Does My Dying Parent Really Need All These Medications?

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As one ages, people are often prescribed more and more medications. Sometimes one medication is given to control the side effects of another medication. After a while the medication list builds up. Taking many medications, what providers call polypharmacy, can have many negative consequences including an increase in falls, bleeding, fatigue and gastro-intestinal symptoms. As one is preparing for the end of life, it makes sense to stop medications that are not offering any benefit. In the medical community, this is known as deprescribing. Deprescribing is the process of reviewing medications and removing medications that may be causing more harm than good. The goal of deprescribing is not to hasten death, but to maximize how well someone is feeling so they can enjoy whatever time they have left.

Which medications should be deprescribed?

Medications to consider stopping or decreasing include:

  • Blood pressure medications
  • Diabetic medications as goals for glucose control are different at the end of life
  • Anti-ulcer medications, PPIs and H2 blockers
  • Supplements, which have limited benefits and not without risks and side effects
  • Osteoporosis medications
  • Coumadin and NOAC (Novel oral anticoagulant) medications, especially when used to prevent strokes from atrial fibrillation
  • Dementia medications, which are no longer effective in the face of severe dementia

One reason some of these medications become unnecessary at the end of life is that they are taken to ward off future disease without any daily benefit. For example, many people take cholesterol medications to prevent heart disease and strokes from happening in the future. While these medications are proven to reduce heart attacks and strokes over the long term, they do not offer protection on a day by day basis. In addition, these medications can have potential unwanted side effects such as muscle aches and dementia.

Other medications for end-of-life

Deprescribing doesn’t mean that you shouldn’t consider other medications that might help at the end of life. Many medicines can make someone at the end stages more comfortable—not just pain medication and anti-anxiety agents but some heart and lung medication as well as anti-nausea medication, laxatives, stimulants, and medical marijuana. Make sure that your or your loved one’s doctor doesn’t misinterpret an interest in deprescribing as desire to stop all medication altogether. As Dr. Barbara Farrell and Dr. Cara Tannenbaum, co-founders of the website deprescribing.org, state: “Safely reducing or stopping medications is a team effort.”

 

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