Question

“My 89-year-old mother-in-law passed all her cognitive tests with flying colors when she moved into a Resident Care Apartment Complex (RCAC) six months ago. Back in 2021, she discontinued her Zoloft on her own because she didn’t want to take it anymore. We see the difference, but she doesn’t. Each year now, she “discontinues” one of her medications without telling us. My sister-in-law (her daughter) wants to start monitoring her meds for compliance. I’m a retired nurse, and I believe that if she remains her own person, it’s her decision. I understand, though, that any side effects of skipping meds end up mostly on my sister-in-law's shoulders. Is there a middle ground we can find to work WITH my mom-in-law? Even if she at least told us she was discontinuing something, it would help. Thanks for the input.”

Answer

Darn those adults who do what they want. In health care, we see this situation all day long. It feels a little bit like medication roulette to some of us. Patients self-medicate, halve their medication, double up, stop and start. The logic often eludes us.

Yes, it can be maddening. These days, with health care organizations getting paid based on outcomes, it’s even more frustrating. Being held accountable for interesting choices made by patients is hard to accept. So, I feel your sister-in-law's pain.

So often when people feel better, they decrease or eliminate the very medication that’s responsible for them feeling better. “Hallelujah, I am healed!” they think, when the medication was only propping them up. She may feel that she knows her body better than her doctors. 

It also may be that the side effects of Zoloft bother her more than the positive effects. Or possibly, she thinks that for some reason the need for the medication went away, which is not usually the case. 

Since she is of sound mind, you cannot force any change against her will. But you already knew that. Her children should be the ones to speak with her about it, and they should offer just a subtle mention of what changes they’ve observed. Then drop it, until the next time she struggles. The reason I suggest not to hit as hard is that she’ll likely need to ponder the comments and reevaluate her actions.

If it gets bad enough where she’s not managing at a reasonable level, a bit more of an intervention by her children is recommended. I even recommend they accompany her to a doctor appointment if she will allow it.

I do applaud you seeking a solution for a tough situation. No one can force a decisional adult to take medication unless ordered by a court. What her children can do, though, is express their concerns and hope their mother will hear them.