What do you do for drug-induced depression? Well, it's more complicated than that...

March 21, 2007 11:05 AM

My mom-in-law is suffering from 1) a new life in a nursing home 2) diabetes 3) Myasthenia gravis 4) the prednisone that is controlling the Myasthenia 5) her other son who rarely visits and pretty much cuts her out of his life. What can I do to help?

She's 77. Last year, she had another Myasthenia crisis, and had to be hospitalized. A few months ago we had to move her out of her own apartment and into a nursing home since her doctors believed that she can no longer live alone because she was falling so much. She feels that her independence is gone and her other son all but forgotten about her. We call her everyday, but the prednisone makes her extremely negative (she's normally a chirpy, positive person. This mamma is entirely different than the one I met 3 years ago. I'm positive that it's the drugs she's taking for diabetes, myasthenia, as well as parkinson's.)

The past few months especially has been very trying for her; her older son has been all but absent (he is the executor of her estate, and his absence means that nothing's been transferred into the nursing home account to pay for her rent there) - he visits only every so often and often does nothing but upset her more. The last visit, my sis-in-law told mom that "I know you don't love me because you didn't call on my birthday." - mamma can hardly remember what day of the week it is nowadays, let alone her birthday!

Lately I find that she's surrendering to the effects of prednisone. She used to try to fight it, I think - and lately she's been rude to other people in the nursing home and taken a major dislike to some of the stuff, and even using racial slurs in private (she's not like that either - afterall, I AM chinese and she accepted me wholeheartedly) to refer to some of them. When I tell her "you're not like that why are you saying that" she'll say things like "you're right it must be the drugs talking" then she'll go on to pick on other things that are negative. The worst thing is, none of us seem to be able to shake her out of that negative rut. It used to be so easy to maker her laugh, and now as much as we try, she just finds it hard to smile.

This will only last another 3-4 months, since they're going to re-evaluate her condition and wean her off the prednisone the upcoming summer. But meanwhile, how do we:

a) Make her older son take responsibility of being her financial executor
b) Cheer her UP!

The suggestion that we take over her finances officially has been raised, but we on this side are afraid that once that has been done, her other son will just vanish and never visit or call again (he has done so and disappeared on her for 8 months, last year for "upsetting" his wife over christmas.)

posted by Sallysings to human relations (9 comments total)

www.seniorcarepharmacist.com has info on pharmacists who are specifically qualified to review medications of older adults and make recommendations for changes. This is something that medicare part D (the prescription drug benefit) will pay for. Drug use in the elderly is incredibly tricky! She can feel better sooner than 3-4 months from now, I hope. A lot of people are in her same situation.
posted by selfmedicating at 11:46 AM on March 21, 2007

I have no good advice for cheering her up. Prednisone can just be super yucky and do bad things to a person's mood. (Is there any chance of talking to her doctors about doing something NOW to help her?)

As to taking over the finances - it sounds like you should. If the brother disappears completely - well, good riddance to him. It sounds like he's an ass when he is around. That may sound harsh but it seems like a better option is for him not to be around than for him to be around and constantly upsetting the mom and/or making childish claims.

I'd remind the brother that Mom won't be around forever and that he's an asshat for his behavior NOW and will forever be known that way unless he changes his tune before a turn for the worse in mom. Right now he's not helping at all - in even the most simple ways.
posted by fluffy battle kitten at 11:49 AM on March 21, 2007

Oh, and I definitely believe it's the drugs she's taking - there is a great quote by an MD specializing in geriatrics about how all new problems seen in elderly patients should be assumed to be medication-related until proven otherwise. It's a very common problem. My email is in the profile and I'd be happy to tell you what little I know, since this is an area of pharmacy I'm thinking of going into after I graduate from pharmacy school next year.
posted by selfmedicating at 11:50 AM on March 21, 2007

I'm so sorry about the rough transition your family is going through.

Utilize your mother-in-laws entire healthcare team. Her doctor, pharmacist, or nurse could give you and your husband some more info about the different conditions and drugs, side effects and whatnot and how to work with all that. The nursing home should have staff that specialize in helping families through these transitions. A social worker or case worker maybe? They work with these issues with many different families. Pick their brains.

Good luck to you and your family.
posted by dog food sugar at 11:54 AM on March 21, 2007

Are you all sure it wouldn't be the best thing for all concerned if the executor brother stayed out of the picture? If the idea in making him the executor was to encourage him to be nice or present for his mother, it's clearly not working.

Something important to think about: is he just the executor, or does he also have control over medical decisions she cannot make for herself? You don't want that responsibility resting in the hands of someone who is not 100% available.
posted by Scram at 11:57 AM on March 21, 2007

I agree that taking over the finances may be a good thing as long as it's something you and your husband can handle. Be aware of your own needs as caretakers.

Your Mom-in-law is probably experiencing some grief and loss over this change in her life. At one time she was self-sufficient and now she is not. That must be scary.

Your brother and sister-in-law are also learning how to deal with this. Give them some time to work through their coping mechanisms. Sounds like they are in some denial right now. Hopefully with time they will adjust better.
posted by dog food sugar at 12:08 PM on March 21, 2007

Sorry to keep posting in this thread but I keep thinking about it - I read a great study showing that people in nursing homes do a lot better the more control they have in their life. The researchers had people visit nursing home residents, and just being asked when they wanted the next visit to be was correlated with all sorts of better outcomes - faster healing, less depression, etc. So I think anything that gives her greater control will be a big help to her - even things you might not consider important, such as having a plant to take care of.
posted by selfmedicating at 3:02 PM on March 21, 2007 [1 favorite]

I don't have any med advice, but it seems very clear from what you say that you and your husband should be her executor/power of atty holders/medical decisionmakers. It would be good to get that switch taken care of while your mother-in-law is still of reasonably sound mind.

The other brother has the responsibility to authorize payment for her care, and isn't doing it? No way should he be holding the purse strings, or responsible for her well-being. Either he's not responsible enough to be in charge, or he doesn't care about her enough to be in charge. Either way, he shouldn't be in charge. Get this changed ASAP.
posted by LobsterMitten at 4:09 PM on March 21, 2007

Extended care and eventual closing of the estate are minefields. From what you have said, it does not sound like the "other son" is the man to negotiate such touchy territory. Have you talked to your mother-in-law's attorney? She must have made a legal document to name "other son" as executor.
If it comes to family dispute and increasing family polarization, a neutral party can be named executor - e.g., a bank. This can be expensive and unsatisfactory, but possible.
Can a discussion be opened with "other son" about making a change? Is it possible that he would be glad to be relieved of a responsibility for which he has shown little aptitude?
OTOH, is it possible that he is doing everything he can for his mother, but she is unable to grasp that due to her meds?
posted by Cranberry at 4:55 PM on March 21, 2007