Unhappy at GPs regarding elderly parent

[RentalsDrivingMeMental]

My dad (late 80s) has always suffered with his bowels. He takes laxatives, prescribed by the GP, every day. He's a bit old school in his thinking, feels he must go to the loo everyday and will sit and strain away until he does. Dad also has arthritis - gets prescribed Co-codamol and Naproxen, both known to cause constipation. He's also one that doesn't want to cause a fuss and is deferential to GPs.

This weekend he can't go to the loo - looks like fecal impaction. He's currently had to be taken to hospital over it (as advised by locum GP) as he's in so much pain and will probably need treatment to clear the blockage.

AIBU to be annoyed that the GP practice he is registered with don't seem to be talking him through his medication? They just give him prescription after prescription. Last year, when I was last able to visit before lockdown, I looked in the kitchen to find a whole mountain of meds! He doesn't know half the time what he's taking them for, just knows he has to as the GP told him to. He's pretty stubborn and won't listen to me telling him to ask for clarification from GP. I've got a feeling there is some senile dementia creeping in too.

I just feel he's being left to it, rather than the GP practice taking an active role in managing his medication.

Anything I can do? Make a complaint?

He's pretty stubborn and won't listen to me telling him to ask for clarification from GP. I've got a feeling there is some senile dementia creeping in too.....I just feel he's being left to it, rather than the GP practice taking an active role in managing his medication

Have you considered that he's stubborn with them too, and tells them he understands everything he is taking?

What do you want them to actually do?

perhaps not complain straight away but ask for his medication to be reviewed to see if all is needed etc. perhaps also mention your concerns re dementia to see if they can access him.

Pharmacists can do medication reviews too.

He may needs something like a bulking agents and a separate laxative

There are other factors that might be making his constipation worse. Dehydration, less activity, change of diet and other medical factors. A complaint seems a bit OTT. Asking for a review and additional support would be fine.

I would ask if he could have his meds delivered in a preprepared blister pack to reduce dose errors and stockpiling.

Having elderly parents at a distance is horrid.

I don’t think a complaint is the right way to approach this - GPs have been under phenomenal pressure and realistically cannot he expected to know the ins and outs of each patient’s circumstances. Perhaps whilst he is in hospital raise it with them and ask if he could have something put it place for medication compliance/a dosette box?

What would “taking an active role in managing his medication” look like, OP?

Genuine question! I’m not sure I understand what you’d be seeking for them to do? He won’t have been prescribed them without the GP talking through what they’re for. So he’s forgotten if he can’t tell you when you ask. By late 80s I’d expect this to be not unusual. Does he have anyone who comes in to help him?

You do know ‘senile dementia’ is an outdated term? Just because he doesn’t think the same way as you do doesn’t mean he’s got dementia. Unless you are with his when he sees his GP you can’t know why conversations they are having. You’d be better served looking at what your DF can take to prevent constipation - a glass of prune juice daily, weetbix for breakfast, drinking plenty each day.

His local chemist could do a medication review. Is that something he’d be prepared to ask for?

PILs have a mountain of unnecessary prescriptions too. I think GPs just give them what they want so they stop wasting their time tbh. Half their load is stuff they could buy at any old supermarket.

YABU.
They would have explained the medication to him when it was prescribed.
They cant control his every moment.
If he cant cope at home he should either be having carers who can sort his medication or be in a care home.
Either he has capacity or he doesnt.
There should be someone who he sees him on a regular basis who is keeping an eye on him.
In most cases this is his family and if there is any concerns they should be asking the GP to review.
The GP isnt a social worker.

What about asking the GP to do a medication review? I do know what you mean, my dad ended up with a big pile of pills and it can get a bit out of control. Would he be happy for you to go to the GP with him, or agree that you are able to discuss his health, medication, etc with the surgery. My dad was happy for me to do this, he just had to sign a form allowing permission. He got to the point where I don't think he fully comprehended everything doctors were advising, etc; deafness didn't help either so it is good of you can be involved in his care and ask the sensible questions he forgets to/doesn't think to ask, etc.

@Soontobe60

You do know ‘senile dementia’ is an outdated term? Just because he doesn’t think the same way as you do doesn’t mean he’s got dementia. Unless you are with his when he sees his GP you can’t know why conversations they are having. You’d be better served looking at what your DF can take to prevent constipation - a glass of prune juice daily, weetbix for breakfast, drinking plenty each day.

From your user name I suspect you may have been stung by the MN tendency to blame any unreasonable behaviour in anyone over the age of 45 on dementia. However if the OP thinks that her father, who she presumably knows well, and who is in his late eighties, is showing signs of dementia then she’s probably right.

GPs just don't do this anymore to any level. Even when we as specialist services ask them to monitor something we can't, they don't unless it's patient led. Those without support fall through the cracks. No time, no consistency of GP. No joined up thinking. But meds reviews should possibly be flagged after a year on the same prescription. I don't think you are wrong btw, just sad that it is like this now.

If he cant cope at home he should either be having carers who can sort his medication or be in a care home. I don't think there's any indication he can't cope at home.

Either he has capacity or he doesnt. Capacity isn't an all or nothing thing. It's assessed case by case, on the basis of the particular decision. You can have capacity to decide whetehr you want to be in a care home but not have capacity to cope with your finances.

At my GP practice you can't get your repeat prescriptions after a certain yearly date without having a meds review.

It's the GP who does the meds review & the pharmacist who can for example organise each day's medication into pill boxes for a week at a time.

If you suspect you dad is getting dementia then my advice is to get health & finance POA set up as soon as possible!!

First thing you should do is speak to your DF and ask that he confirms to his Gp that they are happy to speak to you about his medication / care. And 2nd thing is sort out POA for health and finance so that if he is developing dementia, you get that while he still has capacity to sign it.

I think you need to be careful about complaining about a GP without being clear on what's happened or what you mean by a "more active role in his medication". That might mean a 6 monthly review, it's unlikely to mean a weekly phone call asking about his bowel habits (for example). Equally, if your father can get to a surgery or a pharmacy, unless someone tells a Gp, they would have no idea that there is stacks of medication stored in his home. Capacity is assumed unless proven otherwise, so unless the GP has reason to think that your DF does not have capacity, it will be assumed that he does and can manage his medication unless he tells them otherwise.

YANBU if he is on several medications, it is a good idea to have them reviewed, several common meds have side effects which can cause confusion especially in older people westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file

It's the GP who does the meds review & the pharmacist who can for example organise each day's medication into pill boxes for a week at a time. Pharmacists also advertise a meds review, looking for interactions, giving advice on time of day to take them etc. But you'd have to go back to GP to change prescription I presume.

I thought codeine wasn’t supposed to be prescribed for the elderly for that very reason. So a meds review would defo be helpful to find an alternative.

Is your fathers diet healthy with sufficient fibre in it? They could prescribe fybogel or something to help?

If he’s in the hospital they can review meds with the hospital pharmacist. Over 80% of information given to patients verbally is lost very quickly so it’s not surprising patients forget & a lot of people aren’t taking meds properly.

I have a pill sorter for dh, he says it makes it easier for him to forget to take them all in one go 🤦🏻‍♀️.

Good idea from @Iliketeaagain about Power of Attorney, add that to your list too x

Thanks for the responses.

To clarify (and I hope I don't get accused of a drip feed!), he lives with mum and I live local but as I work in a school I have been loathe to visit unless absolutely necessary as I'm not in a bubble with them.

Complaint may be too strong, but I would hope when the GP prescribes something, they look at his meds he's already on, and consider the implications. I don't feel that always happens (the GP that attended today expressed a different POV from his usual GP over his meds - this confuses him and mum). A meds review sounds like the ideal route.

Dad has capacity, but it's a toss up somedays whether he's just hard of hearing or stubborn, or starting to edge towards dementia (his mum had dementia and my mum feels he is going the same way). He will never challenge authority; if the Gp says "take these" he takes them, no questions asked. Whenever I try to talk to him about his meds, he shuts down a bit. He's aware that he's old (even though he still feels young in his head!) and I guess feels embarrassed and pride is part of this too. He does not like the fact his body is ageing and gets very frustrated. I also feel he doesn't want me involved too much and of course I need to respect that - I am still his little girl in his eyes.

I advised him to move a bit (exercise), but with arthritis, it's painful. I advise to drink more fluids; he has issues with his waterworks so won't do that. He used to be on Fybogel but GP gave him Movicol instead, which he takes religiously (and he has been on this for donkeys years). His diet is pretty OK - mum cooks fresh every day.

I don’t think the drs going to hand over a prescription with no instructions & The drs instructions are on the box, there’s a patient information leaflet inside & any serious interactions would flag up on the screen during the consultation.

When dh was on a higher than usual dose of one med the pharmacist flagged it up to me to make sure we understood it was unusual.

But, if he’s hard of hearing it might be worse than you realise & he’s missing a lot.

Clinical pharmacists and pharmacy technicians are being employed in growing numbers by groups of GP surgeries through NHS funding. One of their focuses is to perform 'Structured Medication Reviews' (though Covid and the vaccination programme may not have allowed as much time for this recently). These reviews go through all medications checking for safety, effectiveness and patient understanding/adherence. GPs don't have the luxury of enough time to do this. Please ask if your father's surgery has access to a clinical pharmacist who can review his meds.