TAKING CARE OF DAD~ MORE ON THE ELDERLY AND ADDICTION

There are some people who abuse alcohol or drugs their entire lives and live to be 80 years old with no problem. On the flip side of this you have people who later in life, form addictions due to an “event” or “trigger”.

Retirement, death of a spouse or loved one, loss of income, or a decline in physical health can all be triggers for addiction in older people. Depression is one of the biggest problems.

You wake up one day unable to do the things you once loved, worried about finances, still grieving the loss of your wife/husband who was also your best friend, your children have their own lives now and you find you have fewer people to talk to. All of these things can lead to depression.

I’ll discuss more about depression at a later date.

A person’s age and gender contributes greatly to how open and honest they will be when answering a doctor’s questions but doctors play a role too. Too often an older adult’s concerns are dismissed as “old age” and prescription medications are used to solve the problem.

The #1 drug prescribed to people over the age of 65 and on Medicare are Benzodiazepines. They are used to treat anxiety, pain, and insomnia. They are also one of the most dangerous medications prescribed to seniors.

According to the American Geriatric Society benzodiazepines pose an increased risk for impaired alertness, respiratory depression and falls.

All benzodiazepines slow down the Central Nervous System. When used for insomnia it’s only effective for a few weeks. When combined with another benzodiazepine you can lose consciousness and stop breathing.

There are symptoms people experience when combining benzodiazepines that you need to contact your doctor if you exhibit:

1. Continuing slurred speech or confusion.
2. Severe drowsiness or weakness.
3. Staggering.

There is a big issue with over-prescribing or “polypharmacy” which means having more prescribed medications on a daily or weekly basis than is healthy for one person to have. It becomes dangerous due to different drug interactions and side effects.

A person with a chronic or serious illness can find it challenging to keep up with a complicated medication schedule. Taking multiple meds at one time can cause some medications to neutralize each other so they end up taking more believing they either didn’t take it or it’s not working.

My Dad didn’t understand why he was still feeling so anxious specifically at the end of his dialysis treatments. He wouldn’t understand unless he had a degree in Pharmacodynamics or was a doctor (most doctors still don’t understand how to adjust medications for patients on dialysis). The pain medication he was on for his compressed nerve was making him anxious as it was being dialyzed. The anxiety medication he normally takes is at a very low dose. He didn’t think twice about doubling the anxiety medication. He would be unsteady on his feet when leaving the Dialysis Center and no one said a word.

Some people go to more than one doctor who may prescribe a medication without knowing what the patient is already taking. Patients don’t always remember all of their medications and don’t make a list like they are asked to.

I usually go with my Dad to any new appointments to fill out the paperwork and list all of his medications. His Nephrologist doesn’t see him in his office he visits him during his dialysis treatment. This means I can’t be there. I’m not there to fill out any new paperwork or to let them know about any new medications. My Dad isn’t going to tell them. My Dad will say everything is “Fine” when the doctor comes around.

Primary Care Physicians should be going over a patient’s list of medications on a regular basis and making adjustments. I know my Dad’s does not. If he did he wouldn’t have prescribed 2 benzodiazepines with an opioid. My Dad shouldn’t still be on Klonopin and they should be looking at Chronic Pain Management instead of him taking Hydrocodone that isn’t even working. I made him stop taking the Restoril. I personally wanted to go to his doctor’s office and tear him a new one for even prescribing it to a 75 year old man. It’s a dangerous medication for anyone to take long term but even more so for people over 65.

None of this matters when you are dealing with someone so full of pride and stubbornness that he won’t admit just how sick he is.

TAKING CARE OF DAD~A LOOK AT ADDICTION IN THE ELDERLY

Chronic pain conditions affect about 30% of elderly people. The first line of treatment they are given when they see their doctor is either an immediate or extended release opioid medication like hydrocodone with acetaminophen.

Elderly patients with chronic pain usually develop insomnia which in turn can make pain worse.

Benzodiazepines are often prescribed for insomnia and anxiety. These would be medications like Klonopin and Ativan. Insomnia and anxiety can both occur with chronic pain.

Older patients  have an increased sensitivity to Benzodiazepines. As we get older we don’t metabolize medications the same way we used to. This can cause an increase in sedation and memory loss. Unfortunately too many people are unaware of this.

With the opioid addiction crisis becoming more of a problem the CDC came up with a set of guidelines for prescribing opioids for chronic pain.

The guidelines are intended to improve communication between providers and patients about the risks and benefits of opioid therapy and reduce the risks associated with long-term opioid therapy.

Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, the should be combined with nonpharmacologic therapy.

Clinicians should prescribe immediate release opioids at first and at the lowest dose. For acute pain 3 days or less is often sufficient, more than 7 days is rarely needed.

Clinicians should avoid prescribing opioid pain medications and benzodiazepines concurrently whenever possible.

My Dad has always had severe anxiety. He never told a doctor about it, I think he only discussed it with my Mom and me.

When he had to go on dialysis he found that towards the end of the three and half hours he felt the overwhelming urge to get up and leave. He couldn’t keep his legs still. He’s always had problems with his legs being restless. He’s always been a light sleeper and now the restless legs were causing him to get no sleep at all. He finally mentioned it to his Primary Care Doctor. His Doctor put him on Klonopin, 5mg three times a day or as needed. I know my Dad, he wasn’t going to take them three times a day and I felt comfortable with it being a low dose.

His health became worse and he was under more stress. He wasn’t sleeping at all and his legs were moving all the time. His Doctor prescribed Restoril 30mg. I wasn’t aware he was taking this medication until he was on it for a few months. I started to notice a change in his behavior.

Restoril is a benzodiazepine. Now he was taking 2 benzodiazepines but this one lasts longer in older adults. The other problem is how these medications work when you’re on dialysis. His Doctor has a habit of not taking this into consideration or looking it up. During the day he was off balance at times and sometimes sounded like he was slurring his words. I was pissed about it and told my Dad he shouldn’t be taking both medications that there were better alternatives, but he was so afraid of going back to not sleeping he wouldn’t listen.

My Dad hurt his back a few months ago. I repeatedly told him to go to the doctor but he refused. He finally went to his Primary Care Doctor who of course prescribed him Hydrocodone on top of everything else he was already taking. I didn’t know he was getting 90 at a time.

My Dad came home a few weeks ago extremely upset. He had crashed his truck into a guardrail and didn’t know how. The truck was brand new and completely totaled. He took out 200 feet of guardrail and both air bags deployed. He refused to go to the Hospital even though his ribs hurt. If they had tested his blood they would’ve found Klonopin, Restoril, and Hydrocodone in it and he would’ve been arrested. He had no idea the medications were still in his system and effecting him as much as they were.

You would think this would’ve scared him but it really hasn’t. He’s in so much pain from the compression in his back and the previous fractures that he can’t sleep. At 75 and being on dialysis he doesn’t want to have surgery and I don’t think anyone would do surgery. The doctors he’s seen have been useless.

I sit here and watch him fade away. He’s down to 149 pounds, he’s all bone with a sunk in face. He doesn’t look like my Dad. He’s getting up in the middle of the night and saying scary things like how he wants to die. He has no memory of what he says or does from the night before. I can’t remember the last time he said something positive.

I don’t know how much longer I can watch him pop pills slowly killing himself. I’ve done this already with my Mom.

I feel so guilty for wanting to have a life of my own. I’m also petrified because I’ve never been away from home.

I don’t want to be 75 and alone. My Dad has had a wife who adored him, children who love him, a job he loved, travel experiences, a lot of good memories. It’s sad that only 1 of his children worries about him but that’s most families. My siblings think I owe my parents because of what I put them through when I was younger. First, my brother was way worse than me. Second, I think I’ve more than made up for my mistakes in ways they will never know or understand. I did it with love, understanding, being there when needed, listening, and on occasion I made some of their dreams come true. I’m proud of that.

But it’s time for me to have a life. I won’t survive mentally watching my Dad die. He’s always been my hero I don’t want to think of him as anything else.

DECISIONS (I CAN’T MAKE THEM)

I have a million things I want to do. A million places I want to go. A million ideas to put into action.

The problem?

I can’t make decisions.

I have energy in my mind but not the rest of me. The thought of taking a shower, doing my hair, make up, getting dressed, is exhausting. So I don’t.

I’m tired all the time.

Then there is the anxiety. The feeling that something bad will happen if I leave the house. The extreme worry that my Dad will get sick or have an accident. It’s not far fetched.

On his way to the post office 2 weeks ago the package he was mailing started to slide off the seat. He took his eyes off the road for a second to catch it. When he did his truck hit the guardrail, his front tire got hooked on it and he took out 200 feet of guardrail. Both airbags deployed, the 2017 $25,000 truck was totaled, and he refused to go to the hospital.

I had to take care of everything for him. He isn’t a people person and he doesn’t hear very well. He thinks you get further dealing with people by using his deep angry voice when my mother always said “You get more with honey than you do with vinegar” a concept he never understood all the years they were married.

Where was my twin sister during this crisis? At the beach, sleeping, taking care of the kids, at the beach, and sleeping. To be fair she has ME/CFS? She had Mono for a long time that wouldn’t go away, she went to several doctors and no matter what they did she was still testing positive for Mono and could barely move. This went on for a few years when she started having a specific type of seizure where you might not notice right away. She would just stare off at nothing but I noticed 2 of her fingers would flutter when it happened. It was harder for me to have empathy because she never did with me.

Lately we were working on our relationship and had made a lot of progress. But I needed her these last 2 days and she couldn’t be there. I understand she’s tired and feels sick. I don’t feel well either. I’m having problems with my kidney stents which is beyond painful, a fever, and headache that makes you want to hit yourself in the head with a hammer.

There’s something really wrong with my Dad. I can’t handle it on my own. He’s lost so much weight. He has diarrhea all the time to the point he isn’t making it to the bathroom. I also noticed that it’s black which I know means blood. He’s cold all the time even when it’s 90 degrees outside. He isn’t sleeping, his legs move constantly. His Primary Care Doctor is giving him the wrong medications.

I don’t know what to do anymore. I didn’t have a summer. I wanted to go somewhere for a few weeks just to take a small break but I don’t think it’s possible. Who would check in on my Dad? I worry about everything all the time. Even about dying alone because I have no contact with the outside world. Plus I quit smoking and gained 30 pounds.