To Med Or Not to Med, That Is the Question

Denise

To Med Or Not to Med, That Is the Question

Denise
button-1015632_640I had a coaching client a few years who cared for her mom who had dementia.

My client's mom entered hospice care in October and died in July. My client's mom continued to take a medication for her dementia throughout her hospice experience.

A few months before her mom's death, my client went through her caregiving budget with me. When we got to the costs of meds, my client expressed dismay at the cost of her mom's medication for dementia which reached hundreds of dollars each month because of the dreaded donut hole. I suggested to my client that she speak with her mom's doctors, including the psychiatrist, and the hospice nurse about discontinuing that medication.

Over the next few coaching sessions, my client and I discussed discontinuing the medication. My client never could stop the med, even after conversations with the doctor and with the hospice nurse. The psychiatrist wanted my client to continue the meds and, ultimately, that's the advice on which my client relied. I suggested that the money spent on the med would be better spent on having more help, which my client really needed. "Many times, these meds help the family more than the patient," the hospice nurse explained to my client.

That was the case with my client. The reality is the medication wasn't helping her mom at this point but it was helping my client. She couldn't stop the med because she couldn't stop hoping she could really and truly help her mom. To my client, discontinuing the med became the equivalent of pulling the plug. And, she wouldn't go against the advice of the psychiatrist.

How do we know when to stop a med? Could meds include instructions on when to discontinue use after reaching a certain stage in the disease process? Research is up for grabs on this. Some question if too many end-stage dementia patents receive too many meds. They also debate whether meds can delay nursing home placement. And, family caregivers share their thoughts about discontinuing meds in articles on Caring.com and AgingCare.com. A helpful article on Living Well describes when it may be appropriate to stop Alzheimer's disease medications. My client's mother, however, was near the end of life but not near the end of the disease process.

Wouldn't it be helpful to know when a medication has run its course? Wouldn't it be comforting to know when a drug can no longer minimize the progression of a disease so you can discontinue the med with a clear conscience? Wouldn't it be a helpful dose of reality to know when we can no longer stave off the march of a disease so it's okay to stop a med? These instructions could become a trigger for a discussion with the doctor about a disease process and prognosis. If we had instructions on when to discontinue, then we could minimize our guilt when we decide to stop a medication. And, we could be realistic about how we can best provide care while spending money in the best way possible.

What do you think? Please share your experiences in our comments section, below.