Parenting 360 – Take 4: Critical Importance of Medication Review

Medication organizer

My last parenting post centered on our adventures in supporting an adult son with Autism Spectrum Disorder (ASD) which have brought us from Washington DC to Israel where he has been able to live away from home in a supportive community for the first time. You can read more about our experiences here, here and here.

Today I am returning to the other side of the coin, the needs of our parents – or other older relatives – who may no longer be able to live independently and who need our support to maintain their quality of life and basic dignity. This is where we are in 2022, experiencing what I call “Parenting 360” in our 2nd Middle Age.

I have to start this out by mentioning how blessed I am to have an amazing “big sister” living nearby to my Mom in Metro Detroit, who faces every challenge with tenacity, and who serves as our Mom’s legal and medical representative. There are four Kling daughters, two living locally and the two youngest overseas. We are all very different; fortunately we are on the same page where it comes to our Mom.

Most of the time I feel like there is very little I can do to help my sister from 6,000 miles away. It is dispiriting when things seem to be going badly and I can’t be there more than a few times a year (and not at all for the first two years of COVID). Then there is the occasional situation that arises that reminds me that all of our efforts matter, as happened recently with regard to my Mom’s medications.

You may have heard over the years about how important it is to routinely review all medications and supplements to ensure that none are contraindicated and/or avoid drug-drug interactions or other possible adverse effects. This is generally important, and particularly critical for older people who may be taking a plethora of drugs and supplements daily, and for whom drugs may have different effects than in younger populations.

To make matters worse, very few clinical trials include elderly people, for the obvious reason that their health is generally more fragile and all medical research carries some level of risk. Essentially we mostly don’t really know what we don’t know about how commonly prescribed drugs effect elderly patients.

This may be the most important thing that I ever write: if you have a family member taking one or more regular medications, supplements and or vitamins, check them on a regular basis for potential adverse reactions and/or contraindications.

Even the right medications can suddenly go wrong. Some time back, my husband and I witnessed this with regard to his mother (z”l), who suffered a severe adverse reaction to a medication that had been helping her for quite some time. In that case the facility where she was living was excellent, and the doctor almost immediately came to understand what had happened and took corrective measures. Still it took several weeks for her to recover.

In the case of my Mom, there was no overnight crisis that made it obvious that something was obviously wrong with her medications. Her deteriorating physical and mental condition came about over a period of months; we were all assured that it was to be expected and would only get worse over time. More specifically, the Assisted Living doctor (not a gerontologist) asserted that our Mom’s dramatically worsening tremors, dizzy spells and falls, memory problems, increasing detachment, reduced speech, lack of mobility and general inability to be comfortable in her own body were part of an expected progression. This led my older sister, quite rationally, to believe that our mother was dying and so my youngest sister and I – both living overseas – rushed back to spend time with her.

The physician at her Assisted Living facility also assured me – by phone and directly to my face – that she was carefully checking Mom’s medications every two weeks and that she was sure Mom’s medications were appropriate for her condition. She was apparently unaware of the potentially serious and debilitating side effects of the drugs she was prescribing for our Mom.

Still with little to lose and a great deal of anxiety about our Mom’s continuing negative trajectory, I decided to dig deeper into her medications. I had seen first hand how even appropriately prescribed medications could result in adverse reactions.

This was not an easy process – just to get the list of neurological medications took much more time than it should have, and required “in your face” communications with the Assisted Living Facility that were not really welcome. I really just needed to know for sure what was going on with the medications and prevailed in the end to receive initially just the neurological – behavioral health – medication list, and later the full list of prescriptions and supplements.

In the process, I learned that our Mom – who has never had any significant diagnosed mental health problems – was taking a boat-load of neurological meds.

On reviewing the publicly available – credible – information from the drug manufacturers themselves and from reliable sources like the Mayo Clinic, etc., it was obvious to me that her worsening symptoms correlated eerily with the well-known side effects for the drugs.
And she was taking one drug every day that was contra-indicated for her, given her medical history of serious heart disease. It never should have been prescribed for her in the first place!

Based on this review it was clear that our Mom’s doc was unable to tell the difference between adverse events caused by medications and the progression of pre-existing conditions. We could not know for sure unless and until we changed her medications. And that is what we did.

Through a series of increasingly insistent emails and late-night (for me) teleconferences and one in-person meeting, over time we were able to eliminate two of the neurological medications from her schedule completely. It took several weeks more to start to see the impact on our Mom.

The results have been shockingly positive:

– Our Mom was always a big reader, so it had been painful to see her stuck in front of a television for much of her day. Now she is once again plowing through her New York Times bestsellers.

– She is no longer (uncharacteristically) passive and once again is able to advocate effectively for her own interests with the Assisted Living staff.

– She has gone from being almost 100% wheel chair dependent to being able to walk with the support of her walker.

– Her tremor is almost unnoticeable and she no longer feels unstable or dizzy most of the time.

– She is much more verbal and socially engaged at meals and activities.

– Talking on the phone with her had become so difficult that it was hard for me to pick up the phone and try – as important as I knew that it was – now she even calls me back if she misses my call.

Exceeding our wildest dreams, our mother now is so much more like our pre-COVID Mom again and I am so grateful to have her in better spirits as well as in improved health. It feels like we found a time machine back to 2019.

The general take-away is that while we are well aware versed in advocating for the best interests of our kids, sometimes it can be much harder to play that same role for parents. And yet there is no alternative, where medications are concerned and more broadly.

Reviewing medications on a regular basis is incredibly important.

If you don’t feel comfortable doing the necessary research yourself, ask a pharmacist, psychiatric nurse or physician. But get it done.

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