The elderly and the medical care community.

I have had similar experiences. The American Gerontological Society publishes a list of medications that should not be used in the elderly - the Beers List (Dr. Beers initiated the list). Yesterday I used that information to get my mother-in law's ditropan stopped. In November she was started on Amlodipine (which controlled her blood pressure) but caused her to have swelling in her legs. In December she was started on fluid pill for the swelling, she complained of having to urinate frequently and was started on ditropan. In January we got the amlodipine stopped. In February, unrelated to those issue, she had severe back pain and was started on Lortab. It was dosed twice a day instead of being used when she complained of pain (prn). She became very confused, agitated and exhibited depressive symptoms. We asked for something for the agitation and Paxil was prescribed. I talked with her doctor and pharmacist about the mental changes, both said the confusion and agitation were not from her medications. Her paxil dose was increased because of increased depressive symptoms, it didn't do any good and may have increased her agitation. Eight weeks ago I started being present when the doctor makes rounds at her nursing home. I got the Lortab switched from twice daily scheduled med to prn by saying she needed in February when her pain was severe, does she need it now? It was changed to prn, she hasn't needed it. The Paxil was changed to Celexa. Her mental status has cleared considerably, her depressed symptoms are less. Yesterday the ditropan was put on hold, if she has bothersome urinary symptoms we'll start it again. One of ditropan's side effects is confusion so I'm hoping her mind clears more. My goal is to get her off medications that have confusion as a side effect unless they are absolutely essential. The nursing home is the best one in the area but there is an attitude of "we know best" so I've needed to be pushy. Yesterday her doctor said that confusion was normal for someone who is 94. We've been on a waiting list to see a gerontologist since April, probably will see him in July. I'm an RN and none of this has been easy. As far as doctors adding medications - I'm reminded of a song we sang when I was a child - There Was an Old Woman Who Swallowed a Fly. She swallowed a fly, then swallowed a spider to catch the fly, then swallowed a bird to catch the spider, then swallowed a cat to catch the bird, then swallowed a dog to catch the cat. Get the connection?