Tranquillizers, opiates and permission to refuse

Discussion in 'End of life care' started by Misstep, Dec 31, 2018.

  1. Misstep

    Misstep Registered User

    Oct 7, 2015
    57
    South Wales
    My mother has stage 7a mixed dementia. I have Lasting Power of Attorney, Health & Welfare. She has something of an occasional history of aggression with staff, last mentioned to me in late 2017. She is now 91, is barely eating and broke her pelvis in early November, for which the GP has prescribed a low-dose opiate patch. I had a call from her home today to say that her psychiatrist visited this morning (I don't know if this was routine or requested, but I was not informed of an impending visit). The nurse from the home told me that the psychiatrist changed my mother's medication (she was on Sertraline, which I previously approved) and has additionally prescribed diazepam and lorazepam. I questioned why, and was told that she is sometimes aggressive when being given personal care. This is the first I've heard of this. She sleeps almost all the time and has become very weak and I'm concerned about why this nurse is telling me that they suddenly need to administer what is effectively a chemical cosh to be able to handle her, when she has been fine for more than a year, as far as I'm aware. (I visit at least twice a week and always ask how she's been). I'm also concerned that she may be aggressive (if she really is) because they're handling her badly when she's in pain. I have previously told the home that they are not to give her tranquillisers without asking me first. They did so twice in 2017. The GP didn't prescribe them again after that, so that they couldn't use them. I was also told the the psychiatrist sanctioned covert administration, which I though needed a case conference. I've spoken to the GP and no aggression issues have been mentioned to them for a long time. I don't want her given tranquillisers and it was her explicit wish when she was capable that I shouldn't allow it. I'm afraid this is a case of staff using drugs to make her compliant. She's at the stage where she said (verbally) she wanted treatment withdrawn (including antibiotics) so that she could be allowed to die. I'm happy for painkillers to be given, but really unhappy about tranquillizers. I'm also worried about the effect of tranquillisers on top of the opiate patch, which I'm worried the psychiatrist may not have been aware of. What can I do to prevent the drugs being given? I'm trying not to get into conflict with the home, but Mum has to come first
     
  2. Jessbow

    Jessbow Registered User

    I would say it very much depended on the doses prescribed and in what circumstances they are administered.
     
  3. Kat loves milk tray

    Kat loves milk tray Registered User

    Jan 1, 2019
    27
    Is the Psychiatrist aware of the Lasting Power of Attorney? Our local GP surgery uses a different computer system to that of our Psychiatrist whom is based within the Mental Health Team.
    Certainly forward your concerns to the Psychiatrist and make him aware of your wishes and your mums.
    Good luck..
     
  4. chickenlady

    chickenlady Registered User

    Feb 28, 2016
    94
    Talk to the manager of the home and raise your concerns, it's better that she has some tranquilliser than is distressed and fighting with the people who are caring for her. Sometimes people become very distressed when being cleaned and changed as they misinterpret personal care for sexual assault, this can lead to physical attacks on staff. If you ask the home manager to describe to you what the circumstances are you might feel more at ease.
     
  5. Misstep

    Misstep Registered User

    Oct 7, 2015
    57
    South Wales
    Hi ChickenLady. I've now involved the home, the GP & psychiatrist. The home confirmed that her aggression has only been happening since she broke her pelvis & only when she's being cleaned at night if she soils herself. I also discovered that at least one of the nurses didn't think she was in any pain (and therefore at least some of the carers will have thought that). The GP confirmed that she would expect her still be be in pain from the pelvis and also that she wonders if her femur was also broken. She has now doubled her pain relief, a new management plan is in place and the psychiatrist has agreed to hold off on the tranquillisers to see what happens. So far, there hasn't been a repeat of the problem (a week so far). Thank you for your input
     
  6. Louise7

    Louise7 Registered User

    Mar 25, 2016
    1,214
    Glad that things have moved forward and the increase in pain relief will hopefully help. Unfortunately it seems to be quite common for pain to be overlooked as a cause of changed behaviour/aggression/agitation in people with dementia.
     

Share This Page

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.