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Hospice Medication Management



Medications

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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