She is a very difficult person to manage. If she is sent for a psychiatric exam what are the consequences?

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Even those with any dementia, can refuse meds, sometimes it's in their best interests to get them to take them, despite their refusals, as they are not in a rational mind....but that is dependent on proper evaluations.

The suggestion to hide meds in her applesauce or pudding, is a good one.
That usually works for elders who have some dementia, and cannot understand or be made to understand, why they need to take meds.

She sounds like she could use a proper evaluation.
When a patient has difficult behaviors, sometimes the facility might try to get meds to help control the behaviors--which might be preferable to allowing the patient to act out, disrupt or cause harm to other patients and staff.
...and it's likely preferable to them telling you to take her home with you!

Psych meds these days are not perfect, and elders can be overly sensitive and may need smaller doses, but the meds can be far better than allowing very disruptive behaviors to cause other unfortunate consequences.

From the expanded details you offered, she needs other help than antidepressant. An abusive or emotionally escalated person is usually -not- able to control themselves--that does -not- sound like antidepressant territory.

Please do get her evaluated to learn what might be right for her needs--whether it is other meds, or rearranging the ones she currently has prescribed. Or something else.

Please keep us posted!
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I want to add to Burt's excerpt of what I sent him in his hug. I couldn't remember what thread was involved or I would have responded directly. He said the caregiver indicated that the patient was agitated and wanted medication suggestions. What I answered was that my mom and my aunt we're both at you take it out of frustration and anxiousness. Buspar helps with anxious and anxiety problems. The full answer was that it is important to determine what the anxiety comes from because a tranquilizer such as ativan or xanax, or even an anti-psychotic up to and including haldol may be necessary depending on the source of the agitation. Thx Burt fot excerpting to respect the nature of my private message to you. In this question, we keep coming back to the NEED for a full evaluation, medical & neuro psych.
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I think it would do you well to try and investigate Buspar, an anti-anxiety medication.

I personally use it 3 times a day, and it has a lot of solid research behind it.

Maybe it will take off the edge of your aggravated and abusive mom.

Just be sure to get a full-blown psychological work-up from an outside doctor that you hire in her medical insurance network.

You need an unbiased opinion.

As a mental health patient, these are my heartfelt observations.

Please follow-up on the progress in your situation.

-- Burt B.
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CarolLynn has mentioned in a hug, (which is a private message), that:

" Both my aunt and later my mom we're on an anxiolytic called Buspar. Worked very well for both of them. "

She wanted me to pass this along.

-- Burt B.
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Unforunately the ones who are hard to handle in a facility does make it somewhat difficult for the other residents. Especially during sundowning, all it takes is for one resident to be disruptive and it sets off a chain reaction. Have they tried to put her meds into applesauce or icecream? This trick usually works, but even then they refuse to eat it. But if is something that they can do figure out what she likes best, chances are she won't turn it down. Best wishes
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I guess I didn't explain well. I think my mother needs to be medicated, she is vey abusive. It is my mother who is refusing to take the medication. Now she has diarrhea and is refusing to take that medication. She readily takes her pain meds and asks for more.
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Why does the AL believe your Mom needs Zoloft? Why not have a psych evaluation? Consider it a second opinion.

As for facilities 'drugging' the elderly so they're easier to deal with, I'm sure it's done. I'm also sure it's not as widespread as families think it is. A person's family members come for visits. They don't see what happens in the wee hours of the night, they often don't really see how their family member interacts with staff and other residents, they rarely see the kind of anxiety their family member is dealing with every waking hour.
They see mom or dad when they're excited to have a visitor, putting on their best face for their children.
I've seen people in a CONSTANT state of agitation and high anxiety - completely distraught all day and night - whose adult children don't want them 'drugged'. It's truly abusive when someone's pain can be eased and their children refuse because they think the staff just wants mom or dad to be 'easy' to care for!
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In my nursing practice, no one can be "forced" to take a medication, unless they are a danger to themselves or others. Zoloft is an antidepressant. What doctor is prescribing this? Anyway, a psychiatric exam is just talking, taking a history, answering questions (and listening to the way you answer them), and a little physical seeing how your reflexes are, etc. Not a big deal. Someone at the assisted living home thinks your mother is depressed. Is she? Maybe instead of an antidepressant she really needs a mood stabilizer, like lithium carbonate (the Gold Standard for bipolar), or one of the other mood stablizers. Maybe it would be a good idea to have a psychiatric checkup just to understand what may be going on with her. Everyone could use a psychiatric consult. Life is very difficult. Best wishes.
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The suggestion to make sure all POA, etc. legal documents get signed, BEFORE your Mom has a Psych eval, is a VERY good point.
As for Lawyers refusing to do legal documents and let a person sign them?? HA! Lawyers cannot diagnose.
IF the person appears, even remotely, to be capable of signing documents, they'll let them. Believe me, one brother in law found a lawyer who had made a great career of forming "plum" estates to manage, not just for himself, but for his son, also a lawyer....the brother in law took fragile G'ma to him, lead her into changing her already set up legal affairs to his favor--totally overturning everything she'd so carefully set up, in ways that she'd NEVER have done, EVER, had she been in her sound mind still...but she still presented a semi-capable mannerism, and it WAS her brother in law--very solicitously caring in his manner.
This kind of scenario is very common.
==DO get her a Psych eval--AFTER you have gotten her legal paperwork all set up.
That anti-depressant is NOT grounds for the Nursing Home to be saying that sort of threat...
==Mom probly has other behaviors they cannot manage.
IF she is having outbursts, an antidepressant is not for that--it is to prevent a person becoming terribly depressed, only.

ALSO, keep in mind, it is a patient's legal right to refuse meds--even the ones who are out of their minds. At least, it has been so at nursing homes I worked in--we were told to do everything we could to get them to take their prescribed meds, but if that failed, then, chart it as "patient refused".
A facility that forces medications, sounds rather out-of-line, and certainly putting themselves on a legal cliff.
Trying to force a patient to take an antidepressant?? Seriously??
IF a patient refused to take meds that keep their breathing open, their heart beating...that might present a greater risk of the person dying fairly quickly after refusing that medicine.
If a patient prescribed anti-psychotic meds refuses, & becomes a serious behavior threat to themselves or others soon after refusing the medication, THAT could be a problem.
But an anti-depressant? The patient is elderly...they may become more depressed--but that usually gives some time to work to change that--either a different medication, or, finding that the antidepressant was the wrong thing to give---but it does not usually become a life-or-death matter for refusing an antidepressant; a depressed person is not very likely to act out and harm others.

The nursing home seems in error for issuing that kind of ultimatum.
But it might help work in favor of better handling of your Mom's estate, if you immediately get legal documents signed [if you don't already have them....THEN do get that psych eval--because that might result in her getting better oversight of her actually necessary meds.
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Valjab & others: Nobody can force a person in their right mind to take a drug they do not want. If Mom is in dementia and you have legal medical authority for her, you have to insist on clarification from the doctor and AL facility people why they want her on this. It could be to counteract the depressive effects of pain meds. If it is behaviorally related, you definitely want an MD psychiatrist (perhaps staring with the facility's psycholigist for some insight on the situation) and only an MD can prescribe anyway. I think it makes perfect sense to do a psych eval BEFORE being put on such a medication if it is behavior related. Valjab, you have given us very little background information, and what else can we do but speculate? Please tell us more.
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This is true, and I redact and apologize for the comment of insinuating shame.
If possible, I would like to edit it out. I guess it was over-reacting on my part because of how Dad was treated in various facilities, and the fact that I do use Zoloft on a regular basis. I just don't want the primary person here abused. I apologize personally to the daughter as she is honestly inquiring what are her options in this particular case. I hope my mis-use of the word shame will not gloss over the points I made. I guess I'm just mad that they would force Zoloft on someone who may not need it.
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BurtAB - many of your points are very important, however I want to share with you that people are on this site to share ideas, information, stresses, dilemmas and feelings. We can rag on nursing homes, doctors, the healthcare system in our families but NO ONE needs to be ashamed of themselves or made to be a feeling that way. Caregiving is a long and dynamic process that can only be helped by support of those who know.
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First of all, you don't drug a person because they are annoying you or
their neighbors.

That is cruel and unusual punishment, and also pure laziness on the
part of all the caregivers. Zoloft is a very specific drug for a very
specific purpose. Namely, depression.

I genetically inherited Bi-Polar Manic depression which began at 16 yrs. in 1977. I'm now 51.

Zoloft, Neurontin, Buspar, and Seroquel have been lifesavers for me.

You have no idea of how painful, heart wrenching and debilitating a
full-blown mental illness is to suffer through.

Now, it took me 18 years to realize that Manic is a medical definition
and it is in no way related to Maniac. No one wants to be deemed
crazy, so I bucked taking my medication.

Your Mom may be making the logical assumption that if I take Zoloft,
then I'm indeed crazy.

You have to find out from her what she thinks about this medication.

The placebo effect is well documented and it may be harmful to her
psyche to take the meds, because if she does then she is admitting that
she indeed is crazy and may enter into a downward spiral.

Unless she has documented and properly diagnosed depression from a Phd
Psychiatrist, I think Zoloft is the wrong choice for dementia.

I think that you should be ashamed at yourself, and the entire staff at the
facility should be fired for abusing the drug Zoloft just ' to calm the
old bat down '.

A proper diagnosis is in order, and I would hire an outside Phd
Psychiatrist that is in her medical insurance network to make a house
call who has no ties whatsoever with the facility.

He or She would have your mom's best interest in mind, and might very
well reprimand the staff.

Don't wait for 'them' to force a psych evaluation which will simply be
a kangaroo court to force her to take meds. That is a violation of
Love on your part.

Please get an outside full-blown MD Psychiatrist not a Psychologist to
evaluate your Mom for dementia, depression or simple anxiety.

There are much better drugs on the market for dementia.

I cared for my dad with my girlfriend in his home until he took his
last breath.

Facilities are lazy and they don't hire the best of nurses.

Make frequent unannounced visits.

You would be surprised what you will find.

We came late one night unannounced when Dad was in a regular hospital
for a time, and they didn't change his bed pan for 3 hours even though
he called them every 20 min to do so.

They were too busy texting their boyfriends.

Don't just use Zoloft as an excuse for a clean a professional diagnosis
that both you and your mother can trust.

Caring for the elderly in this day and age is a industry, and they just
want to shove them in and shove them out, and hurry up and die, so you
won't annoy me anymore -- all the while getting paid exorbitant amounts of money to be a ' caregiver '.

I have a strong feeling that the facility is just using Zoloft as an

Have the outside MD properly evaluate your mom, and it may take some
time to come up with the right medication that will help her be her and
you to have a clear conscious that you are doing all you can to Love
your Mom with the best care.

Seems to me that they just want to drug her to shut her up, and she's
not stupid, and can probably pick that up.

That's why she's bucking on taking it -- she don't want to give them
the pleasure of changing her brain chemistry just to make their job

If they didn't want 12hr shifts of caregiving, then they need to get
into another profession, not abuse the elderly.

I expect some decent well thought out replies to this, because I lived
through it both personally and with my dad.

He didn't need any psychotropics, I did.


Burt B.
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If Zoloft was NOT prescribed by a psychiatrist, I would get a psych appt. ASAP. If she really does need an antidepressant, the psychiatrist might want to give her a different antidepressant other than Zoloft. If your mother is agitated and combative, Cymbalta can have a calming effect. Also, a mild anti-anxiety prescription could help. Ask the psychiatrist about different options.

An ALF cannot force someone to take a drug, but they can ask that she be moved out of their facility if they can't handle her.
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I don't know if this applies, since you don't mention the underlying condition, but .. adding to Skinnona's comment: "Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear and hopelessness in varying degrees. These emotions are common with post-stroke depression, which affects more than a third of stroke survivors." (National Stroke Association). Our doctor prescribed Celexa. At the beginning, she'd wake up and ask why she didn't just die. Within a month or so, she stopped asking. Her temperament completely changed from a demanding, exacting, angry woman to a soft-hearted, compliant (takes meds, follows cues to exercise and dressing, etc .. ), laughs at the slightest provocation (feel free to read the double-entendre, there). She's still Edna, but a softer version.

Like I said .. not sure that's helpful in your situation.

As for the results of the eval, I endorse the others' suggestions: get your mom's physician in the circle, be sure all the necessary end-of-life paperwork is finalized (you DON'T want to have to deal with it if she's found incompetent to make legal and medical conditions, later). At this point YOU are her advocate, just do your best!

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Remember that what you hear from her may not be the whole picture. Talk to her caregivers and work with them to find solutions. Sounds like she may be a bit combative, and they need your help to keep her from hurting herself or others.
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If she is causing disruption with other residents Zoloft or some other drug may be necessary. The other residents are paying to live there and are entitled to a comfortable, peaceful and most of all safe environment. I know that if my mom were to enter a facility she would become quite aggressive and disruptive, medicating would become necessary so I am keeping her at home at along as possible. You then must ask yourself if an assisted memory care situation is appropriate or is a nursing home required.
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Who is the "they" at assisted living who is saying this? The medical director? You mom's own doctor should have a discussion with "they" and then a discussion should ensue about the next steps. SSRIs can be life-savers!
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Please notice this reason why an SSRI may be very important for elderly.
"Serotonin production lessens with age and may be a contributing factor to diseases associated with aging."
Read more on livestrong.
Someone with behavioral issues needs to have a good psych eval and medical intervention--could be medication or cognitive therapy. Many contributers seem to think medications should be vigorously avoided, but in reality, though often misused or over used, when properly used can significantly improve quality of life. Personally, although over 60 I take no prescription meds at present, but have through my life needed and appreciated appropriate medication.
First, educate yourself about the suggested medication. Weigh the risk/benefit ration. Consult with a trusted health professional.
Your mom's life could be greatly improved if this med helps make up for the loss of neuro chemical the elderly fail to continue to make for themselve in adequate amounts.
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There's not much information here, but what is the reason for the zoloft? Is she having panic attacks, anxiety or harmful to herself? I don't know too much about your laws over there as I am in Canada, but your mother has rights to refuse. They can not force her to take anything against her will. Does she have dementia/ or how is her state of mind? I would personally speak with her Dr. about this and see why this is being pushed onto her.
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This sounds like a school for seeing a child to take Ritalin. Galling. Do you already have her trust, her will, her durable POA and her health POA in place. You asked about consequences and the worst I can think of is if those documents are not in place and the neuro/psych evil finds her impaired, she might not be able to sign any documents after that time. But if they're not already signed and she's currently impaired, a lawyer probably isn't going to let her sign anyway. Other than that, Zoloft is a neurotropic drug and I'm a big believer in having drugs of those types only prescribed by a neurologist or a psychiatrist. They can be continued by a PCP, but not initiated IMHO. So, I personally would insist on such an evaluation BEFORE I allowed her to be put on zoloft or anything else of that nature. Those drugs change your brain chemistry and are used all to routinely, almost experimentally.
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They could crush it up and she would not know. But maybe she has a reason why does not want to take it? I would ask her first her reasoning ? I did not know assisted living could force somebody to take any drug?
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