I recently had the privilege of helping Kathy and her grandmother, Joy. Kathy contacted me a couple of months ago for an assessment and to see if her grandmother was appropriate for assisted living. I met with Joy and her son David in her home. We reviewed her legal and financial status. We talked about her diagnosis and medications. I learned that her dementia was pretty far progressed and that she was struggling to walk safely or to remember to eat or drink. She did choose to move to a smaller personal care home for the lower staffing ratios and more concierge care.
Step One: Review the Medications
I scheduled an appointment with a Geriatric Specialist to make sure that the medications were appropriate for her age. (She is 99). After a thorough assessment of medical, cognitive, and functional status the doctor decided to make some significant changes. She was on two blood pressure medications and because of her advanced age and the fact that she weighs under 100 pounds he did not feel that it was necessary for her to stay on both medications. In fact, he took her completely off of one of her blood pressure medications and prescribed her blood pressure to be taken daily. If her blood pressure dropped below a certain point she was not to be given any blood pressure medication that day. She had been on very strong medication for sleep that had a side effect of agitation. Since she was already on a dementia drug to help her stay asleep and to help manage the agitation he stopped the sleep medication and prescribed the much healthier option of Melatonin instead. Kathy had been very concerned that her grandmother was on too many medications because Joy was so much more sedate than she had been at home. Since Joy had been on anti-anxiety medication for agitation, the doctor prescribed for her to slowly wean off of it to help her become more alert and to help prevent a fall. We were so thankful for the doctor's expertise and focused attention to help decrease Joy's medication.
Yikes... the medications don't match!
BUT... the orders were not given to the assisted living so they did not know about the changes. The changes that had been sent to the pharmacy on the doctor's computer while we were in the appointment were not received. I had not been worried because I saw the doctor send the changes to the correct pharmacy, but since I always follow up with the families I serve, I called the assisted living and left a message to confirm that all of the changes had been implemented. The nurse had not received the changes and when she called the pharmacy they had not received the changes either. SO... three days later Joy was still taking the very strong sleeping pill, the same amount of anti-anxiety pills that put her at risk for falls, and both of the blood pressure medications. It took more than two days and several phone calls and visits to get the orders communicated to the personal care home and to the pharmacy.
No-one ever double checks
The sad thing is, this is not uncommon. Many families leave a doctor's office with medication changes that are never implemented because somewhere along the line there is a lack of communication. As an Aging Life Care Manager, I help families ensure that these very important changes are not missed.
If you know of someone who has had recent medication changes we can help them with a comprehensive assessment and medication review to ensure the medications prescribed are the ones being taken. Navigating this time in your loved one's life can be very complicated and you need experts who can present you with the best options and protect your family.
Let us help you take the next steps. visit www.agingcaremanagement.com to get started.