilities or nursing homes
  • Monitor the care received in a nursing home or in assisted living
  • Assist with the monitoring of medications
  • Find appropriate solutions to avoid a crisis
  • Coordinate medical appointments and medical information
  • Assist families in positive decision making
  • Develop care plans for older loved ones not now needing care
Services offered will depend on the educational and professional background of the care manager, but most are qualified to cover items in the list above or can recommend a professional who can.
An Elder Care Coordinator, as a geriatric care manager, can be an important asset to all families in elder care situations.  Here is an example of how an Elder Care Coordinator can help.
Mary is taking care of her aging husband at home.  He has diabetes and is overweight.  Because of the diabetes, her husband has severe neuropathy in his legs and feet and it is difficult for him to walk.  He also has diabetic retinopathy and, therefore, cannot see very well.  Mary has to be careful that she does not injure his feet, because the last time that happened he was in the hospital for four weeks with a severe infection.  She is having difficulty helping him out of bed and with dressing and using the bathroom.  She relies heavily on her son, who lives nearby, to help her manage her husband’s care.
On the advice of a friend, Mary is told about Weekly Law and our Life Care Planning.  The cost of an initial consultation is $250.00.  Mary thinks she has the situation under control and $250.00 for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.
One day Mary is trying to lift her husband and injures her back severely.  She is bedridden and cannot care for her husband.  Her son, who works full time, now has two parents to care for.  On the advice of the same friend, he decides to bring in Weekly Law and pay the fee himself.
At Weekly Law, we do a thorough assessment of the family’s care needs, as well as their legal and financial needs.  Our Elder Care Coordinator arranges for therapists to come in and help Mary with exercises and give advice on lifting.  The ECC recommends some in-home care agencies to come in and help Mary with her recovery and watch over her husband, and Mary chooses one with whom she is comfortable.  The ECC also does a home safety check to make sure the home environment is safe for both Mary and her husband.
The ECC also makes arrangements to rent or purchase medical equipment for lifting, moving and easier use of the bathroom facilities.  Medicare will pay much of this cost.  The ECC determines, with the family’s input, that the in-home care provider should remain caring for Mary and her husband beyond Mary’s recovery time, as this will relieve Mary of most of the burden of caring for her husband.  During their initial consultation, we determined that Mary’s husband was a veteran, and we apply for a VA benefit that will help pay for the cost of care.  Additionally, we updated the couple’s estate plan, and drafted new wills and powers of attorney.  Finally, in anticipation of the possible need for Medicaid in the future, we created a Medicaid Asset Protection Trust for Mary and her husband.
All this, and Mary knew as well that for the next two years, the Elder Care Coordinator would continue monitoring their care needs and would remain available for future situations.  She recently told us that for just over $300 per month, she purchased peace of mind and can now rest easy knowing that she and her husband are taken care of.   As for Mary’s son, he says that when you take into account the time absent from work, the time to find the right care resources for your loved ones, and the cost of travel expenses to monitor their care, the cost of the Life Care Plan was money well spent.  When you add to this the stress of handling your own life circumstances combined with being a caregiver, you will probably wonder how you could have ever done without the services provided by a Life Care Plan.
For more information, give us a call at 815-570-2334.
Every day of every week, Weekly Law is here for you!

 

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