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Why Medicines Change During Hospice Care by Glen Mire, MD

Posted on: September 11th, 2014 by rgremillion

Dr. Mire Why Medicines Change During Hospice Care

Glen Mire, MD

The focus of hospice care is palliative symptom control and patient comfort, not curing disease. When most patients are admitted to hospice, it is usually time to stop certain medications. Our medical team carefully evaluates the functional status of each patient upon admission, and reviews the medicines they are taking. We may decrease dosage or gradually phase out certain medications that no longer benefit the patient. Whether or not we phase out a medication depends on how active and functional the patient is. If they are still alert, socially interactive, and physically active, we usually continue the medication. Hospice does not accelerate the dying process by stopping medications that still benefit the patient.

Blood Pressure, Thyroid and Diabetes Medications Patients who are admitted with high blood pressure, diabetes, or thyroid disease may have their medications gradually reduced. While we do not want uncontrolled blood pressure, diabetes or thyroid disease, which could make the patient feel worse, we don’t want “tight” control of blood sugars or blood pressure either. We must strike the right balance according to the needs of the individual patient. It’s an ongoing evaluation: Whether the benefits of a certain medication outweigh the burdens at that particular time, for that particular patient. We maintain the regimen that best enhances the quality and comfort of life.

A medication that is appropriate for the patient at one time may not still be appropriate a few weeks or months later. It depends on the progression of the disease. For example, as long as patients with diabetes are still eating and drinking, the medication benefit exists. When the patient is no longer eating and drinking normally, medications are reduced to decrease the risk of hypoglycemia (low blood sugar). When patients are in the final stages of dying – are barely conscious, not eating or drinking – on their “death bed” – there is rarely any benefit in continuing blood pressure, thyroid or diabetes medication.

Surprisingly, patients often report an improvement in their sense of well-being and vitality when their pill load is reduced, because the good we thought we were doing doesn’t necessarily translate into patients feeling better.

Alzheimer’s Medications do not cure or prevent dementia, but, at best, help slow its progression. When a hospice patient is admitted, we may either reduce or discontinue those medications, if they are no longer of benefit to the patient. In most cases, it is appropriate to stop these medications when patients are admitted into hospice in the end-stages of dementia.

Symptom Control and Therapies Medications to control pain, anxiety, sleeplessness, and other distressing symptoms such as coughing and diarrhea are appropriate to keep patients physically and mentally comfortable. Occupational and physical therapies focused on rehabilitation are usually discontinued, as they no longer benefit patients with end-stage terminal disease. HoA may provide limited physical and/or occupational therapy to train and instruct families to help them learn how to transfer the patient, for example, from chair to bed. The goal is to enable them to care for their loved one comfortably and safely.

The Ongoing Question At HoA, we continually ask: Is this medication providing benefit, or just risking side effects while no longer providing any benefit? If benefits do NOT outweigh the burden, then it’s probably time to either gradually phase out or stop that particular medication.






September – October 2014 Pillar

Posted on: September 3rd, 2014 by rgremillion

Please enjoy our updated Pillar!    2014 Sept October pillar






Register now for the 3rd Annual “Cycle for Hospice” Bike Ride

Posted on: September 3rd, 2014 by rgremillion

cycle 2014 cover page for website






Taking care of our skin with Dr. Elizabeth McBurney

Posted on: August 14th, 2014 by rgremillion
Join us to learn more about taking care of our skin!

Join us to learn more about taking care of our skin!






Honoring Dame Cicely Mary Strode Saunders, Founder of Modern Hospice Movement

Posted on: July 21st, 2014 by rgremillion

Honoring Dame Cicely Mary Strode Saunders, Founder of Modern Hospice Movement


Posted on July 16, 2014 by Christopher Hewitt (Blog Writer, SevenPonds)
saunders photoJust 9 years ago from last Monday, Dame Cicely Mary Strode Saunders’ life came to a close after 87 years. Born in 1918, she marched across the 20th century as a self-starting woman destined to be remembered as the founder of the modern hospice movement. Thus, in honor of her death day, this week we take a moment to honor her widespread influence and ongoing legacy. Her accomplishments were extraordinary. After attending Oxford, serving as a nurse in WWII, then going to medical school and qualifying as a doctor, Saunders worked for decades “to build a home for dying people, where scientific knowledge should be combined with care and love.” And in 1967 she founded St. Christopher’s Hospice, the first secular, modern hospice in the world.

Saunders’ practices, informed by her own extensive research and firsthand experience with pain management, continue to shape the ethics of hospice care today. Advocating the need for palliative care, the tenacious, driven paragon of proto-feminism disavowed the prevailing ethics in which doctors would attempt to cure their patients at any cost while those who couldn’t be cured were considered failures. Instead, she believed that dying people deserved compassion, respect and assistance with managing pain. And not just physical pain—Saunders widened her notion of pain to include a more holistic complex of physical, emotional and spiritual dimensions.
Along with her progressive ideas on pain and treatment, Saunders corrected the things she found objectionable in the medicine of her day. She renounced the idea that medication had to wear off completely before taking another dose, refused the widely accepted practice of lying to a patient about his or her prognosis and abolished “visiting hours,” which were often an excuse to have mostly “non-visiting hours.” In summary, her cutting-edge decisions are basic protocol for many hospitals today.

Imagine what our world would be if we had more visionaries like Saunders — people so clearly marked by goodness and truth. Audacious, free-thinking and endlessly compassionate, she pushed against the mistakes of her peers to help those most in need of comfort and care. As we watch our aging parents and grandparents, let us remember her lessons as we honor her life, remarkable as it was.






3rd Annual Sr. Independence Day – June 26th

Posted on: June 6th, 2014 by rgremillion
Join us for our 3rd Annual Sr. Independence Day

Join us for our 3rd Annual Sr. Independence Day






Recognizing our Blessings with Lewis Bernard

Posted on: May 12th, 2014 by rgremillion

Lewis Bernanrd FlierLewis Bernanrd FlierOur lives can be full of blessings both seen and
unseen. Often we take for granted the simple things and Lewis Bernard will take
us through the journey of recognizing our blessings. Thursday, May 22nd 12:00noon-1:30pm.   Registration is required
and light lunch will be served.  Call 337-232-1234 to register.

Hospice of Acadiana Conference Center

Lewis B. Bernard






Understanding Colon-Rectal Cancer Presentation by Sylvia Oates

Posted on: March 19th, 2014 by rgremillion

Check out the information for our monthly inservice presentation. This is opportunity for any and all to gather information from professionals passionate about the subject matter.
Sylvia Oates






March – April 2014 Pillar

Posted on: March 19th, 2014 by rgremillion

March-April 2014 Pillar (2)






What is a Sunday Brunch without Classic Jazz?

Posted on: February 27th, 2014 by rgremillion

LAFAYETTE – Hospice of Acadiana is hosting a brunch, “Jazz It Up To Make A Difference,” Sunday, March 23, 2014, first session beginning at 10:30 a.m. The event, which will be held at The Victorian in Broussard, Louisiana, will help continue the efforts that Hospice of Acadiana has made toward Acadiana since 1983. This will be a new and unique kick-off to Hospice of Acadiana’s annual raffle.

     Enjoy the smooth sound of live Jazz, featuring Jeremy Benoit “JB Saax” and the Band. This is a special event for community leaders, philanthropists, and music lovers to be invited and indulge in the festivities of Jazz music, while feasting on delicious food.

To attend, individual tickets are $100 or $1000 to reserve a table. Check out the Hospice of Acadiana website for more information on 2014 Jazzing It Up To Make A Difference kick-off brunch, www.hfacadiana.com. Tickets are available at Hospice of Acadiana Lafayette location, online at www.hfacadiana.com  or calling 232-1234. Tickets are limited, so be sure to get your tickets early.

Thanks to all of the 2014 participants, your donations will go towards continued funding of Hospice programs. Hospice of Acadiana is Acadiana’s oldest and only non-profit hospice.