INTRODUCTION
There are many guidelines for starting and managing medications, but significantly fewer resources exist that address when to consider stopping therapy. Unfortunately, this can result in patients remaining on an abundance of medications near the end-of-life, increasing pill burden, with little to no symptom-relieving benefit. Additionally, in certain scenarios, continuing therapy can result in prolonged medication-related side effects or put the patient at an increased risk of an undesired outcome (fall, dry mouth, increased urinary frequency, confusion, etc.).
Reviewing Medication Management
Medication No Longer Indicated
Medications to prevent long-term complications of cardiovascular or other common disease states in patients with advanced age may no longer be required in patients admitted to hospice, as the focus of care has likely transitioned to symptom management and comfort. Blood pressure, cholesterol, diabetes, osteoporosis, thyroid, and blood thinning medications should be reviewed to determine if continuation is beneficial.
Medication Side Effects
If continued use of a medication results in you feeling side effects, such as dizziness, dry mouth, nausea, low blood sugar, lightheadedness upon standing, or low blood pressure, a medication review with the hospice team may not only result in decreased side effects but also in reduced risk of fall or other undesired event.
Change in Function
If you are having difficulty taking medications due to changes in your ability or comfort swallowing, there may be other options to continue therapy. However, if the medication is not providing symptom relief or benefit, discuss options for use with your hospice team.
Medications to be Considered for Discontinuation in Hospice
Blood Pressure Medications
Often started for the prevention of cardiovascular events
In the hospice setting, preventative benefits of medications often beyond life expectancy
Patients can feel less fatigued following stopping blood pressure medications
Cholesterol Medications
The preventative benefit of statin therapy likely beyond the remaining life expectancy
No symptom-relieving benefit of statin therapy
Anticoagulation Medications
Patients who continued on therapy have significantly increased risk of bleeding event
Patients often continued on therapy beyond the recommended date
Dementia Medications
GI side effects: diarrhea, nausea/vomiting
Increased incontinence
Lack of benefit in patients with severe disease
Type 2 Diabetes Medications
38% of hospice on insulin experience hypoglycemia, 18% with severe event
Insulin injection and BG monitoring can be painful and burdensome
Vitamins/Supplements
If not used for symptom management, may contribute to unnecessary pill burden
Changing nutritional status and intake can impact the risk of side effects with use
Abbey Road Hospice will review your medication list and discuss opportunities to reduce your pill burden and eliminate unnecessary medications. If you have questions or concerns about recommendations or changes to therapy, it is important to communicate these with your hospice team. Your goals and wishes will be taken into consideration when making decisions about medication management.
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