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Mom fell about a month ago, breaking her pelvis and humerus, she's 83 w/severe COPD. She was in awful pain, begging to die, screaming. Doctor started morphine and Dilaudid. She cannot be operated on due to COPD.

One month has passed and she still is on these drugs in same quantity. She is totally out of it now and luckily remembers her childrens' names.

I've questioned doctors and social worker who consults with pain management doctor at her nursing home wing and was told that some doctors don't like to reduce pain meds for fear of having pain come back.

My brother is not accepting that these drugs have so badly affected mom's mind. He thinks they should be cut back so perhaps her mind will returns.

Since mom now has pneumonia, severe COPD, sores on buttocks and a pelvis and humerus that will not be operated on, I think we should just go with what the doctor/staff said and leave meds alone since she is comfortable physically. I think we have to face the facts that mom is never going to walk again and even if she did, her severe COPD hadn't permitted her to walk across the room, dress herself, etc., before this last fall.

Thanks for all your help.

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And dtrinfl2 any doctor or social worker who consults with pain management doctor and say they don't want to reduce her pain meds for fear of the pain coming back is in it for the money. Pain med management is a booming multi-million dollar business and weaning people off meds means reduced profits. Yes, the brain damage from the pain meds is irreversible, but to me, it's worth exploring alternate treatments like occupational and physical therapy to help ease the pain and improve quality of life. It's a delicate balance between treatment and under-treatment for elderly folks regarding pain management. Per wikipedia, Undertreatment in the elderly can be due to a variety of reasons including the misconception that pain is a normal part of aging, therefore it is unrealistic to expect older adults to be pain free. Other misconceptions surrounding pain and older adults are that older adults have decreased pain sensitivity, especially if they have a cognitive dysfunction such as dementia and that opioids should not be administered to older adults as they are too dangerous. However, with appropriate assessment and careful administration and monitoring older adults can have to same level of pain management as any other population of care.
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1nephew...letting her regulating her does herself could kill her. I tried that and she was taking way over her prescribed hydromorphone and morphine pills per day. She was also taking tylenol and everything else she could get her hands on in between like cough medicine and pepto bismol. She's an addict and addicts feel think they feel pain no matter how much they take. Dealing with a elderly addict is 10x more difficult than a younger one because, yes, it seems to make more sense to make them more comfortable than seeing them go through withdrawals, but what you are really doing in slowly killing them and ruining any chance at a better quality of life they may have in their elder years. In my opinion its better to allow her to stay on the meds in a controlled doses to "not let her suffer", but keep the meds "under lock and key" to ensure she doesn't self medicate. Also, if you have any "addict behavior oriented" people in your home, you have to keep those meds locked up or they will go missing. Folks have to realize how potent those meds are and how much street value they have. Don't ever tell people you have them in your possession either. Elderly pain med addiction is a serious problem in the U.S. and the FDA is just now starting to realize something has to be done at the regulatory level to control it. Yes, 1nephew, my mother is going to die, but it's not going to be because she overdosed on pain meds...I won't let that happen.
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Morphine and Dilaudid combo is very potent! She is going to experience hallucinations. Try to get the doc to wean her off.
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Ambriel, In one sentence you say "...don't let your mom suffer if the meds are helping her..." In the very next you say, "Don't let her self medicate and keep the pain meds under lock and key." If you recognize suffering, isn't it morally questionable, even cruel, to in effect control the pain relief she is allowed? Would you want to be in that position? No one knows her level of pain and need for relief better than she does; why would you deny her the right to regulate the dose herself? She is going to die- we all are. Must she have no say in how, when and under what circumstances she dies? How do you want to die, "addicted" to medicine & oblivious, or suffering terrible pain?
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AMEN, midkid!
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Addiction at this point is kind of moot. Keep her comfortable. She can't be "fixed" meaning, no surgery, so the break won't heal....the COPD means she can't ever have surgery..so she is in an untenable spot.

I'd say keep her as sedated as necessary to keep her out of pain, so what if she doesn't remember people's names? That's not the issue here--her comfort for her EOL care should supercede all.

I'm so tired of us being so doggone worried about "addiction" in our very ill and old loved ones. It has such a bad connotation and shouldn't even be mentioned in conjunction with this type of situation. Just keep her out of pain!!!
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I think an evaluation for hospice care, and if it is approved, bringing hospice in is appropriate at this time.
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Sorry, I did mean nuring home. I meantion doctors and nurses.
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She is in a nursing home correct? Only asking because some are suggesting hospice at home just wanted to clarify.
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Breaking a hip is very serious in the elderly. Since she can't be operated on, pain meds may be the only way to keep her painless. I would ask about Hospice at this point. They can come into the home and work with the doctors and nurses there. Medicare pays for everything needed.
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At this stage of her life the word addiction should not even be brought up. She would be in so much pain should they take these meds away. Just keep her comfortable and prepare the family for the end. Do you really want mom to hang on and suffer more? I am sure you dont. You have to let her know its ok to let go, giving her permission is the kindest thing you can do right now. My heart goes out to you and your brother.
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My mother has been addicted to these type of pain meds for a very longs time. I believe its ultimately the cause for the early onset of her dementia. Morphine and Dilaudid are very addictive and I have basically given up hope that she will ever get off these meds. At her age and her pain level, the withdrawal would probably kill her, so we continue the pain clinic routine and try to keep the doses at a safe amount. The FDA has finally started to address the pain killer addiction problem, but it's too late for a lot of elderly people who have been hooked by the drugs through the medical system. All I can tell you is trust your instincts and don't let your mom suffer if the meds are helping her more than hurting her at this stage in her life. Controlling the dosage at this point is very important. Don't let her self medicate and keep the pain meds under lock and key. At this point, your brother needs to understand this damage caused by the pain meds to her mental state is probably not reversible. I was hoping the same thing about my mom, but the doctor confirmed that being on pain meds for a long period of time alters the brain. It's a sad situation for millions of elderly people.
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Absolutely agree with Golden all the medications should be continued as the Drs advise. Mom is getting close to the end. Bro has to be helped to understand that Mom is beginning the dying process and throwing pneumonia into the mix will only increase her downward spiral and being less aware is a kindness. Blessings
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I think at this stage that she needs to be kept comfortable. Her condition is such that it will not likely improve. The COPD will worsen -that is the nature of the disease and she would be in pain and in distress if her symptoms are not treated, Her quality of life is poor and comfort is about all that can be offered. Your brother may be helped by talking to some the medical staff who understand your mother's health issues. I think he is in denial as to the severity of her condition - denial is not that unusual. The end of life of parent is a hard thing to face. My heart goes out to both of you.
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