Hello everyone!
My 99-year old mother recently entered hospice. She's not on any real medications, mainly supplements or things like sodium-bicarb to help with her colostomy/output. Hospice intake asked if we were willing to go through "deprescribing" (a process of tapering or stopping medications to achieve improved health outcomes by reducing exposure to medications that are potentially either harmful or no longer required). Specifically, they wanted to remove things like her daily 81mg aspirin, daily multi-vitamin, and a Vitamin C with iron).
Does anyone have any experience with this, as a process? Thoughts good or bad? Perspectives we should think about?
Mom always took vitamins or supplements, and I feel that was part of what got her to 99. She's never been on any prescription medications other than what was required temporarily when hospitalized. And she certainly doesn't fit the typical example of people on multiple prescriptions that could be working against each other, or making her final time difficult.
Hospice focuses on comfort care rather than prevention.
My mother wasn’t interested in prolonging her life. She didn’t fear death and was ready to die.
Anytime hospice suggested removing meds that were no longer necessary, we agreed. If they added meds to keep her comfortable such as morphine, we agreed to it.
Wishing you peace as you continue on your caregiving journey.
I personally see no harm in allowing her to take her aspirin, daily vitamin and her vitamin C with iron, while she's under hospice care.
My late husband was under hospice care for the last 22 months of his life and he took a butt load of medications for various reasons(mostly for his seizures), and there were several times when hospice tried to get me to discontinue some of his medications. Most of the time I didn't agree with them and he remained on them. The only time I agreed was when it was his cholesterol medicine. He also took a 81 mg aspirin and multi-vitamin right up to the start of his dying process.
So don't forget, just because hospice "recommends" something, it doesn't mean that you have to go along with it.
You do what you feel is best for your mother.
Medications usually discontinued are lifestaining prescription drugs. I don't see where taking her aspirin and multi-vitamin would be lifestaining. My DH takes an 81mg aspirin for his heart because of AFib he has every so many years. Since she has been taking these things for years, I see no problem in continuing them if she wants to but they are really no longer needed. The Vit C with iron, I would discontinue. Iron did a number on my Mom BM wise and its hard to clean them up. The sodium-bicarb may not be needed if you drop the iron.
I cannot imagine why either giving or withholding would make the slightest difference.
I am very surprised that anyone in a Hospice situation would suggest that the goal is "improved health outcome" because the REAL goal for hospice is/should be comfort care for end of life process.
I have never heard the word before "deprescribing", so that's a new one on this RN, but time has marched on since my retirement. Looking it up I found the following online:
https://www.aafp.org/pubs/afp/issues/2019/0101/p7.html
It says that deprescribing is exactly what you just said it is. But as I said, I don't get it.
And to be honest, in end of life Hospice situation I cannot imagine what difference it makes whether she takes the meds you mentioned or not. I doubt an ASA or vitamin is prolonging her life, or making it more uncomfortable, or improving it EITHER.
I would ask specifics:
What medication do you wish to withdraw?
What HARM do you believe this medication is doing?
What is your GOAL in removing this medication?
For me, removing the ASA makes her a bit more prone to stroke, but the ASA itself makes her more prone to a bleed anywhere.
I cannot see what good or harm a medication is doing other than that iron in a vitamin may be constipating.
I just don't get it. So I would ask questions.
Definitely don't stop anything needed to keep the bowels moving. Best of luck to you and your family.
We, the Hospice Nurse and I, went over the meds and for the most part I agreed that they were unnecessary at that time.
Actually the only 2 medications he was on at the time was a Cholesterol medication and Aricept. Both at that point could be discontinued.
Hospice did not "force" the issue and I am sure the Cholesterol medication would have been covered if I had wanted him to continue on with it.
This is your decision Hospice will cover some "formulary" medications but ones that might not be could be filled at the drugstore.
In your case the Vitamins, probably really not being absorbed as efficiently as they should be. The low dose aspirin again is your choice to continue or stop. Does she have a high risk for a heart attack or stroke?
And I hate to be a "debbie downer" but what would you want done if she did have a heart attack or stroke?
If she survived a heart attack the CPR would probably be difficult to recover from (if she is has CPR done) as it will most likely break ribs, crack the sternum and puncture a lung.
Recovering from a stroke is difficult at any age but 99?
There is no right or wrong on this