My mom seemed exhausted for months, and

Tonight, before anything else: put every bottle, blister strip, inhaler, patch and supplement your mom takes — plus anything the hospice team stopped — into one bag, and write one line per item on a paper list. That is the whole job of the next 20 minutes, and it is the thing that makes next week's visit worth the trip.

You are already carrying the strongest clue in this story: her energy came back when the medicines came out. That is a real observation and it is exactly what a medication review is for. What you cannot do at home is decide which medicine did it — stopping or halving anything is a clinician's call with the whole list in front of them.

1. What you have tried, and the better version

"It is just her age." This is the one to retire. Age does explain some slowing, but it does not explain a change that tracks a change in medication. Older adults are the age group most likely to be harmed by medicines, and the effects show up as exactly the things families write off as ageing: tiredness, muddle-headedness, dizziness on standing, constipation, poor sleep. "New or worsening confusion in an older adult is a symptom to investigate, not a stage of ageing" — that is the rule the clinical cards repeat, and it applies to the tiredness too.

Better: turn the observation into a written timeline.

• One column: what changed (medicine started, stopped, dose changed, hospital stay, new symptom).
• Second column: the date.
• Third column: what you noticed, in her words if she has them.
• Bring the hospice discharge paperwork, if there is any, so the stopped list is written down rather than remembered.

Better: ask for the review in the first two minutes of the visit, not in the last. Say: *"I'd like a medication review. For months she was exhausted, and when hospice stopped most of her medicines her energy came back. Can we go through every item together and decide what is still earning its place?"* Then let them read the bag out loud while you tick it off. Asking for a review is a normal, legitimate request — it does not require you to know which medicine is the problem, and it is not asking them to change anything today.

Worth adding: ask whether she should be on one pharmacy, whether a pharmacist can do the interaction check, and whether any medicine she is on needs a blood test to be safe. Also ask what should make you bring her back tonight — get the answer written down.

Tonight, at home, no decisions: keep giving her the medicines that are still prescribed, at the prescribed times, exactly as already instructed. If a medicine of hers is due tonight, it is due. Do not skip, halve or double anything to "test" whether it is the cause — that removes the evidence and puts her at risk. The testing is a conversation with her prescriber, not an experiment at the kitchen table.

2. Constraints and the avoid list

• No diagnosis from us, and no medication change from home. Starting, stopping, halving, doubling, splitting a tablet, changing the timing, or swapping to a different tablet of the same kind is a clinician decision — every time, including for something that looks obviously wrong.
• No copying a stop-list off the internet. The lists of "medicines not to give over-65s" are meant to be used by a prescriber who can see the diagnosis behind each drug. One of these drugs may be the one keeping her out of hospital. Read at the kitchen table, they do harm.
• No sharing, no leftovers, no online purchases. Do not use a leftover course from a previous illness, do not take a tablet from a neighbour or a relative, and do not buy a prescription medicine from an online seller to fill a gap. No mystery powders or "detox" mixes either — they can interact with what she already takes and nobody can see the label.
• No doubling a missed dose to make up for one, and no "evening it out".
• Do not treat a side effect with a second medicine borrowed from the cabinet. The extra tablet is often how the cascade started.
• No sedating medicine to settle her if she becomes drowsy or muddled.
• Nothing by mouth if she is drowsy or confused — that includes her usual tablets.
• Do not leave the weekly pill box where a child or grandchild can reach it. If there are small children in the house, that box moves to a locked or high place tonight.
• Keep vitamins, herbal teas and anything from another prescriber in the same bag — they count as medicines for this visit.

3. A decision tree you can screenshot

```
Is she hard to wake, gasping, collapsed, or not making sense at all?
├─ YES → call your local emergency number now.
│ Say: older adult, many medicines, and exactly when she changed.
└─ NO → Is something NEW since the last few days or weeks?
├─ New confusion / muddle-headedness / seeing things → same day.
├─ A fall, or a head knock, even a small one → same day,
│ and say out loud if she takes a blood thinner.
├─ Not eating, not drinking, very little urine → same day.
├─ New breathlessness, chest discomfort, sweating → now.
├─ One-sided weakness, speech gone, vision changed → now.
└─ Just the months of tiredness, nothing new
→ booked primary care visit next week: bag + list + timeline.
Same-week is fine. Do not turn it into an emergency.
```

4. Red flags — stop the home work and get help

Go now (call your local emergency number, or go to the emergency department): she cannot be woken or is only gasping; new confusion or a sudden change in alertness; a fall with a head strike, or any head injury at all if she takes a blood thinner or an antiplatelet; heavy bleeding or black stools; one-sided weakness, speech or vision change; new breathlessness, chest pressure, or sweating with feeling unwell; a fit; signs of stroke and a possible low blood sugar — these look identical at home and the two need the crew, not the sofa.

Same day, do not wait for the visit: she is not drinking and passing very little urine; she has been drowsy or muddled since a medicine changed; she fell and cannot bear weight or hold her leg; a new bruise or nosebleed that will not stop; she has an infection (urine, chest, wound, sore) and has suddenly gone dull or floppy — older adults often have no fever at all, so "no temperature" is not reassurance.

What not to do while waiting: put nothing in her mouth if she is drowsy; keep her warm; write down when she last ate, drank and passed urine; gather every box in the house including anything recently stopped; bring her glasses and hearing aid so she can be assessed properly. Keep her taking her own prescribed medicine as already instructed until a clinician says otherwise.

5. Success in 24 hours

Not a diagnosis, not a cure. A good 24 hours looks like this:

• One bag, one written list, every box accounted for, including the stopped ones and the supplements.
• A timeline with dates that ties the tiredness to the medication changes.
• The visit is on the calendar, and the request "please do a full medication review" is written at the top of your note so you say it first.
• Her own medicines continue unchanged, taken at their usual times, by whoever is there tonight.
• Everyone in the house knows the same red-flag list, so a sibling covering for you does not have to re-decide it at 2 a.m.

If the visit runs short and the review does not happen, that is a normal outcome, not a failure — ask for a follow-up appointment, or ask whether a pharmacist can do the check first.