Wednesday, 18 January 2017

Care Partner Wednesday--Medication: Servant or Master?

"Medical treatment should be the servant of genuine human caring, never its master." 1

A powerful and radical statement.

What does this look like?

Mr. G. has become increasingly aggressive when care partners try to care for him. Although they can understand that he wants to be independent, and he doesn't want a woman caring for him, the bottom line is he isn't able to care for himself and the staff are all women. Several approaches are tried--smiling, a soft tone of voice, reasoning and explaining, leaving and coming back. These are all good interventions, but they don't work. As time goes on, his agitation increases, and he begins to become physically aggressive. His grip is strong when he grabs arms, and the day he grasped another resident's arm, it became evident something had to be done.

Start low and go slow is always the creed for new medications. Mr. G. was started on a low dose of a medication to reduce his agitation, and within three weeks, things were improving. He began to cooperate during care, and his smile returned. The medication was his servant.

Coming back from a broken hip is difficult, as Miss W. can tell you. Working with physio every day, she practices stretches and and walking and other exercises to strengthen her muscles and improve her balance. She doesn't complain, but the physiotherapist noticed a soft groaning as she neared the end of her session each day. When he asked, she confessed that the increased exercise was causing her pain--pain that her medication wasn't addressing. The work she was doing was important, helping her regain her mobility. However, it wasn't fair to expect her to do it with insufficient pain control. The doctor increased her pain medication, and the next time she had physio, she was able to complete the exercises without excess pain. The medication was her servant.

Mrs. D. appears to be depressed. She had many losses in her life over the last few years, including the loss of her husband, her apartment and her independence because of several serious medical issues. She's eating adequately, but is barely talking, and has lost all interest in the things that used to bring her joy. Staff tried music therapy, volunteer visitors and time in the garden, and although she seemed to enjoy all these things in a limited way, the spark of life was gone. After a month of trying different ideas, and seeing her sadness continue, the doctor started her on a low dose of anti-depressant. A few weeks later, she smiled at a fellow resident and began to talk to her table mates. Her quality of life was slowly returning. The medication served her.

When does medication become the master?

  • When it is prescribed for behavioural issues or depression without careful observation and documentation. At least two to three weeks of observation should be given, asking such questions such as: Was there a trigger? Were any interventions tried? Were they effective? What time of day did the issue occur? Did one approach work better than another? 
  • The medical staff doesn't really know the elders, or don't listen to those who do.
  • Medication isn't reviewed regularly. Those medications that are no longer effective aren't discontinued.
  • There is no follow up. All who care for the elder should be observing to understand the results of the the medication on the elder. 
Medication isn't evil, as some think. Neither is it the great problem-solver. There are so many considerations when prescribing a new medication. 

Is it indicated for the elderly? Many medications that are effective for someone in their forties can be deadly for someone in their nineties because of reduced circulation and kidney function.

What other medications is the person on? What possible drug interactions could there be?

Does the elder have other medical conditions that would make this drug dangerous?

What are the side effects?

Medication, when it is the servant, is a gift. Care partners need to ask insightful questions when a new medication is proposed. With careful consideration and monitoring, medication can serve our elders well.

Care Partner Wednesday--Medication: Servant or Master?

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