Pain Meds and the Elderly

[JustMeUC]

My grandmother is 92 and in an assisted living facility.

She hurt her shoulder about 10 years ago and the doctor started her on Vicodin which she continues to this day. I am fairly certain the shoulder no longer hurts her at least every time I ask her she says she doesn't hurt anymore so I guess she is just addicted to it at this point.

I just read over her monthly statement from the facility and she is now taking 3-10/500 tablets 3 times a day. meaning 90mg of vicodin a day. Does this seem like a LOT of vicodin for someone this age? I know that she has built up a tolerance to it after 10 years but I can't imagine how she functions on it. She has frequent falls, and I am wondering if this could be contributing to it. Luckily, she must have bones made of steel as she has never broken anything but one day I fear she will and that will be the end for her. I know it would be terribly difficult to get her off of it, but I am worried about how it effects her. I know before my back surgery I was taking about 30mg a day and didn't have any ill effects but I was 30-something years old, not 90-something! Now, I occasionally take a 7.5mg and feel a bit loopy as I am not used to it anymore, I can't imagine taking 30mg at once!

Is this normal to have such an elderly patient on so much pain medication? Is there anything that can be done or is it best to just accept that at this age the best thing is to just let her continue the medication if it is not causing her any major issues?

 

[jerome len]

In my opinion you have a couple of choices; 1. at 92 if she is happy and can afford the medication, why change it. 2. If you're concerned about her health or cost, get a 2nd opinion from another Doctor. I think you would need some one that could read her charts, understand the problems of an individual 92 years old to answer your questions. If I'm lucky enough to be alive and happy at 92 years of age I don't think I'd want anyone messing with me. Good luck.....I know your heart is in the right place.

 

[JustMeUC]

Vicodin is a very inexpensive medication actually, as long as you are getting it legally. I read that those pills go for $10 each on the street!

I guess that it would not be worth it to try to get her off of them or even taper down at this point. Anyway, I guess I was just shocked when I saw that. I don't normally look at the bills as my dad takes care of all that and he said he questioned the doctor once and the doc said that it was not that unusual for elderly patients to be on large doses. Anyway, she seems to be mostly ok, I just hope that it is not contributing to the falls. She is supposed to be in a wheelchair but she forgets sometimes and tries to walk and after a couple of steps, down she goes....

 

[H2ODude]

Not sure I'd worry about it at 92. MIL is 88 and takes similar dosage, but tends to cut back if she can to the point she has more pain than should. Problem is when she takes the full amount (which DW and I who care for her usually do not realize as she doesn't share her pain med habit with us) and then before dinner has her usual small glass of red wine. The result is she cannot even use her walker without our help. We try to limit it but she enjoys the wine and at 88 I figure whatever makes her happy.

OTOH a few years ago she insisted on more medication for her tremors. Doctor acquiesced. Over time we thought she was developing Alzheimers. Hallucinations, not recognizing us. Finally dawned on us something not right and got second opinion. Dr. immediately started her tapering down on the tremor meds (which really hadn't helped that much) and she returned to her normal sane self.

You REALLY have to watch the meds in the elderly. While in your case if she's functioning and suffers no ill effects you might just let it go, if you see effects you need to consult Dr. I think it's especially important when there are multiple practitioners. In MIL case there's orthopedist and meds for back, neurologist and meds for tremors, and a host of primary care meds. You need to call attention to the whole list to each or they can miss interactions. Every elderly person (meaning someone of diminishing sharpness) needs an advocate outside the medical establishment to gauge what's going on in my opinion.

 

[JustMeUC]

I think there is only 1 doctor at the facility and she has to use him. She seems really happy there and from what I can tell, she is treated really well. They are always happy and smiling and actually willing to listen to her stories over and over again. Something I have a hard time doing... I even put one of those hidden camera/DVR things in her room for a couple of weeks and they were just the same as when no family was around.

Her biggest problem is she has gone from 120 pounds to about 180 since moving in there and not only has she had to have all new clothes she had to go to a wider wheelchair. They have really GOOD food! I eat with her sometimes in the dining room and am shocked at how good the food is there plus they get lots of snacks and stuff during the day.

 

[Brat]

I would have a discussion with the facility about her diet. Perhaps they can just reduce her portion size.

 

[Buckeye]

I think there is only 1 doctor at the facility and she has to use him. She seems really happy there and from what I can tell, she is treated really well. They are always happy and smiling and actually willing to listen to her stories over and over again. Something I have a hard time doing... I even put one of those hidden camera/DVR things in her room for a couple of weeks and they were just the same as when no family was around.

Her biggest problem is she has gone from 120 pounds to about 180 since moving in there and not only has she had to have all new clothes she had to go to a wider wheelchair. They have really GOOD food! I eat with her sometimes in the dining room and am shocked at how good the food is there plus they get lots of snacks and stuff during the day.

Wow! Seems like the elderly are getting really skinny by that age. The fact she is a little plump seems like a good sign but maybe too much of a good thing.

 

[youbet]

Is this normal to have such an elderly patient on so much pain medication?

My MIL is now in a nursing home. Occasionally I go over and watch a ballgame with her. We split a beer I bring in an insulated lunch bag. (Her primary care doc approved 8 oz beer a day.) She refers to this activity as having me sneak in "pain killers." The NH could care less as long as we use discretion, but MIL seems to think it's more fun if we're "sneaky" with our paper cups.

Not quite sure what to do in your case JustMeUC other than suggesting you talk to the doc and ask why he/she is prescribing it and how he/she thinks it will go in the future. Make sure it's an intentional, planned course of treatment on his/her part.

BTW, my MIL (88 yo) went from fully independent living in her own condo and driving her car to nursing home in just a few months. Bummer. It has me thinking that I need to firm up my own plans in case the 80+ years of additional perfectly healthy life I have penciled in don't happen. (I'm 65.98 yo)

 

[SumDay]

Her biggest problem is she has gone from 120 pounds to about 180 since moving in there and not only has she had to have all new clothes she had to go to a wider wheelchair. They have really GOOD food! I eat with her sometimes in the dining room and am shocked at how good the food is there plus they get lots of snacks and stuff during the day.

When my mother was 92, the nursing home had her on a reduced sodium diet. She spent most of my visits complaining about how horrible the food was and begging me to sneak her a salt shaker. She had Alzheimer's and couldn't remember my dad had died, but my golly she remembered salt. If I make it to that age, and I plan to eat chicken fried steak 5 or 6 times a week, each as much cheese and soda and white bread and real butter as I can take. At that age, I think you deserve some pleasures in life, particularly if you're in a nursing home, no matter how nice it is. If she's happy, my vote would be to leave things alone. They don't like change at that age. Heck, most of us don't like change. JMHO, of course.

 

[MRG]

I'd be more worried about the amount of acetaminophen she's taking. 1500 MG. Three times a day!!! That's over any recommendations I seen.

I'm no doctor, but that's high by any standard I'm aware of.

MRG

 

[JoeWras]

I'd be more worried about the amount of acetaminophen she's taking. 1500 MG. Three times a day!!! That's over any recommendations I seen.

I'm no doctor, but that's high by any standard I'm aware of.

MRG

That's what came to my mind! Over 4 G of APAP. Wow, that's quite a liver load.

My dad was on this stuff and it just added to his mental confusion. He only took a small dose occasionally. Bad enough. He has less confusion without it.