Hi everyone.
My dad (75) has hypertension, COPD, coronary artery disease, Ischemic cardiomyopathy, high cholesterol. He also had two heart attacks in his life, underwent triple bypass surgery, had an abdominal aortic aneurysm repair and has been smoking 1-2 packs of cigarettes daily for more than 60 years. Since his stroke, he has not smoked.
In January 2023, he had an ischemic stroke. When EMTs arrived at the house, his blood pressure was dangerously high (200 over something). He was kept in hospital/rehab for exactly 2 months. While there, he developed delirium. He has been home for about a month now and still dealing with some confusion. Because of that confusion, he is not taking his medication properly. I will prepare the medication daily and bring it to him and a lot of the times he sets them down on the table and if I ask him to take it at that moment, he gets frustrated and says he will take it "soon". Those pills are sometimes still there 24 hours later.
He has gone a few days without taking any of the medications. He is unable to track day/time so when a day passes, he thinks it's only been a few hours or so.
I've tried talking to him. I got his doctor to talk to him. I try encouraging him to take the pills, even by distracting him, such as having a conversation with him and quietly handing him the medication while he speaks but it doesn't seem to help. He does not eat properly, maybe one meal a day with many sugary snacks throughout the day, very little fruit and almost no vegetables.
He gets very easily angry and turns red if I try to push him to do something, so most of the time I have to back off and let him be.
With all of his health issues and lack of medication from a very recent stroke, my question is.. what can I expect? His blood pressure was still elevated while in the hospital even with daily BP medication. So now I'm worried that days without his medication will cause issues. He does not exercise whatsoever either. He sits on the couch most of the day and does nothing else.
I said "even with the Seroquel you're having sleep problems?"
He said he'd stopped taking it, because he didn't remember why he was taking it and didn't think he needed it any longer.
I texted our doctor who asked him to come in for an appointment. He explained the importance of each of dh's meds and said that if he wanted to discuss discontinuation of any of them to call and they'd have a discussion.
It may be that you need to explain to your dad each time you hand him a pill what it's for (that's what they did at my mom's NH and in rehab)
I woukd give his doc a call today and discuss how to handle this.
Thank you so much for your reply. That's a great idea, maybe I do need to explain every time why he needs to take those medications.
I will give that a try! :)
Either a caregiver living with him (which may not be an option if he's so defiant) or a memory care facility.
Does he (or you) measure his BP at home? I would start there and if it's elevated, call the EMTs again to get him back to the hospital for treatment.
Consider asking his doctor to refer him for a cognitive assessment. People often develop Vascular Dementia after strokes. This affects their ability to reason and to understand the consequences of things like not taking medication.
The fact that your dad can get around dies not mean that placement in Assisted Living with Medication Management services would not be useful.
Do some reading about dementia and you will realize that trying to reason with your dad about his meds is not the path you want to take.
Maybe he shouldn't have to take life-extending meds if he doesn't want to? (Or if the previous version of himself wouldn't want that?)
Dr. John Sloan in A Bitter Pill has argued for focusing on quality versus quantity of life. If I remember right, he argues that medications after a certain point should be primarily palliative rather than life-extending.
In a nursing home, this approach might not be an option.
But I could be totally misunderstanding the situation. 75 sounds young to me.
If this *is* a dementia situation, maybe life-extending meds don't make sense?
Or maybe at this point the goal is to stop a bad situation from getting even worse and thus the meds are even more important?
These are real questions to which I do not have answers. They are the questions that keep me up at night whenever I try to plan 1-5-10 years out.
I'm glad you are receiving replies other than this one. Good luck and take care.
I've been asking him almost every day if he has any pains or discomfort of any kind at any time during the day and he always said no, only back pains from time to time, but that's been a chronic issue with him. So I don't think the medications have any negative side effects on him.
I have always wondered about quality of life vs. quantity. He has always told me that he doesn't care about doing what's most important for his health because "we are all going to die anyway" (in a joking tone). No, he is not depressed and never has been. He just doesn't want to give up what he loves just to possibly extend his life. So for him, I think quality of life is what's best at this point.
But, I feel guilty and hopeless as his full time caregiver. I am his baby daughter and when I was a little girl, we were very close, he was the only person who ever played with me! lol. So I feel a sense of responsibility that I need to take care of him as best I can. But refusing medication is what worries me. It has been days now that he hasn't taken it. I don't know if it's because he just doesn't think about it being important or because he just doesn't want to.
After his stroke, he suddenly looks 20 years older. He looks like a different person, just by his face. When I compare him to other 75 year olds, he definitely looks like he's in his 80s. I know that his brother who had no health issues passed at the age of 80. And my father has several issues and is nearly 76. You can understand my anxiety at this point.
I am usually a very optimistic person and I always see the light in everything. But this is the first time in my life where I have a really bad feeling and do not expect much positive progress from here on.
Stroke is a brain injury.
Dementai caused by stroke is very very common. (In fact Vascula Dementia is 2nd most common dementia, Alzeimer's Disease being 1st).
Regardless of label, if Dad cannot look after himself, he needs care. Choices for this next stage are in-home caregivers, or moving into a care facility.
Would Dad be happier around people, with more arranged activities? Or staying in his own space, quietly, with less people?
The bigger concepts now will be less about quantity of life & more about quality of life.
The delirium seems to be getting better, much much better than when he was in the hospital. The thing is, my father has always taken medication as nothing important. The reason he had a stroke in the first place is because he completely stopped taking his medications for around 7 months because he felt like "they were doing nothing". I had no idea he had stopped taking meds because he was completely able to manage them himself.
I am his fulltime caregiver. I live with him and I look after him. But, he's a very stubborn man with lots of pride. He refuses help and insists he can still do everything on his own, or at least tries to, but never wants help. But even though I live with him and care for him, I also need my own life. I am a student right now and cannot watch him 24/7.
I highly doubt he is in a position that would require him moving into a facility. He can still get up and walk around, he eats on his own, can get around to whatever he needs. He just still has that mentality that medication doesn't help. He doesn't understand that his stroke was caused by lack of medication.
My father very much enjoys his own company and being alone but also enjoys being around others sometimes too. Unfortunately, I am his only family, and he doesn't really have any friends.
I understand the concept of quality of life vs quantity. With his lack of medication and the list of health issues, I cannot imagine he would be around too much longer, even though 75 is not very old but he looks like he's in his late 80s.
I am so very sorry, but I don't see an alternative.
At Moms NH they put her pills in pudding or yogurt. Its also harder for older people to swallow some of those big pills.
75 is not elderly I'm 73, but then Dad has a lot wrong with him. Your discription of your Dad sounds like my Dad. The difference is the stroke but he could have had it in his sleep the night he died at age 79. I may consider Hospice for Dad. See what his doctor thinks. Its not a death sentence but he probably will die from what is wrong with him. Better it be in comfort.
In that case, he should be placed in a care facility where they can take care of him. He shouldn't be living alone, and all the yakking and scolding and handing him pills will not work. You might as well save yourself the energy.
You've done the best you could, and it's time to consult with his doctors to find out what type of facility care he needs.
I was also going to suggest perhaps crushing his medications(check with pharmacist first to make sure they can be)and putting them in his food, but if he's not eating much that may be harder to do. Some medications can come in liquid form as well, so you can put in food or drink that way too.
I guess other than threatening him all you can do is let him know that if he doesn't take them while you're standing there watching him, that he will more than likely die sooner than later and if that's what he wants, that's on him, not you.
I cannot and would not threaten my father, especially when he is confused. He already stated that he does not trust me, which is 100% linked to his delirium because he always trusted me with his life and mentioned it a hundred times. So, I cannot tell him that I will put him in a home if he doesn't do this or that, it will just upset him to the point of boiling anger. I also don't see how that could be helpful to him because if I say something like that, he will never trust me again and might never take his medications at all.
Some of his pills says not to crush it, so that's not an option either. He is taking 7 or 8 pills, some are tiny and some are large, so I wouldn't have much luck hiding them in his food anyway. Plus, he doesn't always finish all of his food anyway.
I don't think he's afraid of death. Especially now, he has stated in the last few years that he has nothing to look forward to, which is kind of true. The fear of him dying is all mine, not really his.