MGordon_MD
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Mar 22, 2010, 8:02 AM
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Reclaiming a Parent - From his memoir Brooklyn Beginnings
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By Dr. Michael Gordon
During the past few years, the medical profession and the lay public have become more aware of the potential side effects of some of the mood- and behavior-altering drugs that we often use in older people—often those with dementia—who become agitated and cannot be managed by healthcare staff or by their own families. Years ago, we were not as aware of the problems with these drugs, but, at times, it became apparent that their use was associated with many symptoms that were otherwise attributed to age and dementia.
I was asked to see an eighty-year-old man who was referred to the clinic by his physician at the request of the patient’s children. For the past two years, he had been at home and deteriorating gradually in his mental and physical function. He was less and less able to walk without assistance, and required help in some of the ordinary activities of daily living such as going to the toilet, getting dressed, and taking a shower. The family said that he had just “slowed up,” more so recently, but that it had started after he had been hospitalized the year before with a severe infection. As they were telling me the story, I was taking notes and looking over his medications. He was being prescribed Haloperidol in a fairly large dose. They said he had left the hospital with it and was told it was necessary to treat his agitation and behavioral abnormalities, which the treating doctor attributed to Alzheimer’s disease. As I continued to hear the story, I began looking more intently at the patient and saw that he was fairly immobile and that his face was quite expressionless.
“We wondered how he got Alzheimer’s so fast,” said one of his daughters, “because—before the infection—although he was occasionally forgetful, he was still living on his own and was not having many problems. After he left the hospital, we had to get help for him, and things really never got better. If anything, he is less mobile now and less communicative than he was two years ago.” The examination revealed severe abnormalities in his movements—the kind that one often sees with Parkinson’s disease. I reviewed all of his other medications, and none of them could be implicated in what appeared to be severe side effects of the Haloperidol.
Moreover, the history, and a copy of the discharge summary from that hospitalization sent along by the referring physician, confirmed the family’s comments that prior to that hospitalization he had been functioning reasonably well. The hospitalization appeared to have been precipitated by a severe urinary tract infection, which had been treated; then, a prostate problem, which seemed to be the cause of the urinary infection, was also corrected. But, because he had become very agitated and combative during the infection and, again, after the surgery, he was put on the Haloperidol and discharged home with it, without any instructions to discontinue it once he got better.
Because he was so slow, it was impossible to tell from the examination what the status of his mental or cognitive function might be. I assumed that it might be impaired, but that his Parkinson-like symptoms were probably due to the drug. I instructed the daughters in how to incrementally taper off the drug over the following three weeks and asked them to bring him back to the office in six weeks’ time. When he arrived at that visit, he was a different person. He walked in unaided and, not only could smile at me, but he spoke in sentences. There was evidence of some mild cognitive impairment, but, according to the daughters, his general function was not all that different from how he had been the year before prior to his hospitalization. The patient and his daughters were most pleased—as I was, too—to have such a simple intervention result in so dramatic an improvement. As they left, one of the daughters leaned over to me and said, “Thank you for giving our father back to us.”
Powerful drugs that affect the brain are often prescribed in situations for which they are not really required, or they are needed only on a temporary basis, but are not discontinued. As a result, adverse drug reactions are common in the elderly, and this overmedication is a condition for which those of us who work in the field of geriatrics must remain ever vigilant.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on Mar 23, 2010, 11:26 AM)
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