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?

I had similar with my Mom. She was on a number of meds but wasn't taking them properly. For example, she had no thyroid and didn't take her med so was having bad symptoms. Dad was preoccupied with his own cancer so wasn't reminding her.

We all lived a good few hours away. When Dad went in hospital we had to rush home to help Mom. I got the pharmacy to blister pack her medications so they were in individual dosage bubbles. It helped a bit.

It is a real struggle but I might start first with the pharmacy. They also delivered the blister packs which made a big difference. Can you get the pharmacist to review your Dad's meds?

I am sorry you are dealing with this. It is such a worry.

Your father is an adult with the ability to take control of his own drugs. He can ask for a medicine review with his pharmacist. I’m surprised it hasn’t been offered as most pharmacies do push them for their own funding.

Movicol is a stool softener rather than a laxative and kinder on the bowel. Lactulose will give relief but can cause accidents. I would talk to your GP about these with his painkillers as it may give your dad relief

@LemonRoses

Your father is an adult with the ability to take control of his own drugs. He can ask for a medicine review with his pharmacist. I’m surprised it hasn’t been offered as most pharmacies do push them for their own funding.

The service where community pharmacists provide 'Medicines Use Reviews' is being decommissioned at the end of this financial year (next week) due to Clinical Pharmacists at GP surgeries providing Structured Medication Reviews.

I think you have unreasonable expectations of the gp. They will take a look at your dad's current medication and prescribe accordingly, they will give lifestyle advice but it is up to your dad how much he takes on board. A medication review with the gp should occur at least once a year and your dad's pharmacist can help too. Many stronger painkillers will cause constipation, it is a toss up. To reduce constipation, you said your mum cooks fresh meals but are they dense in carbohydrates? He needs plenty of fibre in his diet, I can understand the not wanting to increase fluid if he has issues with his waterworks but some fruits can help too. Exercise will also help yes he has arthritis but if his pain is manged well why can't he do some exercise, even getting a daily 15 minute walk would make a difference. If the pain isn't manged well then he needs to go back to the go and say so.

@Sceptre86

I think you have unreasonable expectations of the gp. They will take a look at your dad's current medication and prescribe accordingly, they will give lifestyle advice but it is up to your dad how much he takes on board. A medication review with the gp should occur at least once a year and your dad's pharmacist can help too. Many stronger painkillers will cause constipation, it is a toss up. To reduce constipation, you said your mum cooks fresh meals but are they dense in carbohydrates? He needs plenty of fibre in his diet, I can understand the not wanting to increase fluid if he has issues with his waterworks but some fruits can help too. Exercise will also help yes he has arthritis but if his pain is manged well why can't he do some exercise, even getting a daily 15 minute walk would make a difference. If the pain isn't manged well then he needs to go back to the go and say so.

Agree with all of this but GPs are not able to do annual F2F medication reviews with patients in many cases due to workload and the fact that meds change so often in so many patients. They also have too high a workload to check if patients are building up a stock at home, really the community pharmacist is better placed to oversee that. Any painkillers with an opiate in (like co-codamol and most that can be used in the elderly) risk constipation as a side effect and patients are usually advised now about fluids, diet, exercise, etc but this may not have happened if he has been on them for a long time or he may have forgotten. He would be better with a senna tablet than Movicol or lactulose to keep things moving. It would be worth looking if he should still be on naproxen as anti-inflammatories are often not advised for elderly patients now.

I think a few people commenting don't necessarily know what it's like to have an aging parent who has perhaps got a bit stubborn, embarrassed, or stuck in a rut, etc. It might be worth posting in the Elderly Parent section where there are lots of people who have been through a similar scenario, I've found it very helpful in the past. Good luck OP, hope you get somewhere with a medication review

Thanks again for the comments.

Dad was sent home from hospital last night with only part of the blockage removed. He is still in pain and unable to sleep due to it. He is therefore trying to manually extract it himself. Mum says he is red raw and he is also soiling himself. She is extremely stressed by the situation.

I suggested today that they give the GP written permission so I can talk to the GP direct about their care/meds.

To clarify, Dad has not actually seen a GP during lockdown, he has only had phone calls, and repeat prescriptions.

Both my parents do not take the information given to them in by professionals, I have had to be an advocate for mum when she was having cancer treatment a couple of years ago because she just didn't take what the consultant was saying in. It's almost like a processing issue; I'm sure if things were written down for them instead of being given verbally, they may be able to process it over time. Instead my mum gets very upset, feels she is "stupid" and "useless" because she doesn't understand. But she does when I talk it though with her slowly, giving her time to ask questions. Dad, however, just doesn't want to talk to me about it (I guess he never envisaged having to talk about manual extraction with his "little girl"!)

You're right @BoredOfCbeebies - unless you have elderly stubborn parents who are finding it hard to accept help, it's hard to appreciate where I'm coming from.

Years ago my DM was definitely not herself and long story short her GP actually came to her house and went through all her medications. Would he let you accompany him to the Gp if he does a face to face appointment. Though I expect the hospital might do a review of his medication. My DM has a few hospital stays last year and they looked at her medication each time.

May I introduce you all to ~ golden linseeds!
Soak a spoonful in water overnight every night and they will become 'gloopy'.
Knock them back in the morning and your poop will slip out like a yard of satin.
The size of the spoonful is up to you. This won't clear a blockage but once that's shifted, it will keep him regular.
Works with children too. And when it's gloopy it tastes like lychees.

Oh this sounds horribly stressful for all of you. I would ring the GP to explain what is happening and ask them what forms your dad needs to sign to allow them to discuss treatment, medication etc with you - you take the initiative here. Has he been sent home with any strong laxatives, presumably they're expecting the blockage to clear naturally now, otherwise they wouldn't have sent him home?! At least you've got your mum to relay information to you, if your dad is too embarrassed. I think it's really hard for parents to accept help from their children in these situations, all I can say is keep trying.
I wonder if a visit from a district nurse might help? He's more likely to take advice and listen to a stranger perhaps. And longer term, ask for him to be seen by the continence team for general advice - GP should be able to refer. Hope he feels better soon.

Actually a pp is correct about linseeds!! Holland & Barrett or even supermarkets sell them.
I ate a lot in my muesli (2 bowls in one day) no idea why I did that but ended up with actual diarrhoea that day!!

I suggest your dad stops trying to manually evacuate as this is so dangerous it's actually banned in hospitals, it causes tearing.
Instead a bowl of porridge with LOTS of linseeds plus the laxatives he has will do the job.
Also call the district nurses for advice as they have more knowledge than drs on constipation- maybe another enema will help too.

I do sympathise with your dad as I've cared for older ladies in pain from having stools stuck. I found massaging the bottom near the back passage actually helped one poor lady. It was a tip given to me by a nurse.

Update - yesterday dad was taken to A&E again, in pain. He came home late last night with a catheter (bag strapped to his leg), still in pain and now confused. He cannot tell us why he has a catheter, how to empty it, how long it's in for. He's just to wait on a call from urology. He collapsed twice overnight, is now fecally incontinent and mum is having to frequently wash/change the bed. She barely slept last night as she said she kept checking he was still breathing.

Mum phoned GP this morning, was told he wasn't available and to phone again tomorrow morning. Receptionist was advising my mum over the phone about my dads meds.

I've offered to get private nurses to visit to help with his care, but is this what it's now come to?

Oh, and no phone call from urology, and I guess with Easter weekend approaching, we may not hear from them until next week.

OP

I hope you don't mind but .i'm going to flag this thread on the elderly parent board

Then you can get more advice, not sure who will be on which thread but we are here

www.mumsnet.com/Talk/elderly_parents/4200011-The-Cockroach-cafe-new-look-for-spring-2021

I would call out of hours tonight OP and explain how much he has deteriorated and how he has a catheter that you have no idea what to do with or look out for. He needs to be back in hospital. Is he a lot more confused than normal? Is he on antibiotics?

I’d ring out of hours too, if you can find out the urology dept ring them too.

Defo phone for advice. They can’t release someone home with no assistance with emptying a catheter bag. He probably has a uti, which would explain the confusion.

Thanks @AcornAutumn

@NerrSnerr no antibiotics. We thought UTI hence the confusion, but we have been told nothing. It appears that whoever discharged Dad assumed he was with it, heard them and understood it, and would also remember it.

If you think he is muddled with meds can you request a referral to the community matron? They're generally excellent with this situation. Sounds like he is making unwise choices with not drinking more etc.

Have you tried 111 and told them he collapsed twice?

You can phone the DN team tonight for someone to teach him or your mum how to empty the bag. The problem with catheters is that there isn't a service (other than private carers) that will come out every few hours to empty it (unless it's different in your area).

111 should be able to put your through or look on the GP website.

He maybe demonstrated in hospital that he had the dexterity to empty the bag with someone talking him through it and now with his confusion, he can't remember how.

Problem is with catheters is that they can cause a UTI, especially if he is faecally incontinent as well, so he maybe didn't have a uti, but he may well have one now. Also if he's constipated, it's more likely that the catheter will bypass / leak because of the constipation.

I hope you get things sorted - a lot of areas don't have community matrons anymore, so the DN team are probably the first port of call for catheter support.

I think the GP would expect his family to help tbh. It also appears that your dad has been taking everything that is prescribed. It may be that the constipation medication needs to be changed but unless your dad or mum are flagging up that this medication is no longer working, how is the GP supposed to know. The days of the GP phoning or calling round to check on someone no longer exist. I agree that asking for a review would be a good idea.

This is so not the GP's fault. Your anger is totally misplaced, misdirected. He is responsible, and if he's not caisbje/willing/too stubborn, then clearly it's getting to the time when he needs more help/support/guidance/instruction, from a carer or a home?

Just seen your update OP. I would call out of hours. Maybe he wasnt ready to be discharged. If you think he can't advocate for himself, you need to present yourself as his carer and ask to accompany him.