DEAR DR. ROACH: My mother lives with me. She’s 88 and on hospice. She’s totally bedridden. Her brain is fine, but her body has failed her. The problem is that if I try and get her out of the bed for anything (a change of scenery, to change the sheets, etc.), within minutes of getting her into a wheelchair, her blood pressure crashes, and she loses consciousness.

Obviously, this is a huge issue. She’s always complained of a lifelong “vasovagal” issue. This also happened occasionally before she was on hospice, and her cardiologist gave her a new medication — midodrine. But this didn’t help at all. She currently isn’t taking any meds (her choice), except for hydrocodone twice a day for chronic pain and duloxetine for depression.

She did have a mild stroke about five years ago, but the only result was a very mild loss of control in her right arm. This is now completely recovered. She also has a history of low blood pressure and low potassium. Do you have any suggestions to help?

• L.H.

ANSWER: This is a difficult issue, and I’m sure that it’s frustrating for both of you. The most important advice I have would be to change her position very slowly. If she has a hospital bed at home, I’d raise it slowly, perhaps as long as over a half hour, to give her body time to adjust. She should also be sure to get in adequate water and salt daily due to her low blood pressure.

Unfortunately, while I understand her desire to continue the few medications that are helping her, both of them can make the lightheadedness when changing positions worse.

In my opinion, duloxetine is more likely to be exacerbating the problem. An alternative antidepressant is bupropion, which isn’t reported to have an increased risk in worsening the blood-pressure-lowering effect of standing. Hydrocodone may also worsen this effect and, consequently, her symptoms. Lower-risk alternatives include fentanyl and buprenorphine.

If these changes don’t provide adequate relief, I’d consider a different medication, fludrocortisol, which enhances salt and water uptake in the body. This can have the side effect of low potassium, so checking blood tests is recommended — but may be annoying (or worse) — for your mother.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.