Shifting How We Support Seniors in Residential Care – An Opportunity for
Collective Action
Johanna TrimbleBC Patient Voices Network, Steering Committee
Community Engagement Advisory Network (Vancouver Coastal Health)Polypharmacy Working Group, Shared Care, GPSC
World Health Organization Patient Safety Champion
No financial support was received for this presentation.
BC Patient Safety and Quality CouncilJanuary 18, 2013
Who was Fervid Trimble?
Fervid Trimble’s life
Mother, grandmother, Teacher: M Ed, U. of Idaho
Fervid Trimble, age 86, enjoying her apartment in a senior’s residence she’d chosen for herself
Fervid’s “family care team”Johanna, Dale, Fervid and Kathie
Fervid experienced a precipitous mental decline after entering the Care Centre -- we suspected new medications
“Assume that any new symptom you develop upon starting a new drug may be
caused by the drug. If you have a new symptom, psychiatric or otherwise, report it to your doctor”
www.worstpills.org
Delirium
• A temporary, reversible change in consciousness, attention, thinking, memory
• acute condition• unpredictable course• subtle symptoms may be unrecognized or
confused with dementia
Fervid’s drug interaction: Seratonin Syndrome(citalopram, an SSRI antidepressant & tramadol, a pain drug)
Seratonin Syndrome Symptoms1. Cognitive/behavioral: confusion, agitation, lethargy, and
coma. 2. Autonomic instability: rapid heart rate, sweating, rise in
temperature.3. Neuromuscular: twitching a muscle or group of muscles,
coordination problems.
Some of these - noticed by the family - are also symptoms of UTI for which many courses of antibiotics were given, resulting in c. difficile
Medication Review: The family insisted on a meeting and drugs were de-prescribed.
Fervid over-medicated Fervid back to normal
But…Fervid had lost too much function to return to independent living
What we learned from Fervid
Fervid and her beloved Grandson, Evan
Fervid’s words to her family:
“It’s too precious not to live—we’ve enjoyed each other so much. I think it will grow (love). That’s the ticket into the next world. We will always be together…part of the great growing field of love”.
Fervid lived for 4 years in care. If she had died soon after entering, we would not have received her love and wisdom which has meant so much to us.
…it's not just quality of care it's a quality of life issue. Quality of life for my residents. I've seen dramatic differences in the quality of their life when the burden of their medication is reduced...
Books to educate families and staff
A picnic in the garden with Fervid
Dedicated to Fervid Trimble 1917 - 2008
Contact information: [email protected]
