Can anyone point me in the direction of some articles about the issue of narcotics, etc in the older population? I work in a rehab unit in a LTC facility and am amazed at the amount of pts that take a HUGE amount of meds for anxiety, insomnia, and of course, pain. I know that pain is what the pt says it is, but it is no wonder that they fall down so much!
For example, I have a pt right now: came in 2 months ago for a hip fx. Already on 20mg oxycodone, 10 mg ambien and 0.5 xanax prn TID. a family member insisted that pt had been on this for a while. pt compliant in rehab, gets better-enough to go home with said family member. ONE week later, I come in from a day off and pt is back! Fell and broke humerus near shoulder. Is angry b/c the doctor is trying to reduce meds b/c he thinks they are contributing to falls (duh). Pt got percocet 5/325 changed back to 20mg oxy. has ambien and xanax BID. Here's where I have trouble. Pt goes to ortho, gets HIM to change order for xanax to TID!!!!! I work 3-22, so I have let the supervisor know and they are going to contact facility doctor to clarify whose orders to follow. Now pt is non-compliant with PT instructions and has become VERY depressed. Are the elderly WAY too over-medicated, or is it just me?
I am amazed at how many family members seem to push HARD for the most medication. I don't know why they cannot see the correlation between the falls and altered mental status and the medications. Very frustrating.
I hear about controversy re: over use of psych medication in nursing homes... and THAT is contributing to the under-use of meds to help these poor people calm down and get some sleep every now and then.
The controversy, at least here in my state, is that nursing homes overuse psych meds in order to "snow" residents so that facilities require fewer staff to monitor them. Therefore, during the last state survey, social workers were pressuring MD's at my facility to discontinue a lot of the residents' psych meds.
The PROBLEM is that now, we have a lot of residents who holler all night and can't sleep! They aren't necessarily trying to get up, falling, etc... some of them are just lying in bed yelling! I feel terribly SORRY for them, but the MD's won't give them the psych meds that they need so that they can get proper rest.
Last edit by NurseCard on Oct 24, '12
: Reason: formatting