After having had a UTI my uncle began having some mental issues. The Dr. upped his Zoloft to 50 mg. The issues became worse and the Dr. has him on 75 mg Zoloft, 12.5 mg Seraquel, 10 mg. Donepezil, and .05 Atavan when he is really aggitated and that knocks him completely out where he cant function. I live 800 miles from my uncle and my sister live about 1200 miles but we talk to him often. We can tell if something is not right. Sometimes he is so wired and continues to spiral out of control and then they knock him out. I just want to find a place where he does not go way up then way down. He does not know what is going on and that ads to his episodes.
Whether or not your uncle is being overly medicated though is not only a medical but a personal issue, and it's not one on which everyone will agree.
However, if you and your sister are the closest living relatives, and if you were granted HIPAA authority, I think you definitely have a right to address the issue of overmedication. Contact the Administrator or DON at the facility and arrange to have a telephone or video conference to discuss the issue. If they see your concern as valid, they can approach the pill-prescribing doctor.
You could also contact an ombudsperson in that area and ask for a review, if not investigation.
If your uncle is being medicated into a zombie, what quality of life he have? It helps the staff b/c he's basically medicated into submission, but that's not the only way to care for him.
Research the Medicare rankings of facilities, do some of your own investigation of other facilities in the area, and consider a transfer if you have the authority to do so and if you don't get cooperation and/or response from the existing place.
Are there any relatives living closer who do an on-site inspection and document your uncle's behavioral changes when he's doped up?
75mg of Zoloft. this is an anti depressant. Usually patients are started on dosages ranging from 10 to 25 mg but most patients are raised to 50 before they get the full effect of the medication. Zoloft is not a medication that works by the dose. It only works when a recommended level of the drug exists in the body over time. The half life of zoloft is 14 days, so what the doctor is doing is trying to do is to raise the level of zoloft in the body to 50mg. You won't see the full effect of the drug for AT LEAST four weeks because of the half life. 75mg is a low to medium dosage for the drug. Many people take much more. In fact, the drug is recommended at higher levels, up to 200mg a day, even more for a larger person. Also, this drug has no different recommendations for the elderly than it does for younger people. There is no reason to have this drug at a lower level due to age at all, in fact lowering the dosage can reverse the good effects you get from the drug. The side effects for this medication usually wear off after two weeks of use.
12.5mg of seroquel. Seroquel is a drug that is primarily used as an anti psychotic (to reduce or eliminate hallucinations and delusions as well as some paranoid behavior). Additionally seroquel can be used as a sleep aid. Most people start this drug at 50mg unless there are other considerations (such as being on another related medication, being small/low weight etc). 12.5 mg a day is an extremely low dosage. I would imagine that this dosage is ONLY for sleep and not for any other purpose...I can't imagine any reason to put someone with hallucinations on such a low dose. As long as he is able to sleep well, there is no reason to discontinue this drug. Doing so could interrupt his sleep patterns. A reason to increase this drug would be that the patient gets immune to it's effects at such a low dose and requires more. There are some side effects for this medication. In people with dementia it can increase agitation and violence...but if this were the case you'd know straight away, the first or second day. If this has not happened to him yet its extremely unlikely that any future outbursts would be for another reason, not because of this particular drug.
10 mg Donepezil (also known as aricept). this is a drug to treat the symptoms of alzheimers. It can slow the progression of symptoms (it does not slow or stop the disease itself). There are significant, extensive research studies on this drug that say it does not slow the progression of symptoms any more than a placebo and because of the vast and dangerous amounts of side effects, its rate to see this drug used beyond the early stages of alzheimers, when it's effectiveness it at its height. This is a drug that no lab testing can prove works or doesn't work in your patient. For example, if a person was on a drug for high blood pressure, a lab test on blood pressure would prove whether the drug was working or not. There is no lab test for alzheimers. The best people to decide if its worth continuing are the daily caregivers in concert with the prescribing doctor. There are many reasons for discontinuing this drug. I would yield to the caregivers for advice.
.5 mg ativan - this drug is an anti anxiety drug, and unlike zoloft, it works immediately in the system. It has a very short half life which also means it leave the system quickly too. There are two important concerns with ativan treatment. One is that this can cause the opposite of the intended effect in the elderly...but you say it knocks uncle out so that means he does not have this risk factor. Second, this drug is very addictive. While on the surface this doesn't seem like it would be a problem for someone under a strict doctors supervision (it's not like he would overdose)...what it means is that reliance on the drug for calming his mood could happen. He may end up at a point where he physically needs the drug to reduce agitation rather than it being a once in a while tool. The body will "forget" how to calm itself and the drug will be come a dependence. Now, with the elderly, this may not be as much of a concern as maybe they don't have 20 or 30 years left where they will need to work out this addiction, but it is still a consideration. Mainly it is a very positive and effective tool to decrease agitation (which is a terrible state for anyone) and induce relaxation and peace (which is what we are aiming for) and can even reduce anger outbursts and violence.
So, reading that, you can see that he isn't really being overmedicated. Maybe the doctors and the people who physically see him and care for him hands on every day do know. Hes wired and spins out of control because he has alzheimers, his brain is broken, he can no longer control his outbursts, he is scared, confused, and doesn't have any memory of why he is where he is. They are doing what's best.
Angel
Angel
There isn't a drug that works exactly the same for everyone who tries it, and drugs targeting the brain are especially difficult to get right without some experimentation.
Maybe your uncle is on too many drugs. Maybe he is on too few, and one more would bring things into balance. I can't imagine how the caregivers on this forum could judge that! But based on this amateur's experience and listening to other caregivers, nothing on that list seems totally inappropriate.
As Angel points out, the damage to your poor uncle's (from the dementia) causes symptoms that his doctors try to treat.
I understand your dilemma being an advocate from a Distance but I won't allow any prescription meds without my prior approval
Do you participate in the regularly scheduled care conferences that take place every 90 days?
Thur. and never recieved a call back regarding my concerns. On Friday I called to speak to the woman that is in charge and they said she was in a meeting and would call back. She had the nurse call back and again I voiced my concerns. She said she would try to get the Dr. to call me back and if not it would be Wed.(today). They cut back to 6mg on the Serequel and are leaving the rest of the meds in place per my sister who was able to get thru to the lady in charge. I will update this when he calls. No I dont participate in the 90 day call as it is my only day to work but my sister does. I can never get the time I need for the call.
Mom was just given a scrip for Levaquin today (another UTI)
taking 60 mg per day Ritalin for many years. (narcolepsy). It doesn't seem to work anymore. suggestions?