Part three – Reality of care

WINCHESTER – When elderly parents reach a certain stage, often the responsibility to oversee their multiple appointments, medication schedules and general health falls to one of the children in the family, which can leave both the patient and caregiver feeling overwhelmed.

In the midst of the seemingly endless tornado of information, mistakes can be made, which can negatively affect the quality of life of the parent and leave the child feeling responsible for the deterioration of their condition.

Colleen Smith’s mother, Margaret Felker, is 83-years-old, married 65 years and counting, and she is one of the success stories of the de-prescribing program at Winchester District Memorial Hospital.

The caregiver role is ever-increasing as the population ages and prescription totals rise.

For Smith, her mother’s primary caregiver, the constant battle to keep up with doses, refills and medication changes was nerve-wracking because their health is in your hands.

“You don’t want to be the one that’s at fault or blame. When you get that many pills, you tend to second-guess yourself,” she said.

The average person usually isn’t well versed in the complex world of pharmaceutical names for prescriptions.

“When you go to the pharmacy, one doctor calls it this, a physiotherapist maybe calls it something else, or it’s a generic name, the retail pharmacy maybe even calls it something else. It gets very confusing. It gets overwhelming,” said Smith.

Starting and stopping medications, as her mother’s condition changed, added a further complication to her role as caregiver.

“You can’t just start a medication. You have to either wean it in or you have to be weaned off. You have to be able to monitor and look and see what is happening. Could it be because of the medication or is it something physical? I would write all the lists of medications and the dosages because that would change, too. Or it could be so far as two pills the first day, one the next and three the day after,” said Smith.

It’s easy to see how it can all become too much.

“I was losing it. I can’t keep this stuff straight. It’s a reality check. It’s your parents and they’re depending on you. You want to do everything you can as a caregiver, or in my case as a child, to say ‘you looked after me a hell of a long time, I want to make sure you’re alright.’ You get the element of guilt if you don’t feel like you’re doing it. You just start spinning,” said Smith.

Guilt on the part of the child and the parent becomes a very real factor. No parent wants to become a burden and no child wants to let their parent down.

“There was the added stress on her because she thought I was stopping some of the stuff in my life to be able to care for her. She didn’t want it to hinder me in any way shape or form,” said Smith.

Felker, who suffers from Parkinson’s disease, was identified as a potential candidate for the pilot program at WDMH shortly after she fell and broke her hip. Due to her age and the multiple medications she was taking at the time of the accident, also known as polypharmacy, the staff believed she would benefit from the program.

Two out of three Canadians more than 65 years old are on at least five different prescription medications. One out of four Canadians more than 65 years old are taking at least 10 different prescription medications.

High-risk medication can also be a factor with the percentage of patients over 85 taking at least one risky medication at 43 per cent.

Having a professional team assess her symptoms and what could be causing them was a relief for Smith and her mother.

“If you can get that consistent care in a safe place with the professionals, and discover is it the medication that is making you weak or is it the Parkinson’s or is it something else? The people here know what the side effects are and what to expect. They actually monitor them and give suggestions as to how maybe it is medication-related or not,” said Smith. “You get these multiple things attributing to your health and well being, a lot through medication, so when you get prescribed something is it going to work? Is it the right dose? Do you need to be monitored?”

The team approach practiced by WDMH in the pilot program was invaluable to Smith.

“Everybody collaborates even on the discharge plan. Everybody was right here. I felt like I lost 100 pounds. It was a huge weight that got lifted off my shoulders just knowing she was here,” said Smith.

Asked if she, or her mother, ever took the time to sit down with a pharmacist and have their medications explained in detail, Smith responded with an answer that is very common.

“No, absolutely not. Before all of this, my parents were going to their appointments by themselves. They’re of that generation if the doctor says you need to take it, you’re going to take it.”

Part of the problem with polypharmacy is that most people take what each doctor says as gospel. However, that team of doctors may never confer with each other about their particular patient and medications that have been prescribed for years may be too potent, no longer effective or even necessary.

Smith has some advice for those seeking to get control of their medications and are considering the de-prescribing program at WDMH.

“First of all, have that discussion with your family doctor. From a primary caregiver’s point of view, they’re in a safe environment, they’re getting all the care and monitoring and they’re looked after. If they need anything more, it’s here.”

After going through the program, the number of medications Felker was taking was reduced from more than 10 to half that number.

“I feel so good knowing that she is on less medications. Just knowing we have it nipped in the bud and it’s manageable now,” said Smith. “Everybody wants to be independent. If you have your mind and you can be independent, then let’s make that work. I think your quality of life is just elevated.”

While Smith admits the program has helped her get a grip on her mother’s complicated medical plan, it’s much more important that her quality of life has also improved because of it.

“I’ve always said, that no matter how old you are, you still need your parents. When you lose your parents it still hits as hard whether your 10, 20 or 50. I’ve been very fortunate to have a close relationship with my parents and I’m going to have them around for a little bit longer, and they will be able to be independent. You want your parents to enjoy life too. So, if they’re enjoying life, you’re enjoying life,” said Smith.