What do you do when a LO won’t take the medication they need?

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What do you do when a LO won’t take the medication they need?

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Hi everyone. After a stroke in the spring and then heart surgery this fall (late 70s) my LO still is trying to refuse to take the one med they need: the blood thinner. What do we do? I feel like my LO still has the opportunity to make a good recovery, but her obstinance in that area could compromise her length of life. How do I handle this? I feel deep frustration rise every time that we have a meds conversation with her (she is a retired medical professional as well, which doesn’t help lol)

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This is a very common question asked on this forum. The answer depends on other variables, which we will need to know from you.

Since you don't mention anywhere, even in your profile, that your LO has any cognitive decline/impairment what reason does she give for refusing?

Since her stroke has she has any cognitive problems? Or does she have any problems swallowing any foods/liquids since her stroke? Has she ever had a swallow test?

What forms of the medication have you tried giving her? Does the med she needs come in patch, liquid or suppository? Are you breaking up the current meds and trying to give it to her in her food? If so, the meds can be extremely bitter...

More info would be helpful, but in the end if she has all her mental capacity she is allowed to make her own decisions and refuse the meds.

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Thank you. No problem swallowing, no real cognitive decline. As I mentioned in the post, she is a retired medical professional (nurse). That plays a HUGE part. I believe that she thinks she knows better than the folks caring for her (in the facility in which she resides) and better than us. She has always resisted meds, so this is just that, amplified.

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If your LO is cognizant and able to make her own medical decisions, there's not much you CAN do. You can go "hard line" on her ("you might have the right to refuse your meds, but I don't have to stand by and watch while you make the decision to NOT take the best care of yourself. Find another caregiver!"), but that's a hard decision to make, much less stand by.

Could it be your LO has had enough? Late 70's isn't all that old nowadays, but for how long has she been battling illness? Could it be she's tired of it all? If so, it might be time to talk about a hospice evaluation.

One thing you might want to consider doing: when she has her next doctor's appointment, the 3 of you discuss this together - for YOUR protection. See, if your LO is ever brought to an ER, the chances are the medical staff there isn't going to ask her why she isn't taking her meds...but they very well might ask you why YOU'RE not giving her her meds. I would bring this up to her doctor, while she's there, and INSIST they make a note in her chart that she's capable of making her own decisions, and she is deciding HERSELF to not take her prescribed medication. It might save you some serious heartache down the road, especially if some over-zealous ER attending decides to notify the authorities that you're "denying" her medication.

Good luck.

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Thank you. She is in a facility, so that isn’t on us. It has only been since May, otherwise, she has been healthy and lived independently in her own home. We don’t think she is ready to let go and die (she also lived with us for a time and we didn’t get that vibe from her then either).

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Notgoodenough hit a nail on the head!

I remember my grandma had to go on blood thinners after she had a stroke(?)..I just remember she would get these incredible nosebleeds. I mean, absolute gushers. The first one I saw absolutely terrified me. We live in a desert climate and so the air just dried her out terribly.

We used to have to take her to the ER to have the bleeders cauterized. It was a big deal---she would often have them during the night and wake up covered in blood. Plus her bedding and nightgowns---she luckily rarely had any in public!!

At about age 85 or so, she quit taking them, decided to let nature takes it's course. She died almost 10 years later with no ill effects from the lack of blood thinners.

I do think her dr gave her an ointment to put in her nose to keep it moist.

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Not taking a blood thinner of some type, at least aspirin after stroke and heart attack is not safe unless she has been told that she is definitely not hypercoagulable. Her PCP can answer that question. Refusal without medical justification increases the probability that she will have more events that will leave her progressively less functional. If she is in an assisted living she is impaired in some way, otherwise she could have gone back to her own home with support services. Is she depressed? Angry about not being in her own home? Or just stubborn? You suggest it is just stubborness, so her own doctor needs to address this with her. You have done the best you can.

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Thank you, DrBenshir. This is pretty much where we are. She lived with us from May thru September, and we talked to her about meds everyday it seems (when she had 8 meds to take). She has been in the hospital 3 times, and each time she goes to a facility to recover. The meds have been an issue there with the staff as well. She is not depressed or angry, just obstinate when it comes to medication. And we have seen her have issues that could have been prevented if she just cooperated. Thanks for the reminder that we have done our best.

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Does she have specific advance medical directives, and do you know them? If not, she should. Have you asked her why she does not want to take the blood thinners? Is she thinking logically after the stroke? Are you able to talk to her doctor, or go to her doctor with her to find out if there are any alternatives?

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My mom is a nurse and when my dad asked her if she would be okay if God took him; he decided to stop taking his heart medications. He knew that quality of life could decline and he have a stroke or heart attack that he may survive without medications or he could go “home”. We had the pastor come over for bedside communion and we were ready. He passed peacefully almost 3 weeks later and we thought it would be 4 or 5 days. In that time, goodbyes were said. Since we believe our days are numbered by the Lord, the quality of life was the only question in our minds. Would he have a stroke and still live in a vegetative state until he had his numbered days? This was prayerfully considered and we asked the Lord to block anything that was not of his will and best plan and to grant his best plan. Right now my mom is still compliant with medications but if that changes, we are prepared to go the route of my dad; praying for wisdom and mercy for my mom.

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Perhaps a doctor she admires or another nurse friend she loves and trusts can convince her. There are so many new blood thinners on the market now, like Eliquis, where you don't need to be constantly tested like when you are on Warfarin. These newer drugs may not have been used very much when she was practicing.
In the end, if she is mentally cognizant and living on her own, there is nothing you can do at this point. I wish her best recovery.

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My husband loves chocolate, so I crush his Warfarin and put it in chocolate pudding. Works every time. He takes his meds with no problem.

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What is an LO? All these abbreviations people use are not common language.

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LO is short for Loved One.

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What is an LO? I looked it up on Google and it is not there as a person or a relationship.

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LO is abbreviation for Loved One

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Since your loved one is a retired nurse and only balks at this one medication, stop trying to have conversations about "you need to take this medicine" and "this is why you need it." It might be better to just give it to her and say, "here is your medicine" and "do you want to swallow it with water or _______ (insert favorite beverage)". She might also be more amenable during certain times of the day. Ask the staff if they can disguise it in some food - pudding, applesauce... as well.

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Are there other options other than the blood thinner? Or the particular medication that has been prescribed?
If not then this is a battle that you choose to have.
If she is of sound mind, knows the risks of both taking the medication and not taking it then it is her choice to make.
You can make the argument that if by not taking the medication IF she were to have a devastating stroke or heart attack that would not kill her but would leave her incapacitated it would make caring for her more difficult and something that you might not be able to do. So at that point discuss where she would want to be placed. (I am sure given this scenario she may realize that taking the medication might keep her out of a Skilled Nursing facility and just might reconsider)
If she is willing to take that risk....then all you can do is support her.

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If she is of sound mind, then it’s her choice. If she isn’t, then I’d talk to the pharmacist and see if there is another medication that could be used in place, or if they are aware of another way to administer.

Blood thinners are a mixed bag of blessings. They’re prescribed so the person doesn’t have a cardiovascular stroke. However, they GREATLY increase the chances of a vascular stroke (the blood vessels in the brain hemorrhaging) which is what happened to my father in August, aged 75. The result has been disastrous, and we’re looking at a 6-18 month recovery, with the possibility of vascular dementia. Now, it’s possible that we’ve avoided another kind of stroke, but seeing my father so debilitated, so unlike himself, so confused and angry…I wouldn’t wish it on my worst enemy.

Talk to her doctor if you have Medical POA. If not, her choice. After seeing my father go through this, I honestly don’t know if I would take them either.

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What reason does she give for refusing?

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My soon to be 95 y/o mother HAD to go OFF of blood thinners in 2018 b/c she was getting the mother of ALL nosebleeds to the point of being rushed to the ER twice a month. Last time I met her in the ER, the doctor was photographing the blood clot that came out of her throat, that's how huge it was; the size of a large plum. He was planning to post the photo on the bulletin board in the lounge for all the medical personnel to see, since he'd never seen a clot that large in his entire career. That's where blood thinners got my mother; to hell and back, with me going along for the ride.

That was almost 4 years ago and she's still alive today.

If your loved one is refusing to take blood thinners, so be it. If s/he is of sound mind, it is their right to do as they see fit. If refusal to take this medication shortens their life on Earth, that is their prerogative too. That won't necessarily be the case, though, see above for more details.

IMO, elders take WAY too many medications anyway. And blood thinners tend to create more problems than they cure.

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Maybe she’s not trying to live forever? When I see all the people in my dads nursing home, nobody seems enthusiastic about being alive. Also, maybe she’s cold from them.

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My husband has chronic A-Fib and was on Pradaxa for many years. In 2019 I found him on the kitchen floor in a puddle of blood. The EMT talked him into going to the ER for a CT scan as he hit his head and was on blood thinners.
The CT revealed 2 subdural hematomas which required surgery. He has not taken any blood thinners since May 2019, not even aspirin. He was scheduled for a Watchman procedure which he refused to go thru with. He has had no problems thus far. If and when he does, we will deal with it.

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My husband refused the Watchman also. He said he is tired of being cut on. I found out today he has stopped blood thinners because he is tired of bleeding all the time. It is up to him. It isn't any fun washing blood off the bedding all the time either.

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Perhaps she feels that the risks that go with blood thinners aren't worth it. One good fall, and you've got a brain bleed that may kill you.

It happened with my FIL. He wouldn't even take an aspirin, but he did take his blood thinners. Had he known that if he hit his head he could die, I guarantee you he wouldn't have taken them. However, not being especially informed was his specialty, so he didn't take aspirin because he feared becoming addicted to painkillers(!) and he didn't pay attention when his doctor told him he could get a brain bleed from his blood thinners. Because he didn't inform himself, he lived with terrible knee pain and died after hitting his head and being too proud to admit it.

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have you considered seeing if a product called The Watchman which is a one time procedure that implants a device in the lower part of the heart. They insert it through a vein in your leg. If you qualify, you can get off blood thinners for the rest of life.

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Oh wow, good information!

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CaringinVA: Imho, perhaps you should consult his physician on this matter. Best of luck.

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Duplicate post because of site issues.

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Of course this is not an easy situation to be in (which is why we are here, reaching out).

See my response below [this response].
* Get professional therapist support (for her and perhaps for yourself).
* Listen to her; reflect back what you hear. She wants and needs to be acknowledged (preaching to her 'take your meds' will further add more frustration - to both of you).
* Give her space and time; do not go to 'fear' in yourself (of what may happen).
* See if other ways to give her meds, i.e., in food.
* Separate out how you feel and how she feels.
* DO NOT have a 'meds conversation' - you know where this goes. And, the conversation needs to be focused on deeper feelings (depression, vulnerability, dependent on another, embarrassment, etc.).
* Speak in "I" statements, not YOU (need to ... ) statements. If you show her your vulnerability and sadness, fears, etc., she will perhaps share hers. This is intimacy.

* Take care of yourself and do not push. Incorporate others into her life. Learn ways you can take care of yourself which do not include her - like going out for a walk in the park or in the mountains (?) Clear your head and emotions. Start with a clean slate each day and don't let YOUR frustration build up (and then interact with her, and her frustration). This will be combustible and further distance yourself from her (or her from you). You need to be neutral around her and let her express everything she feels.

Gena in Marin

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Thank you everyone for taking the time to share and weigh in. I appreciate the space to vent as well as the perspectives and advice given.

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CaringinVA: Thank you for your post.

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What do you do when a LO won’t take the medication they need?

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