Many people believe that if they choose hospice, they must give up all their medications in favor of comfort medications.
The truth is medications are tailored to each hospice patient’s needs. At Care Dimensions, that starts with a medication review.
This review ensures that patients are receiving the best combination of medications and therapies for their needs, goals, and quality of life. Some hospice patients may remain on all their medications, while others may choose to stop taking certain medications that are no longer beneficial or cause harm. Decisions are always made collaboratively with the patient, family, hospice staff, and the patient’s doctor.
Studies show that taking more than five medications daily increases the risk of adverse interactions, side effects, and medication errors. As we age and our health changes, medications tend to be added to treat certain conditions or symptoms but may not be reevaluated for their safety and necessity.
Some common reasons why patients may choose to discontinue certain medications while on hospice care include:
Older adults may require lower doses of medications to achieve the same effect or to prevent side effects and organ damage. Examples of physical changes and their effects include:
Before starting hospice, patients may see multiple doctors for different conditions, and each prescriber may not have a full list of the patient’s medications to assess safety before prescribing a new medication. Many patients also take over-the-counter medications, vitamins, and supplements that may not show up in medical records. Some doctors may hesitate changing drugs prescribed by another doctor, which can result in a buildup of medications. The hospice team can review all prescription, non-prescription, vitamin, and supplement medications and advise the patient and caregiver so they may decide whether to change their medication routine.
It is important for patients and their caregivers to understand that certain medications may not lead to the best quality of life. Discussions around discontinuing them may help patients manage symptoms. For example:
Many patients approaching end of life have difficulty swallowing. The hospice team’s goal is to ensure the patient receives the biggest benefit from the fewest medications. The team can talk with the patient and caregiver about which of their current medications may not be clinically beneficial.
The patient’s and caregiver’s understanding and comfort with all decisions is key to quality hospice care. Choosing to stop a certain medication may improve a hospice patient’s quality of life, but that decision can be made only after careful consideration by the patient and care team.
About the author
Allyson Beechy, PharmD., has been working with Care Dimensions through a partnership with the Dana-Farber Cancer Institute/Harvard Interprofessional Palliative Care Fellowship Program.
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Since 1978, Care Dimensions has provided comprehensive and compassionate care for individuals and families dealing with life-threatening illnesses. As the non-profit leader in advanced illness care, we offer services in over 100 communities in Massachusetts.