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?

OP - one reason he may have a catheter is because when people get chronically constipated and faecally impacted, it also can block off their waterworks, so they also go into urinary retention. This is very painful and distressing and needs a catheter until the constipation is resolved. The hospital should not have discharged him without a plan for the catheter care and checking that he can manage it independently but in my experience (community nursing) this does happen more often than it should. I'm sorry your parents are having to cope with such a distressing situation. Can I suggest you contact your local district nurses - they can liaise with the hospital, find out the plan for the catheter and potentially help your mum with the catheter care. Or at least show her what to do with it. They also may have someone in their team to help with the constipation - he may need more/different laxatives, or may even need manual evacuation. They can also sort out some skin protection to stop him getting red raw, he will be at risk of moisture abs pressure damage on the skin on his bottom with everything that is going on. With regards to confusion, although things like a UTI are common culprits, constipation alone is enough to tip a frail older person into delirium. So that may also be the cause. Once this crisis situation is resolved I think it would be very reasonable to request the GP carries out a medication review. Over prescribing and polypharmacy is common in the elderly and can be problematic. Best of luck.

PS in my area we have a rapid response team of nurses/physios/OTs who's main remit is to prevent admissions in cases like this - it would be worth asking if any service like this exists in your area.

Um...could people read the Op's posts at least? There is new situation and IMHO it's an emergency. Really OP call 111.

Yes 111 at this time of night...he may or may not need to go back to hospital but none of us can tell from here.

Unless he regularly has issues that the laxatives don't help with, the GP won't know he's having issues.

I would recommend him requesting Etoricoxib instead of Naproxen. It's a NSAID (anti inflammatory) but has worked well for my friends and relative with arthritis and cause less constipation and bowel issues.

@RentalsDrivingMeMental please phone 111 - your dad could be suffering delerium (acute confusion) due to constipation or a uti now.

Then In the morning contact PALS ASAP at the hospital and explain the situation - once they are involved things tend to start moving.

I don't really think there is cause to complain about the GP, although perfectly reasonable to expect/ask for a meds review.

However I'm really shocked from what you've said in your most recent update. It's possible they think that constipation is causing urinary retention hence the catheter, but sending home without him understanding the plan AND whilst newly confused is very poor.

The only suggestion I can make is to take him back to a&e and get him assessed again. Sorry. I know that's shit.

And I think I would complain to PALS to find out why this has happened, and I'd probably be emailing the GP practice manager as your practice sound worse every time you update!

(Sorry- confusing- I meant I wouldn't complain based on your original post but subsequent updates have changed my mind)

@RentalsDrivingMeMental how is he doing? I hope you have got to the bottom of why he was catheterised and sent home.

[quote Totallyworthit]@RentalsDrivingMeMental how is he doing? I hope you have got to the bottom of why he was catheterised and sent home.[/quote]
Thanks for asking after him.

He is still at home (not been to A&E but did have a paramedic visit him end of last week after calling 111 due to pain) but is incontinent and mum has become his carer. GP/nurse booked in for next week after my sister and I rang them asking for them to contact my parents - the nursing team knew nothing about him.

Dad has now been able to tell us what happened in bits and pieces - he is still in pain - catheter he says was put in as he told the hospital he was having problems peeing.

My sister wrote to PALS and they have passed on our concerns as to how his discharge was handled. Parents have now signed forms allowing their GP to discuss any aspects of their care with us going forward (POA not needed, we just want to know what is happening so we can support them).

It’s good that you will be able to discuss care with the Drs in future, your poor M & D must be quite distressed with everything that’s gone on. I hope he soon has better ongoing care and they can get his pain under control. A worrying time for you & your sister, I hope he feels better soon