Expert: Paula Damgaard - 7/9/2009

Question
My mother, 84, had osteoporosis with backand hip pain. was on Vicodin for pain. Eventually got better, enough to drive and care for herself, like always. Then she fell last week and broke a rib. Now she is in a nursing home for rehab.The problem is - in hospital she was given many many doeses of morphine for pain IV and then subcutaneous. She was confused and saying crazy things. They gave her Haldol. (I did not know this) she was like a zombie and would barely speak for almost 3 days. Then she talked but said people were beating her up, a man wanted to kill her etc. Now she is at the nursing home and when I left she yelled for me. They called me as soon as I got home and said she will not take medication (tranquilizer and her other meds) I talked to her on phone but she was adamant - they are killing her and would not take the meds. They kept her in a reclining chair by desk to keep her calm. Before all this, she was hearing the same music over and over at home. No one else heard it. Was confused as to what day it was but this was because of all the vicodin, I assume, she was taking. She was still taking care of her self, doing her checking acct.  bills, Was lucid. do you think she was getting dementia and then the drugs are making it worse. Will it be permanent? No one seems to know. Nursing home keeps calling me even tho I am there all the time. Can I come calm her down etc. I have a father in bad shape and 2 grandkis with cystic fibrosis so I have my hands full. I cannot be in all places at once and do go there alot but cannot run up there every time she does not want a pill etc. talking to her does not good. You cannot reason with her at all. Any thoughts or input would be greatly appreciated. Thank you

Answer
Hi Donna, what a mess!  My first suggestion would be to take her to a doctor who specializes in dementia or at  least geriatics.  Call the Alzheimer's Assoc in your area, you can find them in the white pages and ask them if they know of any doctors in your area that specialize in this.  

She needs to be evaluated to see if all the medications she is on is causing the problem or whether or not it is dementia.  She could very well have been developing dementia and the stress of the fall etc could have pushed her over the edge.  But pain meds don't help with ones cognition.  So evaluating all of her meds will allow them to sort that out.  Paranoia does go with dementia, but it also goes with medications.  The other question I have is: have they checked her for a urinary tract infection?  

Generally whenever I get a call about a patient whose personality has taken a sharp turn, I tell the family to check her urine.  75%of elderly women walk around with UTIs and they go unnoticed until behaviors change.  As we age we don't have the same symptoms that we had when we were younger to let us know we have one.  

SO my advice is to 1. find a doctor but in the meantime while you wait for the appointment; 2. check her urine.

If she has a UTI an antibiotic will clear it right up and then you should still proceed with the doctor appointment to make sure what is going on with her.

I hope this helps and I hope it works!!  Good luck you really have your hands full.

Paula