My mother is probably in worse shape than your parents, but she is no longer on cholesterol, BP meds and aspirin. Her cholesterol and BP have been WNL since she stopped.
I am also of the mindset to make all medication decisions with a clear eye on what time it is. Prolonging a demise or risking complicated side effects or drug interactions become absurd at some point. The question is when. A body with severe discomfort, a mind fading away, multiple conditions that are likely to progress to a devastating level over time, and age are a few variables to stir in. My father never required much medication, likely has a slow progressing vascular dementia and is 92. Conferred with Drs years ago and got him off statin medication. I wish we had done it sooner. Every situation is different, it is a worthwhile conversation to have.
If you are at the no treatment fork in the road, good to be sure you have paperwork beyond a DNR to back it up. The names of the forms vary by state, but they are very specific. I found it helpful to review the entire form with my father’s primary. Good way to understand options and medical status of patient, as well as feel more confidant about choices.
It is a hard decision in the best, or should I say straightforward circumstances. But what if there is disagreement on the med/treatment strategy between family members - siblings or spouses?
One thing to do is show all her prescriptions to her pharmacist, and have them give an opinion about what each medication is supposed to accomplish, and what the side effects are.
@mominmd the downside of discontinuing some meds may be risk of stroke or heart attack- on top of dementia. Perhaps you can think that you didn’t put parent at further risk.
It is truly a precarious decision.
My Dad was Dx with terminal untreatable cancer, but continued on cholesterol meds until he died, in his case it was a bit of denial, as in he hoped something would be invented to cure him. But even so, I don’t think any doctor every addressed the uselessness of cholesterol meds in a terminal person.
I feel strongly that once the brain is broken we should not try so hard to keep the body alive, let it do what it’s going to do, of course, always keeping the person comfortable.
I agree totally with what esobay wrote.
South Jersey, yes, risk of stroke or heart attack can increase when stopping those meds. Some would say that one of those options is not a bad way to go, if the mind is gone already. Known side effects of statins include muscle aching and confusion, so they might feel a bit better off the statins, and have better quality of life for the short time left when the drug is stopped. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm
Regarding disagreement, hopefully one person has POA, and has been chosen for that role based on their previous discussions as to what the parent wants, and is able to advocate at time of crisis. It is helpful if you have a provider on board, who can suggest in the direction of best outcome for the patient, so the onus is not one one family member to fight the rest. This is one reason to have in depth conversations while the parent is still alive, with all family members present. And then write it up in detail!
My MIL has had her meds administered by the AL nurse since they moved in. My FIL was self-administering until it became apparent a month or so ago that he couldn’t do it himself (doubling up on oxy is not a good idea). Right now, the only thing he’s allowed to take on his own is the Nitro pill(s) when needed.
When we met with my mother’s neurologist after her dementia diagnosis, he was very upfront about her getting to the point where meds that could prolong life (cholesterol, BP) should be discontinued. At that point, she would be taking only those things that help with quality of life - antidepressant, anti anxiety, sleep, pain. She’s already stopped the meds for her type 2 diabetes as well as superfluous vitamins.
@greatlakesmom "South Jersey, yes, risk of stroke or heart attack can increase when stopping those meds. Some would say that one of those options is not a bad way to go, "
Total agreement there. The complication is if stroke or heart attack is not fatal
I took statin for short while and convinced I had memory issues.
Dr took my 94 yo mother off bp med (water pill) and sleep med after a fall. It was his idea which meds to stop. Working with him and letting him know the issues and concerns helped. She is still on cholesterol and namenda, vit d and calcium.
Said before that when my friend took her mother off most meds (somewhat gradually,) her mother perked up a bit. Though she did have dementia, the function she had left had been affected by the combo of meds. It’s an option to wean them, no?
I believe Aricept is what led to my grandmother’s decline, her side effect was diarrhea, which led to dehydration and all the rest of what comes with that, including her processing. Then later, in the hospital, they determined she did not have Alzheimers, but a more normal decline in cognitive abilities (in her mid-90’s, at that point, probably ‘mild cog impairment,’ which Aricept is not appropriate for- I think not approved for.) So be cautious.
This is what is suggested by someone at the CCRC. I just think it is unnecessary for him to take the pills and it would decrease his QOL even more to hire someone to come in and watch him take the pills. I really just want to stop them. I think I forgot to mention, mom’s doctor, at my suggestion, took her off all of her medications. Later on her BP was pretty high and she was put back on one BP medication. Really, she didn’t instantly have a stroke or heart attack by taking her off her 2 cholesterol meds/aspirin and weaning down on BP meds. Remember, statins (cholesterol) help “down the road.” Her trial of Aricept made no difference and her doctor was happy to take her off. Dad looks over at her, with her one pill, and gets pretty frustrated. He doesn’t seem to have side effects, but I sure am statin intolerant (terrible muscle pain with small doses) and mom brightened quite a bit off her cholesterol meds.
I have no siblings as my brother died a little less than 2 years ago. The responsibility and the decision is mine alone as I don’t feel my dad is competent to make decisions. One of my physician colleagues suggested I just become passive and take him off his meds without “permission” from the doctor.
Typically we just talk about the risks and benefits of the medications. I have medical power of attorney, so I’m not just a relative wanting to stop his medications. The doctor admitted there was no “right” answer to this.
@esobay yes about me wanting to preserve the status quo. But, that’s not really possible with aging parents, or for anyone really. It’s a moving target.
One step forward two steps back for me today. Last week I went to see my dad and he was happy, but he kept nagging me about the bank. I hadn’t seen him since Friday because my car was in the shop. Today first thing he starts harping about the bank. I told him I work (which is true), he asked if my sister could, I said she worked (and lived an hour away). Then I said I could figure out a way to do it, but that I would be going with him and staying with him and bringing him back. That made him very angry. He wants me to just drop him off at the bank, and then in his fantasy he will get his money and ride off into the sunset, alone (he said he will call his friends and find a place to live). When I told him that wasn’t happening he said he is going to sue me. Yikes. I get it, he wants to be in control of his own life. He is a lot better than when he was first hospitalized, which I attribute to eating and not drinking. But still confused about some things. I tried to tell him that I love him, and I have his back, but it didn’t help. Do I just keep going back like nothing happened?
Medications carry risks. They are not the only cause of falls (the biggest injury-related cause of death in people age 65 or older) but they are a significant cause. Certainly, there is value to many drugs, even in the elderly, but I certainly think it’s worth having the conversation with the physician about reducing or stopping some or all of the meds. My father had one very severe illness as a result of a drug interaction and his final stroke might have been related to inadequately monitored resumption of a drug that he was temporarily off, for minor surgery.
http://www.jsonline.com/story/news/health/2016/09/20/new-screening-helps-stop-elderly-fall-deaths/90745720/
@tx5athome – Yes, I’d keep just going back as if it hadn’t happened. Tough stuff; I’m sorry.
But you make sure that, somehow, you get your own right support for the challenge of dealing with it.
@tx5athome tough call. The only suggestion I have is to make sure that you have some way to keep him from leaving with anyone you don’t know. Happened to my Dad’s wife, she made friends with a visiting relative (not hers, someone else) who believed her tales. And She drove wife to bank. Where she withdrew from Dad’s account (which did NOT contain her signature… it had been set up to protect it from her since. duh… she was crazy) . That is why I have guardianship; I can limit who can visit, etc. POA doesn’t help for contradicting wishes of a convincing person.
I don’t think I’m really saying that. I just want to discontinue the meds that have no therapeutic benefit for an 80 year old demented man like we were able to do for my mom.
@tx5athome yes, just go back like nothing happened. What your dad is saying to you is normal behavior. He feels helpless (and is!) and it’s normal for him to react negatively towards the ones he love.
@tx5athome , your story hurts to read it sounds so familiar. With FIL it was the car keys instead of the bank, but same fixation on getting back control of his life. And it never really stopped, although he could sometimes be redirected. Toward the end, he spend most of the time when he had visitors telling stories about his earlier life - his time in the service, his childhood, etc. If we could get him started on a story he’d go on forever. He didn’t want to hear our stories or grandkid stories, he just didn’t care about anyone except himself.
And oh, the stories he’d tell about the NH and hospital staff. Orgies in the hallways, according to him. Not sure where all that came from.
DH seemed to be the trigger for the car keys demand - the one he blamed the most for being stuck in a facility. DH’s siblings were off the hook for some reason. Not fair, but that’s just the way it was.
Strangely my mother hated to drive and my now deceased dad did all of it. However that was the fixation when we told her she could not drive. Had no interest in the bank accounts. I was the one she blamed and brother got off on this one. Not much you can do. Just realize that it is the illness and age not you. She has no interest in what I or her only grand children (my kids) do. She used to love to hear about them. It is just the dementia. I think 2 year old behavior and it makes sense.