As my mom's (91) POA, can I refuse a physician's prescription order if I feel it's not in mom's best interest?

If your mother doesn't want to take an SSRI, then that's that. She doesn't have to take it.

Having said the above with all the emphasis at my command... If you (or anybody else) are not happy about a practitioner's prescription or recommended treatment of any sort, the thing to do is talk to the practitioner.

Your mother is suffering pain and anxiety. The relationship between pain and anxiety is close - one feeds the other, and your poor mother is the victim. SSRIs do have side effects, this is true, but I imagine her psychologist has taken the potential risks into account and has concluded that the potential benefit of relieving your mother's anxiety outweighs those risks.

Her age has no relevance at all. Why would it become okay for her to live with pain and anxiety because she's 91?

But the psychologist, or any other prescribing practitioner whose patient she is, can tell you far more about this as it applies to your mother than we can. You as MPOA have concerns, questions and reservations - so talk to the psychologist about them, ideally with your mother, and decide together what's best.

My mom, at 90, suffered from increasing anxiety due to her cognitive issues. Her geriatric psychiatriat prescribed a low dose of anti-anxiety medication which worked well.

Then mom had a stroke, which resulted in a diagnosis of vascular dementia. My mom's level of anxiety skyrocketed. She wept, wrung her hands and seemed to be in a near- constant state of dread and fear.

We consented to a trial of Lexapro, an SSRI. I was concerned about side effects, as are you, in part because mom had tried Zoloft once and it hadn't gone well. (In retrospect, I think she read the package insert and developed side effects listed there due to suggestibility).

Lexapro was a lifesaver for mom and for us. As her brain deteriorated, another antidepressant, Remeron, was added and she tolerated that as well.

I think of dementia as having a "broken brain". The chemicals that maintain good mental health are sometimes in short supply and need supplementing. Not sure why you wouldn't give this therapeutic medication a try.

What other meds would you like to see prescibed for your mom?

Have you discussed your concerns with the person who is doing the prescribing? In general, psychologists don't have prescribing priveleges; many work with an MD or Advanced Practise Nurse to do the writing of the prescription.

I find that, in general, doctors are willing to let you follow their thought process in why they are chosing a certain med, or class of meds for a particular issue. So for example, a straight anti-anxiety med might be prescribed for a younger person in this sitation, but they often lead to falls in an elder, making an SSRI with antianxiety properties a better choice.

I am curious why you don't want your mom on an SSRI. Is it due to a heart issues, as CM describes?

I had the good fortune to establish a really positive relationship with the psychiatric PA (who was licensed to prescribe) in the very first visit she made to my LO.

She assessed my LO, and we immediately met to discuss her proposed recommendations.

When I asked that a VERY SMALL DOSE of medication(s) be tried, the PA immediately agreed with me, and that was what was done.

I did not feel that her age, 91 at the time, was the most important factor in her treatment.

Before Covid, she was seen every 3 or 4 months, and now, having been vaccinated, she will be seen again. She is also carefully monitored by the staff in her memory care unit.

I have contacted the PA many times with questions about my LO’s behavioral and affective issues. If you are able to do so, you might have the chance of addressing and clarifying your concerns faster than attempting to have to evoke your POA.

Hope this works out well for your mother.

I was my husbands POA for both medical and durable, and there were several times when hospice wanted to prescribe different medications for my husband. If I felt they were unnecessary or that he didn't need them for some reason, I just told them no, I'm not going to give that to him, so don't waste your time prescribing it. They never gave me a hard time about that, so hoping you can stick up for your mom and what's in her best interest as well. Best wishes.

If Mom is competent, she can turn it down. If incompetent, then u can turn it down if you have Medical POA. Just don't pick it up. But in my Moms AL the RN was incharge of ordering the meds and having it delivered to the AL. Once delivered not allowed to send it back.

I was surprised to read that a Psycholgist was allowed to prescribe medication since they aren't Medical Doctors. But seems the states of Louisiana, New Mexico, Illinois, Iowa, and Idaho allow it if they have the training.

Can you ask the doctor to prescribe something else? My 83 year old mother in law takes Buspar with no noticeable side effects. It has been the only she can take without complaining of side effects and she has tried numerous medications. My mother in law absolutely can NOT function without something.

Why would you call upon a psychologist to help your mother alleviate pain and anxiety and then decide to refuse the prescribed medication? I suggest you speak directly to this psychologist about your concerns and your rights. If your mother is of sound mind, she herself can refuse anything she doesn't want, of course.

My mother is 94 and I'd be willing to try ANYTHING to help her relax a bit and get rid of the pain she feels in her legs on a daily basis! Any meds can be discontinued if need be.

I remember when my mother got a small partial plate at the dentist when she was in her late 80s. I brought her some Polident and a denture bath to soak it in every evening. After reading the insert inside the package, she decided she wouldn't use the Polident cleaner at all because it could easily poison her. So she stopped using the partial plate entirely.

Anxiety is an ugly thing and only worsens when left untreated. Whether she approves the recommended meds or not, it's a good idea to get her pain and anxiety treated, one way or another.

Good luck!

If you are also her designated medical POA then you have every right to refuse certain drugs or procedures for your mom if it is not for a life-threatening condition.
All too often care facilities will drug up their residents to make caring for them easier. If your mom has anxiety, ask her doctor to prescribe an anti-anxiety drug like lorazepam that can be given to her as needed. It works really well for most people and doesn't come with all the side effects of psychotropic drugs.
Say no to the SSRI and yes to an as-needed anti-anxiety drug like lorazepam or xanax.

Wow! So you ask for something for pain and then you want to refuse it? I would suggest you discuss it with a pharmacist if not the psychologist first! Some of the antidepressants have been shown to be a good pain reliever, not addictive and have the benefit of helping improve the mood of someone depressed (you might become depressed if you were in chronic pain). So I suggest that unless you have been educated on the drug by someone knowledgeable, that you don't have a negative reaction...

I didn't think psychologists could write prescriptions, I thought that was only psychiatrists and M.D.s. Correct me if I'm wrong, but SSRIs are for anxiety, but maybe she would have less anxiety if her pain is relieved. You don't mention if she takes anything for the pain.

If your Mom and you do not want her to take an antidepressant for anxiety and pain, fine. I get it. Thing is, SSRI drugs are the first thing docs throw to see what sticks. At 91, that could be a long guessing game to find one that might help her anxiety. But the odds are, she will still have pain while navigating side effects of (Guess)SRI meds. Then repeat until one is found that helps her anxiety. You just want peace for her, and now. Is that too much to ask?

Is it possible that she could be consuming food or drink to make anxiety worse? Coffee or wheat? Does her anxiety start a few hours after her no or low protein breakfast? The first place effected by low BS\glucose is in the brain. Some ppl get mad, some angry, foggy, tired or some anxious. I have seen a pattern in my seniors with all 3 and have seen improvements by eliminating, substituting and keeping glucose levels even as possible. Enter small protein snack ever 2 hrs or before.
And last, if the doc is not hearing either of you on this, Hospice is always an option if she qualifies. Hospice does not mean she is actively dying, but at 91 there is failure to thrive. It is never too early for HOV if someone cannot be helped by docs with their pain and anxiety. I am a huge advocate for peaceful quality of time left rather than quantity of time, months or years left. That is just what they do. And I know my suggestion of HOV is biased, I have endured anxiety & panic attacks my entire life and there is nothing more exhausting. Not to mention the years of countless ?SRI meds docs said would work for my anxiety and did not. I could have enjoyed my 20s and 30’s had I just been given an anti anxiety med. There is no reason why she should not be given the smallest dose on a PRN basis & that goes for her pain too... best wishes for your dear Mom💕

As POA talk to her doctor about her medical care and drug treatment. You are the one who has to help her with medication decisions now. At age 91 you would want to have pain management, but there a lot of choices for the anxiety. Sometimes assisted living facilities take the path of least resistence, but you don't have to go along with this. You can ask the pharmacy not to fill the prescription while you are discussing options with her doctor.

Have you or your mom in your presence voiced your concern to the doctor prescribing this medication? Before simply refusing it I would recommend making sure you have a clear picture about why that particular drug is being prescribed and what he or she hopes your mother will gain from it. There are several antidepressants that are used for their side affects because they block pain receptors. That said I think it’s a valid concern that at her age trial and error with these meds seems more difficult and time consuming. It also seems like the wrong specialist if the goal is her pain relief so if indeed that is the goal along with her anxiety (which could be very interconnected) I would ask that a specialist in geriatric care/pain be consulted as well. Maybe together with the psychologist (who probably works with a psychiatrist that actually prescribes) they can come up with a plan and explain it to you and Mom so it makes sense to you. It’s also of course possible that is happening behind the scenes given the medical care is being done through her AL facility and a good discussion with her medical team, including this prescriber, will shed some light on why this drug now for you.

You and mom if she’s capable have every right to understand and agree with treatment but don’t go in with an advasrial approach, skeptical sure but start by just making it clear you want to understand the thinking, the choices and why this is the plan rather than refusing the plan right off the bat. Hopefully this will also establish a relationship that will put you in the loop from now on. Good luck!

Not knowing why your mother has pain and anxiety, a possible solution is palliative care. The following is from the site listed. You would contact your local Hospice for an evaluation. These are a multidiscipline team who are experts in symptom control. Good luck.

What Are Palliative Care and Hospice Care? | National Institute on Aging (nih.gov)
Who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life. Palliative care can be provided along with curative treatment and does not depend on prognosis.

A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.

Yes

You should go directly to the prescribing doctor. I am uncertain why you are unwilling to "try" something that may help your Mom. Often low dose anti-depressants help with pain and anxiety. If it isn't working, then you can ask it be withdrawn, and again, speak to the doctor. A psychologist cannot order drugs in most areas. Only a psychiatrist or MD can. Speak to the person ordering this. Let the facility where Mom lives know what she is taking and that it is new and ask them to be on the lookout for any increase in anxiety, and drowsiness or difference in gait, any falls. Tell them you are worried about a mind altering drug in an elder this old.
Wishing you good luck. If your Mom is in distress something should be done. See if you can make an appointment with her psychologist, taking your POA papers with you, and tell her you are very worried, and why.

SSRI for pain? I would look for a second opinion. Follow your instincts.

Any drug that alleviates anxiety can also help with pain. My Dh is on Zoloft for (among other things) for restless legs syndrome, anxiety, and pain. I'm pretty sure he takes it about half the time, or less.

I add my query as to why you took mom in to see a doc and then don't choose to follow the treatment. I mean, you definitely have that RIGHT, but what a waste of time.

Personally, seeing my mom's anxiety ramping up, up, up over the past year, I WISH she would get something for anxiety. But she is now a high fall risk and no dr will give her anything for pain or anxiety. At 91, it frustrates me that they will not help her out. She faked a few too many falls and that made her a 'risk' even though she truly had not 'fallen'. Geriatric patients can be hard to work with!

Go BACK to the dr or find another one. Doctors are not mind readers, and they kind of have a 'list' they run through. Many elderly patients are notorious for not being very forthcoming with their issues and the poor doc is left guessing and playing guinea pig, b/c a patient won't be truthful, or expect the doc to just 'know'. And believe me, they DON'T. 2 of my kids are Drs and they are awesome in their own fields, but have them look at a sore throat--I can dx strep better than they can. I'm definitely better at psych things than they are.

SORRY

GREETINGS BABA777,
AS A RETIRED NURSE AND A CAREGIVER, I SAY THAT YOUR MOM, AT 91, DOES NOT NEED AN SSRI TO ADD TO HER BUCKET LIST OF MEDICAL PROBLEMS. IF SHE WAS SUFFERING FROM A UTI, THEN I WOULD SAY, OF COURSE TREAT HER WITH THE APPROPRIATE ANTIBIOTIC AND FLUIDS. SINCE YOU HAVE HER POA YOU DO HAVE THE RIGHT & RESPONSIBILITY TO CONSULT WITH THE PHARMACIST.

SSRIs are work well for pain relief. I have been on Cymbalta for 10+ years to manage my pain. My mom as well takes it and without it she complains of pain. As a nurse, I see more and more patients on SSRIs for pain. The side effects to alternative pain medications, in my opinion, can be more severe in the elderly. SSRIs have made a huge difference in my Mom’s life as well as my own. It is worth a try for you Mom. If she were to have side effects that she were unable to tolerate then she could just refuse to take the medication. That is her right as well as yours. I hope this helps in your decision, and if you decide to try it, I hope it helps her pain. God bless.

Yes, you should tell her Dr and the Pharmacists that you and your mom have decided that she will not be taking these meds.

All meds have side effects and you need to decide if the benefits out weigh the side effects.

MY 96 yr old Dad is in his own home with 24 7 Caregiver Care and has Nurses and a Nurse Practioner visit him.

I have told them more than once regarding different Rx's that I don't feel comfortable with him taking and he doesn't take them nor do I have them filled.

It is totally up to you and your mom.

One of the bad things about Old Folks Homes are any time a person is the least causing them what they consider trouble, they get the Dr at the Living Facility to prescribe a Rx.

Mout all Seniors are on way too many meds.

Do what you think is right but besides a gut feeling, ask the Pharmacist and look up on line the benefits and side effects.

Also, ask the Pharmacists what would be a good option with less side effects.

Talk to the dr about the side effects that concern you. Ask about other drugs that may have fewer effects. Then make your decision. Mom has a right of what and what not to take.

Even if the doctor calls in the prescription, you do not have to pick it up. The suggestion to ask the pharmacist for advice on alternative drugs is an excellent idea. Pharmacists often have the best knowledge and advice about drugs, side effects and interactions. Sometimes doctors pass along what the latest drug rep has pushed without having much awareness of side effects.

If she starts taking an SSRI, be very careful about taking her off. My mom was taken off Paxil cold-Turkey and suffered seizures and permanent brain damage. It needs to be weaned off very carefully.

The hospitalist - not her regular doctor who knew her - wanted to put my mom on Sertraline for anxiety and dementia. I looked it up and saw that it could make the dementia worse, so I refused ( the hospital nurse said, good for you!) You want someone who understands the elderly and doesn't just push the most popular drug on them. Sometimes the cure is worse than the disease. In my experience, Palliative care is also big on sedation - this is my only complaint about them. Hospice is, of course, REALLY big on sedation and most elderly want to reduce pain but not end up lolling out of their chair in a coma. My aunt in nursing home made the mistake of yelling fire one day - from then on she said, why can't I stay awake. Oh, I knew....

AS a palliative care nurse practitioner, I can share this: the SSRIs have been found to help pain, especially nerve-related pain, in some people, in ways we don't fully understand. It is NOT through their sedating effects but a sort of nerve-calming that actually treats the pain and allow for the use of much less narcotics. With dose-adjustments, these can be safe in very elderly patients. I echo those that recommend palliative care and those that recommend a conversation with your provider about the regime that they are prescribing.

While you have a POA this does not necessarily give you card blanche to refuse medication or medical treatments on behalf of your mom. If your mom is still considered competent, she can refuse treatment, and you need to accept her decision to take or refuse any treatment options. Be careful not to overstep your position as a POA as you don't want to be accused of coercion either. I would consider contacting an elder law attorney and asking if you have the rights you suggest you have under your POA authority. A POA is not the same as a guardian of mom's healthcare.

SSRIs, as opposed to say benzos, are fairly safe, though I know that is not the point of the question.

Even with benzos, my own dad suffered agitation in his first year or two of ALZ.

The MD prescribed a benzo, I cannot remember which one and that helped a whole lot. The MD said use it very limitedly, as you can get addicted.

I said hes a 92 yo man. So what if he gets addicted, isnt comfort better for him? The MD said the other issue was how it effected balance. That resonated with me more.

But as people get into ALZ,shoudlnt anything that provides comfort be OK? I knwo this sounds cold, but ALZ is basically terminal.