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Pain medication for older patients must be carefully chosen and closely monitored

Carol Bursack of Minding Our Elders

Dear Carol: My dad has Alzheimer's. Recently, he had a bad fall and needed to be hospitalized. Dad was given Dilaudid for pain, but the drug affected his dementia so badly that I begged them to take him off of it. The hospitalist agreed, and he found something else for the pain, but Dad still hasn't improved. It's been two weeks and Dad's dementia is off the charts. The staff said that he may still improve, but that we must remember that Alzheimer's is a progressive disease so he may simply be getting worse because of the disease. This change was so sudden that I can't buy this thinking. Is there anything that I can do? — FT

Dear FT: I understand your situation better than I'd like because my dad went through something similar. You have my heartfelt sympathy. Staying on top of the medication, and questioning anything that seems to make your dad worse, is smart.

People with dementia have every right to as much pain management as anyone else — maybe more, since they can't always understand what is happening — but their brains are fragile, so drugs must be carefully chosen and the effects closely monitored.

The next step may be to work with his primary doctor to see if any drugs have been added to his health management routine since the surgery, or shortly before that time. There are times when people are hospitalized and necessary drugs are added, but these drugs may continue to be prescribed even after the time for their need has passed. Also, drugs that were added shortly before the surgery may have built up in his system and could be causing issues. It's good to check on all possibilities.

Additionally, suggest that his primary doctor order lab work for a urinary tract infection. It is common to catheterize hospital patients which can increase the chances of a UTI. Even if he wasn't catheterized, it doesn't hurt for him to be checked since a UTI can happen more easily with elders, and these infections can cause confusion and disorientation.

If you haven't discussed what happened after the hospitalization with the doctor who treats your dad's dementia, that's something that you need to do soon. If your dad is not seeing a specialist, this would be a good time for him to start. There is an array of drugs for pain control, so there may be something else that doesn't affect your dad adversely, and a neurologist may be able to suggest a better option than what is now being used.

Another discussion to have with the doctor is about what you've gathered about your dad's fall. Did he simply trip? Did he not see something because of the effects of Alzheimer's on the way he interprets what he sees? Could he have had a small stroke? The more that you, your dad's primary doctor, and the neurologist know about your dad's health, the better off your dad will be.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at She can be reached at