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.