Painkillers make everything worse?

[blightygirl]

Hello! I am a newbie here, and would very much like to ask for advice - Alzheimers is a frightening world, trying to do everything right for my mother-in-law but not knowing how.

My Mum-in-law is in hospital after having a second fall in 3 months. She broke her hip on Xmas eve, and was allowed home after 2 months. Sadly she fell again in the early hours going to the commode after being at home for a short while, and has another fracture tho not as severe. She's not too bad with the Alzheimers, well, she wasnt. She was able to follow a conversation, even though she didnt remember it after a couple of minutes, but always ready to laugh and join in. Since being in hospital, she's got worse - I suspect due to being given tramadol, oramporph, codeine and para's 4 times a day. We've asked the nurse to reconsider her medication because she's just 'not there'. Talking about people who are long gone, many sentences made of just random words - she also doesnt recognise her son anymore and thinks he's someone else. This is a rapid decline in just 12 days.

Do you think these meds are making her worse? The hospital seem to have no training in Alz, and just dose her up until there is little of her personality left. She already has curvature of the spine and it always aches, so am worried that when she's asked if in pain, she will always say yes, and they are dosing her up too much. She's also wetting herself because she's so away with the fairies that she forgets to ask the nurse to use the toilet - and going to the loo was never a problem at home, apart from needing some help to get there.

Also, without meaning to take to mickey out of you all, but how do you chose a home? Mum in law is looked after by her hubby, and although we pop around a lot, hubby is struggling. He had a stroke on Sat night, and is also now in hospital. We think its time for Mum to go into a home, for at least a few months while we look after dad, although he wont be happy for her to go into a home, he's a very proud man. I just dont want to make a mistake as you hear so many horror stories over care homes, and she's so vulnerable. The hospital are trying to discharge her at the moment so need to find somewhere.

Thanks so so much for reading this, I appreciate anything you can tell me. Its all very new, and we're at a loss.

X

[jeany123]

I am sorry to here about your mother-in-law ,I just wanted to say that I was given Tramadol after my knee replacement and I felt as though I was away with the fairies , I just couldn't rouse myself at all and didn't know what was going on around me 'this is just me though and could have different results with other people ,


Jeany x

[Witzend]

Also, without meaning to take to mickey out of you all, but how do you chose a home?


X

Hi, BLighty girl, sorry you're having to go through all this - it's so worrying.

Don't know about the meds but would guess they (and the anaesthetic) will have affected her.

Re choosing a home, we've done this twice now for different relatives. I do think you need to go and see quite a few to get a 'feel'. Any good home should be happy for you to pop in on a casual basis for a quick look around (after a phone call to check) , though obviously you will probably need to make an appt. for a more serious discussion. I would certainly discount any that asks for an appointment before you go at all.

Try not to be too influenced by decor - we've found that homes with very smart, stylish communal areas are not necessarily the best - these are for the relatives. Comfortable and homely are IMO far more important.

In a specialist dementia home, if you are new to it all, it can be very scary to see people just slumped in chairs or shouting out, etc. but 'slumping' often means they are past wanting or being able to do anything else, and some people do shout out.

A good CH should provide regular activities for those who enjoy them (they don't all want them). Most of the residents should appear clean and cared-for and reasonably nicely dressed, though the odd one who isn't doesn't necessarily mean staff don't bother. I have found my own mother wandering around in trousers and jumper with her nightie on as well - not from want of trying on staff's part - she can just be too stroppy to allow help. Though most of the time she's nicely dressed, hair nicely done, etc. (might add, far nicer than it usually was before she went in, when she was often refusing to bath or have her hair washed)

The odd whiff of wee should IMO not necessarily be a deterrent where a certain number are incontinent, but a strong smell over most of the place certainly is.

Above all, I think you need to take to the staff - see how they behave with residents, do they seem naturally kind and patient or are they smothering irritation/impatience because they know they're being watched? And of course specialist dementia training is vital for any carer - not many of us have a clue how to cope with it until we've actually been at the sharp end.

Lastly, if you think a care home is going to be necessary sooner or later, it is IMO better to be able to choose one slightly sooner, rather than maybe wait for the crisis that almost inevitably happens (or carers simply can't cope any more) and then find that the one you like best has no room available.

Good luck anyway.

[2jays]

Hello! I am a newbie here, and would very much like to ask for advice - Alzheimers is a frightening world, trying to do everything right for my mother-in-law but not knowing how.

My Mum-in-law is in hospital after having a second fall in 3 months. She broke her hip on Xmas eve, and was allowed home after 2 months. Sadly she fell again in the early hours going to the commode after being at home for a short while, and has another fracture tho not as severe. She's not too bad with the Alzheimers, well, she wasnt. She was able to follow a conversation, even though she didnt remember it after a couple of minutes, but always ready to laugh and join in. Since being in hospital, she's got worse - I suspect due to being given tramadol, oramporph, codeine and para's 4 times a day. We've asked the nurse to reconsider her medication because she's just 'not there'. Talking about people who are long gone, many sentences made of just random words - she also doesnt recognise her son anymore and thinks he's someone else. This is a rapid decline in just 12 days.

Do you think these meds are making her worse? The hospital seem to have no training in Alz, and just dose her up until there is little of her personality left. She already has curvature of the spine and it always aches, so am worried that when she's asked if in pain, she will always say yes, and they are dosing her up too much. She's also wetting herself because she's so away with the fairies that she forgets to ask the nurse to use the toilet - and going to the loo was never a problem at home, apart from needing some help to get there.

Also, without meaning to take to mickey out of you all, but how do you chose a home? Mum in law is looked after by her hubby, and although we pop around a lot, hubby is struggling. He had a stroke on Sat night, and is also now in hospital. We think its time for Mum to go into a home, for at least a few months while we look after dad, although he wont be happy for her to go into a home, he's a very proud man. I just dont want to make a mistake as you hear so many horror stories over care homes, and she's so vulnerable. The hospital are trying to discharge her at the moment so need to find somewhere.

Thanks so so much for reading this, I appreciate anything you can tell me. Its all very new, and we're at a loss.

X

Hi and welcome to talking point sorry you have the need to find us

Well... From reading your post it seems to me that your MIL (mother-in-law) needs respite care whilst your FIL is in hosp. Do not let the hosp discharge her until they have done a full care needs assessment as it seems that her last discharge she was not fully assessed. - do not let them make you feel you HAVE to look after MIL and think long and hard about doing so by reading posts on here, before you make your decision.

Your FIL may be a very proud man (and I am sure he is) but they do say pride comes before a fall - in his case it was a stroke - or is it your hubby who has had the stroke)
Anyway it really does sound like IF MIL comes home, there is a need for more input from social services, carers, doctor, etc to give you help. It is a well know fact on here that any hospital admittance, can cause a down turn in a person with dementia and their behaviour. I know nothing about drug reactions, so do not fe I can comment in that.

There are an amazing number of fact sheets on here - you can access them by clicking the fact sheet tab at the top of this page - hopefully someone who can, will put a link into this post - on my phone and still working out how to do it -

Thinking of you
xx

[blightygirl]

My warmest thanks to you all, I really appreciate you taking the time out to give your thoughts and tips - and they are very very helpful indeed!


Witzend - Good to know what to look out for on a home, and I just hope we can find one - also a great tip about not leaving it too late! We would like to chose one that is near her husband, so he can visit easily. I dont think he will be allowed to drive for a year or so after his stroke, and although we can take him often, it wont be every day which I know he'd like to do. So thanks! I think we will get onto it today after the hospital visits.


Jeany - thanks! I had some once too, but immediately felt tingly, so stopped after one dose and no weirdness. I guess its pretty strong stuff, I think there was a comedy show called tramadol nights?! Must be a clue in that somewhere, lol. I suspect that it, and oramorph are to blame but I want to try and find out for sure - dont want MIL in pain because of our meddling.


2jays, thanks too, and yes, I hope the hospital dont put too much pressure on my partner or father in law. We told the hospital yesterday where MIL is in that she cannot come home anymore, as FIL is in hospital with the stroke. My partner said he would like to look after his mum but after being in the same situation as a child, I asked him to think long and hard before making the decision of being a full-time carer. My grandma lived with us for ten years, who also had alz, and although I was quite sheltered from it as a kid, as I got older I could see the effect it had on my mum, who was stressed and unhappy. I would try to help as much as I can but nothing was enough to make a difference. I guess whatever he choses to do, I will support him but am worried because he has little patience for day to day life, let alone become a carer. Dont tell him I said that!!!

Again, thanks so much for all your help and advice, I really do appreciate it. What a wonderful place this is, just very sad that its something awful that brings people together.

xx

[Nebiroth]

First, there are the effects of the injury itself and the following surgery+general anaesthetic to consider. These are all well known for heightening the symptoms of dementia (and occasionally producing symptoms in normally healthy persons). The post-operative confusion etc (called "delirium") is a well known and familiar phenomenon associated with general anaesthetics and the liklihood of it happening and the severity rise with the age of the patient. Ward staff may refer to it as "the Midnight Madness" as it most commonly strikes late at night in the first few days following surgery.

My dad had it, and attempted to leave the hospital - he somehow managed to sneak past the duty nurse trailing drains and a drip stand, made it to a phone and called mym mum demanding to be taken home. It took orderlies and nurses to restrain and sedate hime. Another patient smashed a window with his drip stand and attempted to climb out (several floors up!)

Then there is the change of routine, people and place associated with a hospital stay - often a source of added confusioin in dementia.

Lastly, the painkillers you list - except Paracetamol - are all opioids. They are probably using different types of drug because some are strong but short-acting, others less strong but last longer. Less powerful but long lasting drugs are used to treat pain, but stronger, short acting drugs are sometimes used in combination with these to address what is called "breakthrough pain" - which generally occurs in short bouts and is not relieved by general pain relief.

Paracetamol is used to treat mild pain but aso has a useful anti-inflammatory effect.

All opioid drugs have the potential to produce symptoms of confusion and disorientation. Tramadol is a widely used drug on prescription for pain that paracetamol cannot releieve sufficiently. Oromorph is powerful and usually used under medical supervision. Tramadol is notorious for the effects it can have, espescially in the elderly.

My mum was prescribed Tramadol for severe back back (arthritis) and suffered from panic attacks and palpitations. These stopped as soon as she stopped the Tramadol.

As you say, in dementia the patient can be unreliable or unable to relate accurately their pain which can lead to high doses of pain relief (whereas other patients may be allowed to self-administer which very often leads to their taking much lower doses than a nurse trying to guage a patient's pain levels would give)

Perhaps it would be worth asking the hospital to have a pain specialist assess your mum, preferably someone who is familiar with dementia.

Certainly, those with dementia tend to be more sensitive to pain, perhaps in the same way that a small child will become very distressed over the smallest injury - adults tend to learn a level of pain tolerance.

[blightygirl]

Nebiroth - thankyou!

Am sorry to hear about your pop's experience, and that the docs didnt notice him sneaking past, not good. I hope all ended well that day and he was ok.

I think you are right, the meds must be to blame, or at least largely. She didnt have an operation this time, was told where the fracture was and the amount of damage from the fall meant they didnt think an op was suitable, so she didnt have any effects from surgery. She was actually quite alert and 'with it' for the first couple of days, and has gone down hill from there. I am worried that they are using the strong stuff too readily - great idea over a pain specialist.

x

[lin1]

Hello
I am really sorry to hear about your MIL and FIL

I thought this factsheet might be helpful with regads to your MIL
it about hospital discharge
http://www.alzheimers.org.uk/site/sc...documentID=173