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Thread: Guardians and medication

  1. #1
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    Guardians and medication

    My mom has advanced dementia and today her doctor prescribed high blood pressure medication, as it has been getting higher over the past (unspecified) weeks, according to the nurse at the facility.

    She has two guardians, a professional hired by the family and my brother, not the brother who is in charge of her money. Today the professional guardian asked the doctor to discontinue the medication. The facility nurse said it was prescribed to prevent a stroke.

    My brother is saying we should go ahead with the doctor recomendation but the professional guardian is very "in charge" and will order things discontinued.

    I have issues with this guardian who has sought to exclude me from medical decisions for Mom and denied Mom medical care in past. So that's a problem I have with her. But I have no legal standing now with respect to medical decisions.

    I can also see her point about medication, but when I have requested hospice, palliative care only for her, I have been repeatedly shut down by both guardians and the facility. This doesn't make sense to me as this would seem to me what she is after here. But I do not think she wants to give up control.

    I am creeped out by the way she takes charge and orders the doctors and nurses around--she has done it before, and facility has mentioned it to me, that she is abrupt and harsh.

    What would you do? Do you think she is doing the right thing? I'm not a fan of going against doctor's orders, especially for philosophical reasons. But I am also a realist.

  2. #2
    Senior Member rosarugosa's Avatar
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    Wow, that sounds like such a difficult situation, Tybee. It must be tough to feel so powerless to help your mother. What about you or your brother asking her what her rationale is, just so you can understand where she is coming from?

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    I cannot because we have clashed big time over this when I have asked her in the past. I am wondering whether I should bring up the idea of hospice again, since this would seem to be a palliative-care only model.

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    Senior Member herbgeek's Avatar
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    We haven't gotten to that point yet, but mom will need to have the battery in her pacemaker replaced in the nearish future. My sister and I are of conflicted minds on that. Mom has little quality of life now, despite our best efforts. She has repeatedly said she wants to/is ready to die and be with my father. Do we artificially keep her alive? She would have died about 8 years ago without the pacemaker- she was weak and frequently fainting. Replacing the battery sounds like the "right" thing, but is it really? She has lost so much memory, and she just cries a lot because my dad isn't there to make the world make sense for her.

    I'm wondering if maybe this is where your guardian might be at. She sound annoying as hell, but maybe she doesn't want to prolong a life of someone who isn't enjoying it? Does your Mom have a DNR with the facility?

    From my understanding, one needs to have 6 months or less projected to live before entering hospice. Does she have a terminal condition in addition to the dementia?

  5. #5
    Yppej
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    Assuming she did not have a stroke, what is her life expectancy given the dementia? Can she still do things like swallow?

    I guess I would consider how near the end she is when deciding whether to try to prevent a stroke.

    This has got to be so hard for you.

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    Senior Member iris lilies's Avatar
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    That sounds very difficult.

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    Thanks, herbgeek and Yppej and Iris. herbgeek, yes, the guardian is of this mind, and Mom does have a DNR and a POLST, too. Only terminal condition is dementia and kidney failure, but supposedly the kidney failure is pretty typical for her age (?) No one will get her tested for numbers. When I asked, guardian said, what's the point?

    I think her doctor thinks she has less than a year, and she can still swallow. But she barely eats. She sleeps a lot.

  8. #8
    Senior Member Teacher Terry's Avatar
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    What a difficult decision. When my friend went on hospice in a nursing home the nurse said all medications are stopped. My friend’s cancer came back and I didn’t treat it as she had advanced dementia. However, if your mom had a stroke and it didn’t kill her it could make her physical condition much worse. The nurse said that the reasons behind stopping all medications is that patients are more at risk of falling. It didn’t make sense to me. Herbgeek, I’m your mom’s situation I probably wouldn’t replace the battery.

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    Quote Originally Posted by Teacher Terry View Post
    However, if your mom had a stroke and it didn’t kill her it could make her physical condition much worse. ... . Herbgeek, I’m your mom’s situation I probably wouldn’t replace the battery.
    Terry, that is what concerns me, too. herbgeek, I did not focus enough on your mom's issue until I read Terry's post. That is a horrible decision to have to make. I can see it both ways.

  10. #10
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by herbgeek View Post
    We haven't gotten to that point yet, but mom will need to have the battery in her pacemaker replaced in the nearish future. My sister and I are of conflicted minds on that. Mom has little quality of life now, despite our best efforts. She has repeatedly said she wants to/is ready to die and be with my father. Do we artificially keep her alive? She would have died about 8 years ago without the pacemaker- she was weak and frequently fainting. Replacing the battery sounds like the "right" thing, but is it really? She has lost so much memory, and she just cries a lot because my dad isn't there to make the world make sense for her.

    I'm wondering if maybe this is where your guardian might be at. She sound annoying as hell, but maybe she doesn't want to prolong a life of someone who isn't enjoying it? Does your Mom have a DNR with the facility?

    From my understanding, one needs to have 6 months or less projected to live before entering hospice. Does she have a terminal condition in addition to the dementia?
    I read a book some years ago by a wife who regretted even putting a pacemaker into her husband’s chest. He was in the early to mid stages of dementia, as I remember it. That surgery alone knocked him down a couple of pegs on the functionality scale and he never recovered from it. So, it just prolonged a greatly diminished life.

    Modern medicine does not always do us favors.

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