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Is mom being over-medicated in a nursing home?

Dear Carol: My mother has had bipolar disorder for most of her life, though medications have helped her stay fairly balanced. She also has diabetes and severe breathing problems so she's recently entered a nursing home. Mom knew that the move was necessary for her safety and started out quite happy. The staff is great and the home offers a lot of activities for when she's felt up to it. Lately, though, she's been so lethargic that I've inquired about her medications. It seems that the doctor, who is a geriatrician, has changed them significantly. I realize that Mom has a tricky combination of health problems that require medicating, but I'm wondering if they are purposely overmedicating Mom to make her easier to care for. I don't like being suspicious, but I've read so much about this. What's your take? - Rob

Dear Rob: You are smart to stay on top of your mom's medications. Yes, there are facilities where overmedicating to make caregiving easier for staff is still a problem, but it's also wise to understand that overmedication can occur, particularly with older people who have complicated health issues, even when the doctors involved are trying their best to do the right thing.

You've likely read where the government recommends that psychotropic drugs should only be used for the elderly when absolutely necessary since some of these drugs can be used in excess to do exactly what you suspect. They not only can make a person lethargic, they can be responsible for falls, confusion, and interactions with other medications. Still, for people with mental illness, some of these drugs are often necessary for their own well-being.

If you're curious, Nursing Home Compare, which can be found on the Medicare.gov website, tracks nursing homes for quality. While it's not entirely free of self-reporting, it's still a good tool, so you may want to check the ranking of this nursing home. Just don't use the site as your only tool for making decisions.

The facility where your mom lives sounds like a good one. I think that you would have noticed negligent care in other ways if their sole aim is to overmedicate. My view is that, since geriatricians aren't psychiatrists, it's possible that this doctor should have the input from your mother's psychiatrist. If the doctors could work together on the medications that your mother needs, that may help. Talk with the nursing home's administrator to see if this is possible.

Understand, too, that while your mom has many health issues she is also aging, as everyone will. She may be sleeping more or be more lethargic simply because her overall health is waning. Still, looking at the medications is an excellent idea. The wrong type or dose of a medication could be causing these issues, so it's possible that her quality of life could improve with the help of both doctors.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carolbursack@msn.com.

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