Help. 92 year old suddenly unable to manage meds.

[Inthechillyhoursandminutes]

Right up front, this is not my DF but the DF of a close friend.

That friend lives 10 miles from his DF, works evenings / nights and has supported DF with shopping, hospital visits, work around the house, entertainment etc. for the last 20 years. That necessitates a visit most days.

Suddenly, and with no warning his DF has started taking his meds randomly and developing anger / irritation symptoms.

We have bought pill boxes which my friend fills on a weekly basis, but have realised that is not working because his DF doesn’t know what day of the week it is. So we have bought a day / date digital clock which sits next to the pill boxes. Still pills are being taken randomly. Several lots of morning pills on one day, but no afternoon drugs etc.

Now this week, my friend is receiving phone calls at work with DF shouting at him that he is sabotaging the pill box. Also accusations that the phone or TV has been sabotaged.

Obviously this is causing concern, especially as his DF is an Insulin dependent Diabetic.

Today, in need of help. and to understand what is going on, my friend phoned his DF’s GP to ask for advice and if necessary an assessment for his DF. The receptionist advised that this issue is not something a GP can help with.

So I am hoping (with the permission of my friend) that the combined wisdom of MN might be able to point us in the right direction. Where does my friend go to access help with his DF? What resources are available in this situation?

He is not able to live with DF, needs to work and is being run ragged trying to deal with the increasing demands and anger coming from his DF. He can never get a day off, go on holiday etc. and now even his sleep is being increasingly disturbed by the phone calls.

You are wrong, many people have long acting insulin once daily.
And I presume you mean DKA and not Ketosis as they are not the same thing
and yes he needs seen by a doctor, thats why i said that

Yes there is a once per day insulin which keeps you at a certain level but then you have insulin for each meal

Lived with exh for 20 years

If GP won’t do check (and they absolutely should, sudden onset sounds like infection, exacerbated by not taking meds) then call 111. Say diabetes, sudden confusion and anger

Your friend needs a Pivotell box. It has a built in alarm and a flashing light. Social services organised one for my late husband, but you can buy them.

This might sort the pill problem. The surgery might organise for the District Nurses to do the insulin injections.

https://www.manageathome.co.uk/pd/pivotell-mk3-automatic-pill-dispenser_13653?identifiers=pla-2330483614925249&Campaign=***JF_Assetless_%20(Catch%20All)&CampaignId=710453551&AdGroup=Assetless&AdGroupId=1258942131166399&AdId=78684011133392&Network=s&msclkid=61703e10e9e9135ded60595b53b2a329

I'm shocked that the GP isn't prepared to liaise with social work for you. Friend needs to stress the insulin problem. When DH was discharged from hospital, the ward nurses talked about organising the District Nurses to do DH's injections. (He proved that he could them himself, however.)

I'm guessing that we only got help with that cos DH was being discharged from hospital. Your friend might have to phone SW herself.

Yes. DH was measuring his insulin for every meal, but after his stroke he was switched to two injections a day, set by the surgery.

Towards the end, he was only on one a day.

Tell anyone who will listen - GP, pharmacist any other specialist medics he sees. Social care is on its knees so you really have to push hard and advocate for the person.

Urgent GP appointment as well to rule out a UTI (bladder infection) or TIA ( type of stroke understated by being known as a mini-stroke).

(UTI used to send my MIL into a crazy possessed angry lady).

One of the earliest problems my mum had when she was developing dementia was managing her medication and she often missed doses and occasionally took too much, which was caused real problems as she was taking warfarin. I know not many health authorities provide this service now, but my mum's GP arranged for the district nurse to visit twice each day to administer her medication. She had been taking some pills 4x each day, but he changed the dosage so that she just took two lots each day, and I had to buy a lockable box to keep all her pills in. She was initially very indignant about the nurse coming in, but eventually accepted it. Knowing that someone was going in twice every day was also really reassuring.

He can ring Adult Social Care at his local Council and request an urgent assessment. If a care package is required, it will be means-tested, so his DF won't have to pay anything as he is on a low income, unless he has very substantial savings.

Thank you once again !!

So much useful information here and confirmation for my friend that there is potentially help out there. He has acted as his Dad’s care and support for so long, but is becoming overwhelmed now.

He is now planning another GP phone call tomorrow to ask for a joint appointment with his Dad.

He is also planning a Pivotell and if necessary after the GP appointment will be contacting Social Services for an assessment.

Friend should NOT be discussing with or asking for advice from the receptionist. The receptionist is seriously overstepping their role.
I agree with pp saying that an urgent GP appointment is needed and your friend should attend with his father.
Also agree that father needs input from support services - whatever is available.

I am guessing that the GP hasn't had the opportunity to address this as the receptionist seems to be making the clinical decisions.

The dosette boxes won't help if he's still taking the wrong one. We filled them in a hospital for patients to take home. You could have up to four compartments for each day; if he took the morning dose at night or mixed up any other times, it could be dangerous.

Dosette boxes are no use at all if the patient doesn't know what day or time it is. They are good if a carer is giving the meds though. The trouble is that different areas have different rules and policies around carers giving meds and some pharmacists have stopped making up the boxes due to lack of staff and huge workloads.

GP review exclude acute medical
problems like UTI , organise dementia screening and daily district nurse visit to give insulin and give him his pills.
Complaint to practice manager regarding receptionist inappropriately with- holding / training appointments .

In the context of a clock next to them saying the day and time, it would be more helpful than the pull boxes that only say the day and the pills are not seperate into the 4 times in a day.

This

My mums carers are insistent that they only take pills (or supervise my mother taking pills) from the original packets, so they can be sure that they are administering the correct medicine - once they have been placed in dosette boxes you don't know what they are.

Yes, and in some places they refuse to take the pills out of original packages because they don't want to take that responsibility, therefore it has to be a Dosette box. It used to drive me mad when I was working. Sometimes they wouldn't give any meds at all and the poor district nurses (already run ragged) had to go out and do it. I retired 8 years ago, so I am not up to speed with what happens now but it used to be a minefield.

The Pivotell box that I mention upthread is divided into compartments. Not only does it have an alarm light and bell, but the inner part of the contraption rotates, leaving the tablet for that time open. You just have to tip it over.

My husband only got his because the usual boxes that you can get out of the chemist's were too awkward for him to get into - one hand didn't work and the other was a bit shaky.

The PIvotell box that I mention upthread was filled by me. However, I was told that there was one pharmacist in our town that also filled these for patients, as an alternative to dosette boxes.

It must vary, depending on the care company. My mum's carers would only issue tablets that were in dosette boxes.

It would have to be dosette boxes made up by a pharmacy not ones that a relative has made up.

Yes, they were sealed and made up by a pharmacy.