I have a patient who is over 80 and being seen for anxiety, OCD about cleanliness, and depression. I am at a loss on what to do for her.

SITUATION: Patient needs help in ambulating and is a self professed "night owl" and sleeps only 4 hours a night. Her son fearful of his mother falling again stays awake with her and works a FT job in the day. In one case the son took his mother to the bathroom to wash her face and brush her teeth, while doing this the son falls asleep and the mother refused to walk unassisted to her bed and hence was up all night holding her toothbrush until the son woke up. Once the patient is awake the son feeds her even if its 2 in the AM.

I have suggested many things to do like make a list of things that need to be done the next day, choose one task and complete it that day, allow others to help with cleaning the house, do her nightly ritual of washing her face and brushing her teeth after dinner, not to feed her at 2 in the AM but put her back to bed to no avail.

The MD has prescribed several meds but the son/family refuses to give them to her because of the possible side effects (ambien makes her more alert, go figure) and trazodone, etc.

Please help