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Onhold1 Asked February 2023

Why would any doctor put a 96 year old woman on Ativan and she already fell?

My mother went into a NH and has always been independent. My mother new prior that my sister in law was taking her stuff. After my brother and sister in law put her in and made her incapacitated by mother would cuss at sister in law. I am in another state. I requested no Ativan and nurses try to get off but sister in law pushes for her to get it. Then she fell and still in Ativan. Warned that she could fall again and die but they do not care.

Lymie61 Feb 2023
It is so hard being far away and trying to understand what is going on when you aren’t actually witnessing and experiencing it. I see this with the brother who lives across the country, he tries to stay out of decisions, we consult him but he defers to my other brother and I because we are involved in the day to day care. He is always willing to be a sounding board too but he isn’t there day to day so it’s hard to really comprehend for him and I know it’s hard for him to watch from so far away just in different ways.

Hard as it is to hear and believe often when you are in contact from a distance, it’s unlikely she would be in NH if she didn’t need one. A patient has to have medical need, qualify for a NH bed, family can’t just put them in one for no reason. I don’t know the details but it seems reasonable to me that your always independent mothers needs have increased to the point where she isn’t able to be so independent. I don’t know what factors contribute to her need for NH care over IL, AL or MC but it seems like a reasonable guess to me that cognitive issues come into play given her sudden distrust of people close to her and then the addition of Ativan subsequent to her moving into residential care. Again Ativan isn’t typically just prescribed and given lightly. The falling may be a separate or a related issue, perhaps the propensity to fall contributed to her entering NH and perhaps she is very steady on her feet making any possible side effect from Ativan less likely and more immediately noticeable. Then again maybe its as simple as the possible benefit from the Ativan is greater than the possible side effects, either way only professionals, a doctor, can actually prescribe it so there were stop gaps before your mother started receiving it.

As her child especially who is living far away, you can’t help but worry and second guess these big changes she is likely complaining about, as you should. But while doing so keep in mind that you are very lucky to have a brother and a SIL who are so involved and “on the ground” so to speak, many of us here know first hand just how much more difficult that is than it looks and being constantly second guessed or worse accused doesn’t help anyone. So visit if you can and see for yourself, talk to the doctors and nurses but don’t be quick to question the people who are there doing the work and most in touch with Mom, her doctors and her needs. Showing interest in what is happening exactly is ok, it’s good but demanding you know now why this or that while they are in the mist of it without offering them back up or just a place to vent, offering assistance and compassion is just placing a bigger burden on those people who are doing the heavy lifting. I know that isn’t your intention, you want what’s best for Mom and the likelihood is they do do too approach your concerns from that perspective as much as possible unless they prove themselves to not be acting in her best interest, her best interest not theirs not yours but Mom’s. It can be a very hard thing to separate out so be kind to yourself as well. All of this is the same in my opinion no matter what the legalities but of course if that’s what it ends up boiling down to others are rite, if someone was appointed POA, MPOA, DPOA they have the legal say.

MicheleDL Feb 2023
Not knowing what Ativan does I Googled Ativan Uses -
When taken appropriately under a doctor's supervision, Ativan can help reduce many of the common symptoms of anxiety, including panic attacks, unjustified fears, sleeplessness, agitation, and restlessness. In addition to treating anxiety, Ativan is prescribed for seizure, spasms, alcohol withdrawal, or insomnia.

Googling - What are the side effects of Ativan?
Confusion.
Lack of muscle control.
Blood in urine or stool.
Stomach pain.
Weight loss.
Tremors.
Overdose.
Addiction.

I also looked up -
What Happens When Older Adults Take Ativan? Since Ativan is a central nervous system depressant, people who take it may experience drowsiness, discoordination and unsteadiness. Older adults may be more sensitive to these effects.

I can imagine you're fears and concerns, but if you're a back seat driver there isn't much you can do.
As far as being independent, my husband can't wipe his behind but thinks he's in charge and control of everything and talks a good game.
If you're not there, you're not hands on, you're not elbow deep in her care, you're not an eye witness, believing that you are fully informed is difficult to accept. Maybe for your convenience you believe what you wanted to believe because of guilt or perhaps your own incapacities.

Your profile does not say anything about your involvement in your mother's care.
Zero.

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gladimhere Feb 2023
It is hard to not be close at this stage of mom's life, isn't it? When is the last time you saw mom? Maybe it is time to visit, but not to critique her care. Go to see mom and how she is doing. Let your bro and SIL know you appreciate them for all they are doing. They are not the aging experts, the staff at the facility are.

And like said, old people fall.

MJ1929 Feb 2023
Only the person with the legal responsibility to make medical decisions for her can request to have Ativan withdrawn. (I doubt it's the reason for her fall anyway.)

If that isn't you, then that's the end of it.

NeedHelpWithMom Feb 2023
My mom fell before taking Ativan and fell after taking it. At a certain age or with certain conditions elderly people will fall, regardless of meds or lack of meds. It’s sad but true.

The Ativan is needed or it wouldn’t be prescribed. Do you want your mom to be in an agitated mood or would you rather her be calm? The Ativan will help to keep her calm.

I am sorry that your mom is falling. I hated that my mom fell due to her Parkinson’s disease. It’s awful. Wishing you peace during this difficult time.

lealonnie1 Feb 2023
How is it that you live out of state but know what's going on with your mother, who's at fault, and a "thief" to boot, which is not germain to this issue?

A DOCTOR has to prescribe Ativan for a reason he feels is warranted.

Falls happen to ALL elders regardless of what meds they take. It's always a trade off as to whether the mediation will help MORE than it harms. This is the dichotomy of elder care and until/unless you're involved with the day to day management of it, is incomprehensible.

If you hold poa, go pick mom up and take her home with you where you can care for her as you see fit. If your SIL holds poa, she gets to make the calls. See if mom will change the poa designation to you, if she is of sound mind, so you can then take over her care and management 24/7 and withdraw any meds you'd like.

Nobody can "put an independent elder into a SNF" without her consent btw, UNLESS there is dementia or incompetentcy at play.

My mother lived in Memory Care AL for 3 years and Ativan kept her calm and from freaking out every afternoon. I thank God for that medication all the time. And nobody has ever accused me of "not caring if she fell and died as a result." That kind of talk comes from the armchair critics who do nothing in terms of care but have TONS of opinions about what those of us who ARE are doing wrong.

Either leave your brother and SIL in charge of mom's care and thank them for all they do, or look into taking over mom's care and management yourself. That's how empathy is earned: thru scar tissue.

Ohwow323 Feb 2023
If you have MPOA then you can let them know that you do not want them to give that to her! You will need to let them know you are MPOA. However if you are not then you have no control over that. If brother is MPOA then let him know the side effects of that medication and that there are other meds for her problems. Hugs

Grandma1954 Feb 2023
Who is POA for Health? That is the person that the staff and the doctor will listen to.
Falls happen. It is not a matter of IF but WHEN
Many medications can have side effects making a person more prone to falls.

Fawnby Feb 2023
The reality is that a 96-year-old person is going to die sooner rather than later. You don't mention dementia, but based on mom's behavior of believing that someone is taking her things and swearing at your SIL, I gather that dementia is involved also. She's presumably in a nursing home because the facility can provide the level of care that she needs now. She can't live alone and is no longer independent. She was incapacitated before she entered the NH or they most likely would have turned her away.

You probably don't know much about her medical situation other than what you've heard from her, which may not be reliable. How many total times has she fallen? How many times a day has she fallen? Why have doctors prescribed Ativan - is it because she's agitated and keeps trying to get out of her bed alone? Is it because she's yelling and thrashing around? Is she a danger to others, including the caregivers, or to herself? There may be good reasons for her to take Ativan that you don't know about.

Once they start falling at that age, they keep falling. She'll fall whether she's on Ativan or not. Of course she could die from falling. And of course, at 96 she can die in her sleep. Or not. I've been through this with both parents, who died in their 90s. Frankly, because of what I saw with them, if I were 96 and falling often, I'd prefer to be medicated to the point where I couldn't get up.

I'm very sorry for your mother's condition, but there's little you can do about it. That's what happens to us when we get old.

JoAnn29 Feb 2023
Yes, who is POA. If brother, he is the only one staff should be talking to, not even the wife. If wife, not much u can do.

By the way, Nurses have no control over medications. The Doctor orders it, the Nurses dispense it. They cannot change a dosage or stop the medication without a Dr's order unless they are Nurse Practitioners. They can recommend that a resident be placed on a certain med but the Dr is the one who writes up the script.
lorrising Feb 2023
As a Registered Nurse, I can attest that nurses can refuse to give a medication that they feel will harm the patient whether a physician has ordered it or not. It is part of the nursing assessment and nurses are ultimately responsible for the medication that they give. When a med is ordered I am legally required to assess the patient and if the med will produce harm I can hold it and notify the physician as to why it was held. If the physician insists that it be given but I am not comfortable giving it the physician may choose to give it himself or ask another nurse to administer the medication. Ultimately MY license is on the line and it is part of the exercise of clinical judgment when administering medication to determine its appropriateness. I am always free to check with the doctor and ask why it is being given.
AlvaDeer Feb 2023
If you are not POA you have no say in any of this, so all of it is a moot point. Your best contact now is your sister,in law who clearly IS in charge, That the doctor continues to allow the ativan after a fall is quite remarkable, you are correct. Facilities will give what is ordered because they CAN and because they don't want your Mom running around cussing at anyone at night. Yet any sleep meds, and especially this one, can increase the chance of falls. It is always a Catch-22, this. Seniors without meds often are anxious or acting out in care; yet medicate with anything and you increase chance of falls. It falls under "Not everything can be fixed". I am so sorry, but I am afraid you are helpless. Calmly discuss with your brother that these meds are endangering your Mom at this point. You can't do much else.

babsjvd Feb 2023
Elderly fall..simple fact.. our bodies wear out, no longer have strength.
and once the falls start they continue. A fact of life..I doubt it is caused by Ativan

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