My mom has had the issue of saying she is constipated but actually isn't. The forum was of help with their answers. However, now she has anxiety attacks or panic attacks. They have become more severe and more often and the constipation issue has lessened. These attacks come on unprevoked out of nowhere. Doctor wants to keep her off of medications at her age of 92. Any suggestions? Thank you.
Cam you involve a geriatric psychiatrist in her care? My mom found relief from her panic, anxiety and dread with a combination of Remeron, Lexapro and a very low dose of klonopin.
However, if your mom lives alone I might be able to understand if the Dr. has concerns about her taking anti-anxiety medication while alone at her age.
I agree with Hugemom. Maybe make an appointment for your mom with her Dr. and go with her to advocate on her behalf.
They told me that the liver cannot sustain the drug damage at their age. With diminished liver function from a long life of prescription drugs...the risks are much much greater than for a younger person.
There comes a time when the risk/benefit equation is harder and harder to balance. Doc didn't want to come down on the wrong side of that
I said the neurologist had noted that my mother had a lot of anxieties and that there were meds to help with that. The doctor (PCP) said she did not like to put her older patients on those kinds of meds.
Great...just great. My mother would refuse seeing a geriatic psychiatrist. She refuses to see that neurologist again, too.
My mother no longer even allows me into doctor visits with her, because she doesn't like them talking to me and not her. She's 91, with very poor balance, poor hearing, neuropathy in her feet, atrial fibrillation, only has eyesight in one eye...and she lives alone. Won't hire someone to clean or someone to monitor her when she showers (she's mentioned that stepping out of the bathroom is a problem, since she can't feel her feet very well).
And so it goes....she's "independent," dontcha know!
The doctor may have been weighing risk/benefit because pharmaceuticals can be very harsh on the elderly - but didn't clearly communicate this with you. For example, Ativan is commonly used to treat anxiety in the elderly. However, in the last few years elite medical schools like Harvard University have reported that Ativan and other drugs in its same class have been clinically documented to cause Alzheimer's disease in patients predisposed to this medical condition. Google this finding. Proton-pump inhibitors for acid reflux also has been linked to Alzheimer's disease. Google this, too. My mother was on Prevacid for only one month and then boom - she was very combative and with extreme agitation. She has vascular dementia. After taking her off of this drug, it took one week to calm her down and was no longer combative.
Get a second opinion. Take your loved one to a geriatric psychiatrist for an evaluation.
Another option is to meet with a board-certified and licensed naturopathic physican for natural options. Google American Association of Naturopathic Physicians to see if one is in your area. These doctors are licensed as primary care doctors in my State. Don't go to someone who isn't board-certified and licensed by their State. There are a lot of con artists claiming to be "naturopaths" but they're not and tarnish the reputation of true naturopathic physicians.
I have long since come to terms with the fact I am in fact, addicted to benzodiazepenes...and that's NOT the worst thing that can happen. My psych dc monitors me and it's just something that I have to deal with.
If your mother's clueless doc is letting her suffer needlessly, then fire him! Find a doc with some compassion and help mother. At 92, she isn't going to become addicted and if she does, so what? IS that going to be the primary thing that everyone talks about at her funeral? That she died addicted to valium?
Sorry to come of angry, but this kind of "lack of care" just boils me. Just b/c someone is "elderly" they suddenly can't have/do/be something--everyone is individual. Panic attacks are horrible--they can go on for DAYS and you want to scream, cry and throw things the whole time.
Poor mom. And those aren't coming out of "nowhere" they could be coming from a tired, dying brain. Point it, they are miserable. Until my hubby had a couple, he just thought I was nuts and should "man up" thru them.
Setting up a visual record is an excellent idea so the Dr can make his own judgement.
Many Drs are very reluctant to place elderly patients on tranquilizers or anti anxiety drugs drugs for several reasons. It increases the risk of falls , the elderly don't metabolize drugs as fast as some one younger and the effects may be the opposite of what is expected. I don't think addiction is really too much of a problem in the same way as opioids and alcohol are.
I have taken Zoloft for well over 20 years with very good effect. It kind of smoothes out the bumps and I have no intention of discontinuing. Recently several Dr.s have noted on my med list summaries that it should be discontinued. Just like that stop it cold turkey. Fortunately my PCP is very compassionate and continues to prescribe. I can assure you some of the drugs prescribed for other conditions have such horrible side effects that I would not continue to take them if they were not life preserving.
I like to make the distinction between addiction and dependence. Addiction is the condition where you just have to have the next dose at any cost just like an alcoholic. Dependence is when you need a medication to keep you healthy. I consider the need for a diabetic to be dependent on insulin but not addicted because they get ill if they miss it, they don't crave it. The same goes for thyroid and many other prescriptions.
Clearly this mom needs some kind of medication because she is actually suffering adverse effects without help.
Years ago I took my mother to an internist and asked about a script for Aricept, as I had read about it and felt it might address some issues at the time. The doctor refused to prescribe it b/c of its side effects. At the time I was irritated with him, but in retrospect and after learning more about the side effects of some of the common meds used with seniors, I respected him for his decision.
I saw firsthand the negative side effects and reversal of intent when psychotropics were prescribed for my father during a long, complicated illness lasting about 7 months. The drugs didn't calm him; they agitated him and made him very anxious, and very visibly unsettled, uncharacteristic for this stalwart man.
That occurred in our county; when I took him to Ann Arbor, where treatment was much more sophisticated, psychotropic drugs weren't an issue. They knew more and treated him more accordingly and safely.
I think the first issue is whether a doctor has determined any possible cause for the anxiety, i.e., is it generalized, issue specific, incident or person specific? Can you isolate causes by documenting what happens before she becomes anxious?
This is probably going to sound like a tree hugger's comment, and perhaps it is, but I've experimented with foods to calm anxiety, which often occurs when some aspect of critical caregiving is beyond my ability to address and I can't find outside sources (leaving me with significant and potentially dire unsolved issues), when I just can't do it all and everything is a priority, or when his need for care, keeping up his house and keeping up mine conflict or when my father's health slips a notch closer to the end. The latter is one of the more anxiety producing situations I'm addressing now.
I've found that fish, whether filets or tuna in a salad or sandwich, calms me down. I've also discovered that a good salad, with greens including red romaine or red lettuce, broccoli or green peppers, works EVERY time. I sleep better, wake up less neurotic, and more calm.
And, the best thing I can do is to avoid my favorite food - chocolate. Even though chocolate is a quick antidote, the sugar in it as well as other foods aggravates anxiety.
A second opinion from a geriatric psychiatrist would be a wonderful next step.
You can find holistic doctors in your area through the internet.
If I make it into my 90s I think my goal will be to have the chance to be content, to be comfortable, and as pain-free as possible. If I had the choice between living with some symptom that reduced my comfort and prevented me from being content or taking some pill that would remove the discomfort but put me at risk for dying sooner with liver problems, I would take the pill. What is the point of ensuring a longer miserable life? I hope at that point in my life I have a doctor who listens to elderly patients!
My mom started developing serious anxiety issues and panic attacks back in late 2009, after a couple of episodes of extremely high blood pressure (EMTs recorded 260/118). All of a sudden, every little thing set mom off; storms, a future holiday, needing to take a car service to a dentist appointment. A limousine ride (a treat given to her by my SIL) to visit her elderly sister was "harrowing". While my mom was never the calmest person on the planet, this was a new experience for us.
We tried EVERYTHING! Explaining, reasoning, calming music, aromatherapy. Having aides stay with her 24/7. NOTHING worked.
My brother referred to all this as "stuff mom is doing to herself".
Mom's doctor had her on a low, PRN dose of Xanax which she hadn't used much. Now, even taken every day in wasn't making a dent. After two successive days of "emergencies" I took her to the doctor, who prescribed Zoloft. That made her suicidal after one pill (I swear, she read the package insert).
So on the third day (racing from work in the far reaches of Brooklyn to Westchester) I said enough is enough and we installed mom, first in AL and then in Independent Living.
There she was seen by a lovely on-site doctor, who gave her his cell phone number (that went a long way to calming mom down, but there was still underlying panic about a lot of other issues). He referred her to the visiting geriatric psychiatrist, who switched her to klonopin. Doctor called me after about 2 months and said:
"Barbara, you need to get your mom in for a neurocognitive evaluation to investigate her anxiety. I really want this worked up in the proper way so we can make a good treatment plan."
Cognitive? Mom? Mom was sharp as a tack!
Took mom for the two session, 6 hour testing. MRI, psychiatric visit, etc.
Mom had Mild Cognitive Impairment. She'd had a previously undiagnosed stroke which had essentially robbed her of her ability to prioritize, to reason and to see consequences (I'd be anxious too!)
Finding this out made the psychiatrist more comfortable with treating mom's anxiety with regular doses of Klonopin. Keeping her calm helped with the blood pressure as well.
Sometimes there is an underlying physical reason for anxiety. It pays to investigate.
Later, mom had a big stroke, which took out most of her language centers. It also broke her brain in such a way that she was diagnosed with Vascular Dementia. This led to MORE anxiety. A cocktail of antidepressants and Klonopin got her through the last several years in a mostly non agitated state.
I refused to allow my mom to be in pain, psychic or physical. She didn't deserve that at the end of her life. Like Jeanne, I understand that there is a risk/benefit analysis to be made, but allowing demented elders to be panicked and anxious when there is a relatively easy fix is cruel.
Barb, I think your approach was a very thorough one, investigating the situation and the options. And the information on the stroke made a significant impact on the decisions, at least in my opinion.
My impression of the OP's post was that none of the diagnostic work-up done for your mother had yet been done for the OP, and that she was at a point at she had not had the benefit of more investigative analysis of what her mother's condition was and why it was that way.
I've always thought that you had a particularly analytical approach to your mother's care (and that's a compliment.)
Look, I keep track of IQ points for a living. I did NOT recognize that my mom had lost any. Her doctor of many years treated her as "patient exhibiting some symptoms of anxiety" without investigating the causes.
One of the reasons I have such faith in geriatric psychiatrists is that over the years, we've gotten SUCH good advice from them. they seem to be the last MDs standing who actually consider the whole patient.
Sometimes I read posts in which it sounds as if someone has aggregated a lot of terms and concluded the parent has a - c symptoms, or x - z symptoms. And sometimes the conclusions are very predictable, even if the circumstances don't fit.
I often wonder how much of what someone reads about older people and their conditions is really gathered from reading other posts as opposed to scientific, medical analysis.
Having observed that, I am not a medical professional and these are just observations from posts here, from a variety of people at different stages and comprehension of caregiving.
And I've also found that I sometimes experience strange symptoms and ask these questions of myself, especially in stressful times.
PS: Also I bring her a vegetable smoothie twice a week to keep her bowels open and she loves the "treat".
My DH, 96 yr, was suffering Panic Attacks and Depression and his GP wanted him on Zoloft but I fought it for a year - until they became too frequent. Now he is calmer and smiles again. If they don't "overdose," the Zoloft (or whatever) is a blessing to the patient.
I have mixed feelings about holding off for the year. The attacks weren't as frequent and he denied depression so we did what we thought best. But when I saw him sitting "hang dogged with his head down" I knew the time had come.
Find another doctor. Just question everything - the medicine used and the dosage. My DH is on half a pill or 50mg and he can function well.
I agree with others. I'm not a proponent of medication in elders after 90 -- but in the case of anxiety and fearfulness - then ABSOLUTELY, the dr should prescribe based on poster's description. What's the use in living if elder is terrified? Dr. should prescribe medication and see how mom is. Liver failure or other, I'd prefer to take a pill and not feel fearful, anxious and die early from liver disease than face each day terrified and anxious.
See another doctor and document your observations. I'm pretty certain they will prescribe something in addition to some behavior modifications suggestions to help your mom.
Good luck