Blood pressure & cholesterol medicine for a 97-year-old man?

Mmm. Tricky one.

Was that cholesterol reading before or after the meds? As I'm sure you know, it certainly doesn't seem to need intervention. The blood pressure is a teensy bit higher than ideal, I believe? - but in a 97 year old, surely any tinkering with it needs to be done with extreme caution.

The thing is, the px seems standard, what you would expect; but your father is not a standard patient. All I can say is if it were me, I would go to his established GP (if he has one you're happy with) or back to his cardiologist/attending physician, and say the equivalent of "not happy, what are we doing, could we go back to the drawing board please." With as much polite jumping up and down and snarling as necessary.

Changes have to be clinically justified in each individual patient, not just made for their own sake. Make them concentrate on *him*.

No 97 yr old needs to be started off on cholesterol meds. My Ma needed BP meds until she turned 92 now off them as she drops too much. A very common problem in the aged and needs that geriatrician needed to assess his need and response. Seek a second opinion

Probably not. What they're trying to do is prolong quantity of life instead of quality of life. Talk with his doctors and see what you can do to get him off these meds. Then get hospice involved as it sounds like he's done. Living all those years without medication and then having a stroke is nature's way of moving things along. I'm so sorry to hear that he's lost so much of his independence. But at least he has you. Hugs, hang in there. We're here for you.

Your instincts are great. I’m sure that he doesn’t need exactly what he’s been given. He may need some heart medication. It’s always possible he was “off” around the time he was suffering the stroke, and doesn’t need them now. (It can be hard to find a doctor willing to listen to your concerns about reducing medications—keep trying).

How lucky he is to have you as an advocate!

Its very important to work with a cardiologist to wean slowly (and not take him off meds yourself). Don’t settle for anyone who isn’t a specialist.

These days lots of people live past 100, and it sounds like he didn’t have much damage from the stroke.

Does he read? The first 3 months following a stroke are important - the brain can repair and can greatly improve with therapy. Does he have PT and OT?

If not, puzzles of any type, helping with household chores, reading, writing and short walks will all be very therapeutic. Have him write lists of things, fruits, countries of the world, zoo animals. Lists of anything that might interest him.

If he can, ask him to write short notes to friends and family members. Those will be treasured.

I wish you the best.

I could go on all day. My life became centered around providing therapy and healing! What a beautiful, cherished time!

Play...
Checkers, and any games he likes, I could literally see improvement with each game of Checkers. Make sure games are “easy” enough that he doesn’t get stressed out, and just sees this as fun. Rummicub is great since he likes cards- and working with the “tiles” is good for fine motor skills. Go to the movies (discuss afterward). Take him to beautiful places where he can watch birds. Play music from his era (easy through Amazon). The music will take ten years off!

Do things that Improve hand-eye coordination (table tennis?)

Try to help him get some exercise every day. We would go to the shopping mall. In the beginning, we would walk and sit on every bench. He was holding onto me like a walker. That meant we would walk 20 feet, sit down for 10 minutes get up walk 20 feet. He started saying, “let’s keep going” and we would skip a bench. In about a month we worked up to two miles without stopping. Walking at the mall was nice because the temperature was constant, the floor surface was perfectly smooth and safe. He got Vans (skateboarding shoes). Their smooth, flat, solid, large sole promotes balance. He loved all the “cool shoes” comments and he looked sharp! If your dad is a veteran, get him one of those nice caps - he’ll get friendly interactions and “thank yous” from strangers that will lift his spirits and make him feel valuable and appreciated.

My dad also liked using a stationary bike, and that was nice because he didn’t have to focus on balancing, like he did when when walking

I’m so happy for you that you have this time together! You are so lucky.

Enjoy!

It's important to ask questions of the doctors and other medical staff. I worked in a field in which I provided technical advice to doctors as well as educational presentations. Some of them are brilliant and keenly interested in giving their patients the best care, others less so, and a few others who made me wonder how they made it through high school.

When my mother's BP dropped to frighteningly low levels multiple people in the healthcare system assured me that she was end of life. Sorry but no, she was on multiple medications that needed to be tweaked, several of which lowered BP. I'm convinced that this period of excessively low BP contributed to her vascular dementia because her brain was starved of oxygen. BTW, she lived a decade after I was initially told she was EOL, and several years after discontinuing almost all her blood thinners, BP and cholesterol meds.

Hello.. Prayers to you & Dad..

With my Dad, I talked to Dr/NP.. Discontinued his BP med.. First, with that low of BP, they become a fall risk.. Can develop orthostatic hypotension..Also, Some BP meds have a diuretic tied into them, ie., losartan hctz(sp?), causing/exacerbating dehydration..I took Dad off cholesterol med..He lost weight, so his numbers were good w/o meds..

Pls rest, as one caregiver to another.. Hug your Dad every day❤️

I did read your earlier response. 140/70 is not bad for an older person. Too low means they have a hard time functioning. Usually B/P meds are given when pain makes ur b/p shoot up. With my husband its when he has an Afib problem, once in a blue moon. With Mom her B/P med was upped for pain. DH got it during an AFib incident. I questioned both at discharge. Answer, because of pain and bp went up. I told them Mom was no longer in pain and DH bp was normal. My Mom couldn't get up off the couch and the PCP couldn't believe my husband could walk because their bp was too low. I no longer go with hospital recommendations. I have both see their PCPs right after a hospital stay. I have even asked hospital doctors to consult with PCP, they won't.

There is no reason for a cholesterol med if ur under 200. A statin will effect them cognitively.

Sounds unlikely his blood pressure at 140/70 is not high for someone his age. Clearly something is taking it to a dangerously low level and one has to think this is the medication if it is the only change. Ask Drs to leave him off medication for a week and see if he is better.

I'm not sure why they would put him on cholesterol medication at this point even if it was high unless the medication is also used to help regulate his A-fib, they do often use a combination of medications for that which work in different ways and the right balance is what controls the A-fib. Controlling that is particularly important if that was the cause of his stroke, you don't need or want another stroke if it can be helped of course and A-fib can be a prime cause. As I recall either the A-fib it's self or something about getting it managed can elevate cholesterol temporarily too, seems like that happened with Mom. Unless the medication is actually being used for something else and it's just a cholesterol med too (maybe someone gave you that use because it seemed easier or like it would concern you less?) I'm with you on there not being any point in starting that at 97. If you want to give him something for high C try Red Yeast Rice, it's over the counter, natural supplement that works very well (funny story about how my husband tested that).

Managing the HR however is important and shouldn't be ignored here again because you don't need another stroke to deal with so I would make sure he has a good cardiologist along with the neurologist that has likely been the one in charge of his stroke care, they look at things differently. Mom was on a BP medication before being hospitalized for A-fib, I don't remember off hand if she was on it pre-stroke and heart surgery but when she went in with the A-fib it was one of the medications they used to get it under control by more than quadrupling her dose and had to bring that back down a bit because it dropped her BP too much, when they weren't able to manage the HR with that medication and maybe one other she had been on for a while...they added a blood thinner and adjusted the two until they had her rate under control and managed. It took time and as I say balancing but they were using the Metoprolol (known to us as BP med) first as I recall. I remember being shocked at how much higher a dose she was sent home on.

Addressing your last question first: "Does a 97 year old man need to take this medicine when all his life he never took any medicine?" Maybe, maybe not. One can't determine that because we never took medication before that we don't need it now. We age. We get ill, We encounter issues that need treatment. So long as it's absolutely necessary and doesn't impact quality of life, I would have less issue with it, but I would still want to be informed about how much and why, DEtails, plus what to be concerned about for side effects.

I am a proponent of less or no meds and currently take OTC Vit D3 and 2 aspirin a day. In the past I was told to take Fosamax for early osteoporosis (looked it up and said nope, not happening!) and prior to that cholesterol meds - nope, I will figure this out and fix it without meds (and had to figure it out myself as docs were clueless then as to the REAL cause of some high cholesterol, such as blaming eggs, organ meats, cakes, cookies, pies, MILK, stuff I didn't even consume!) In my case, processed foods! Basically anything with a shelf life - ditch it! Eating various nuts will help raise the "good" HDL. My total runs over the recommended 200, but only because HDL is higher than suggested (and good!)

Have you discussed ALL concerns and questions in detail with his doctor(s), aka why so much, can it be reduced or eventually eliminated? His BP values before were not bad. The cholesterol - was that LDL, HDL or total? If total, why cholesterol meds? Anything under 200 is considered GOOD! What kind of doctor Rxed these meds (I see another post from you where they agreed to stop the cholesterol meds)? Regular PCP/GP or cardiologist?

We here are not doctors (there might be some among us who are, but no one should ever Dx or Rx without seeing a patient and test results!) We should not say yay or nay whether the meds are necessary.

Personally I would question his doctors about his condition(s) and any/all meds, especially given that 140/70 isn't that bad, esp at 97 (values could be higher when readings taken at doc office or hospital.) Our mother has been on multiple BP meds for a long time, and hers is still usually 140/something. Systolic 140 is on the highest end of "pre-high BP", diastolic 70 is "mid-average", so that shouldn't be a concern. If he gets okay to light exercise, he can likely get/keep his BP lower naturally. However there may be other reasons for the meds. Asking questions about the medications and dosages, monitoring his BP when at home (don't repeat over and over, take a couple of readings/day AT MOST, usually at the same time each day) and record it. If he is still running low-normal all the time, you have documentation to show to the doctor. Doc may be willing to adjust the meds (certainly don't stop them if his readings are 'normal' - the meds may be getting it under control.) I would also not rely solely on a PCP, unless he/she is a cardiologist. The type and dosage should be carefully formulated for your dad and your dad alone, preferably by a cardiologist, not for some point on a chart.

Best of luck getting and staying informed and hope for many more healthy years for dad!

It is really popular to bad mouth cholesterol lowering medications and I see a lot of that on this forum, however the advice to discontinue statins in older adults is directed to people who are taking it prophylactically and have never had heart problems or stroke. I was amazed when the advanced ultrasound given to my mother showed a marked decrease in carotic plaques after her neurologist moved to aggressively treat her TIAs with statins, diet and different BP medications, I would never have believed it possible in a 90 year old woman. Unfortunately by then the damage had already been done, my chief regret is that something wasn't done 20 years sooner.
.

What your dad needs is whatever HE wants, at this point. 97 and beginning new meds? I'd say it's his doctor who needs a treatment plan of some kind. Do you want to prolong his life by a few days or months, or do you want him to have a better quality of life in the time he has left. A higher BP will mean more energy, more life for your dad. Best of luck to him and you.

That is WAY too low...what happens if he doesn't take it, how high does it go...sounds like he doesn't need to be on them.

He needs a cardiologist not a GP since he has Afib. He could live many more years yet. The 124 total cholesterol is very low and a good range. So I don’t understand getting a statin for that unless his LDL stats were high. Or perhaps there is a reason with the Afib. A specialist is important.

I had the same issue with my dad's Dr. I think they are just taught and brainwashed to subscribe meds.
I worked with a nurse (at his facility) to slowly get him off any cholesterol drug and we found he only require a little something for BP. Not as much as they had him on!
If his Dr. refuses, find another! He could go unconscious with that low of BP
(my mom had episodes of that).
Your dad may not require anything....

All the best!!

Docs tend to follow guidelines. Guidelines say after a stroke/AMI, a statin/blood-thinner should be prescribed. These drugs are not a panacea and come with side effects, but, says Big Pharma research, the drugs' benefits outweigh the risk and they prescribe. Low bp can be a fall risk...

Your dad still has his agency and nothing says your dad HAS TO take medication that is prescribed. I'd let your dad decide.

Even persons with dementia living in nursing homes have the legal right to refuse meds, believe it or not. Your dad cannot be ordered by his doctor to take any medication he is not happy about. Doctors are trained to prescribe medicine and encouraged by big pharma to prescribe and prescribe more and more. And most drugs have side effects that require--you got it--even more meds! And more doctors' visits.

Gut reaction the doctors, by prescribing the cholesterol medication and the BP medication are probably trying to prevent another stroke that either may be fatal or life altering.
If he is of sound mind and can understand the reasoning behind the "why" he is taking the medication he can determine if he wants to continue it. If he is not of sound mind and if you are his POA for health you can decide if you want him to continue with the medication.
After my Husband was diagnosed with dementia I made the decision to have him put back on a cholesterol medication (he decided years prior that he did not want to take it after being on it for about 6 months) I decided that it would be more difficult for me to care for him if he had a life altering stroke along with the dementia. After he went on Hospice I decided to discontinue his cholesterol medication. He lived another 3 years and although he may have had "mini strokes" (I think he also had vascular dementia so I don't think the meds would have helped in any case) he never had a major stroke.

So given the risks for a stroke, the possible outcome if he did have another stroke he or you or both of you along with consulting with his doctor can make an informed decision.

Your dad or his POA have total control of what he takes. The doctor only sees him for a few minutes and consults unreliable statistics. You are with him much much more than the doctor and see infinitely more. You can consider the doctor's advice but don't be intimidated by the white coat.

NO! AND, no one is supposed to be on Cholesterol meds at 90, let alone 97.
If his BP is that low - stop the BP medicine too.

When changing or dropping medications, best to inquire about withdrawal symptoms instead of stopping cold turkey.

My 97 yr old mother was prescribed a daily aspirin after her stroke, instead of cholesterol lowering medications.

Ask his doctor. He should be able to tell you why he prescribed them. It’s trendy to complain about medication and” Big Pharma” but a lot of people in their 60s would be dead long ago without them.

Check with his Dr. first. My Mom103 was taken off one BP med and Cholesterol meds by cardiologist a few years ago. (Statins cause problems and her blood pressure was not high - medicines had not been changed in 19 years) . Recently she wound up in hospital - thought it was stroke - turned out to be very low blood pressure. Carvedilol (BP and CHF) dose lowered way down. Another drug discontinued altogether. She was taking 3 drugs that work by lowering blood pressure (although one is needed for PAH - she is no longer able to take). Now on oxygen 24/7. (very bad CHF) All drugs need to be reevaluated at least every 6 months - and any time there is a change in health.

Blood work will show dehydration.

The reason you cannot get a clear answer is the CMS Shared Savings Program which involves as much as a 60% payback for either denying treatment or the end of an elder's life. 34 years working at a major university in medicine, and our docs flying to D.C. to set up death panels was very educational and terrifying, as my parents were aging at that time. Now I am living the horrors of these programs where a 90+ y.o. is always in the crosshairs. My Dad was murdered by an LTAC, after inserting an unnecessary trach (they used no ventilator, and routinely knocked off the t-bar with his sats staying at 98 to 100% and heart rate at 69). My favorite Uncle was sent down the same grist mill and we could not prevent it. He had a simple uneventful ERCP for a blocked biliary duct with "no blood loss" except that after his death of an infection we got the bill including 6 units of blood. At the same time, my Mom had a UTI and collapsed breaking her leg. Both these fit elders were kept in the ER (different hospitals, but both feeding into the same long term acute care facility) for over 7 hours with no hydration of nourishment. Even after being assigned an inpatient room, the dehydration continued. Both had long q-tips inserted unto their nostrils with regular taking of their temperatures. This nasal q-tip issue is done under circumstances when a patient has come from another recent hospital stay to prevent transmission of MRSA. But in my Uncle and Mom's case neither had been in hospital in years. Within 6 hours, both of them spiked a very high fever with a terrible cough. At that time, a nurse came in and inserted betadine into their nostrils. I think this was to destroy the evidence of seeding them with type A enfluenza. After my Uncle was taken home, he died. My Mom was still in hospital, and we were told she had congestive heart failure. I have taken care of her for over 20 years, worked in medicine and as a consultant for athletes, so I know what congestive heart failure is. They used that excuse to deny her hydration, gave her hydrochlorothiazide and lasix at the same time. They never took tests to assess her electrolyte washout and continued on a saltless diet. I asked for a doppler which showed her ejection fraction was excellent (took four days to get the result as they continued their dehydration program), and destroyed their game. Her hospitalist actually threw the copy of her result at me and grunted "she doesn't have congestive heart failure, in fact her ejection fraction is excellent," turned and stomped out of Mom's room, and I never saw him again. They tried to transfer her out to Kindred Hospital, the same hospital responsible for Dad's death. We took her home, and are still dealing with the damage the hospital inflicted on my recently very fit and active Mom. Many years ago, my parents excellent doctor who did not have priveleges at these hospitals took them both off statins and due to their fitness gave them blood pressure meds to be taken as needed. Beetroot and magnesium were really quite effective. He said, and my research at my hospital, showed that elders do better with slightly elevated blood pressure, because perfusion is better. I thank God we found this doc, because their prior high class concierge doc was destroying them. Modern medicine is very dangerous for elders, and my experience in medicine and my age of 72 is keeping me away from allopathic medicine. We are living through the actualization of 1984 (nothing is as it seems). Everything a doctor tells you must be researched, so don't get lazy, if you value your loved one's life. God bless all of you and may He give you the energy, insight and intellectual curiosity to fight this new holocaust of elder abuse!

Blood Pressure will fluctuate and you should maintain a log with notes. If he is dehydrated it could be causing the low blood pressure. Dehydration can sometimes also raise it too. I would cut back or skip a day of medicine and see the results.

You really need to talk to the Dr. PLease don't assume you can take him off either.
TAlk to the Dr and ask him what he thinks. A stroke is a very close to have the results. I have taken care 2 of my brothers and also I have had high blood pressure due to some circumstances. I am 75. 92 is quite a feat for him.
I know you are quite concerned. Drs do what is right and they understand the situation. I do care by all means and these things can bring questions.
Jane

Be very cautious about low blood pressure. That is exactly what happened to my mother, who demanded to live alone in another state 500 miles from me. She was at the point of passing out so I got a night nurse to stay with her pro bono until I could arrive to move in with her and live with her in her home for an extended period.