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.
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.
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 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.
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