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In This Episode:
Dr. K addresses a reader’s concerns about the morphine and lorazepam (brand name Ativan) that were given to her relatives with dementia, while on hospice. She covers:
- Common end of life symptoms, and which symptoms are common in people with advanced Alzheimer’s
- How morphine is usually used at the end of life, to manage problems such as pain and shortness of breath
- Why it’s usually possible to use morphine to control symptoms without “hastening” death
- Why it’s unclear that lorazepam should be used as often as it is, in hospice care
- How to choose a good hospice provider
- How to be proactive, to avoid problems and misunderstandings with the hospice team
- What you can do, if you’re concerned about the care a loved one is receiving while on hospice
Related episode:
043 – How Hospice Helps at the End of Life, & Hospice for Alzheimer’s
Related Resources:
- Q&A: Hospice in Dementia, Medications, & What to Do If You’re Concerned
- Canadian Virtual Hospice: Does morphine make death come sooner?
- National Hospice & Palliative Care Organization: Choosing a Quality Hospice Worksheet
- Initial Hospice Admission & Comfort Med Orders
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Daughter says
My dad was not terminally ill. The overdose of all three drugs “opioids” killed him. He was never told he had less than 6 months to live. His health conditions were under the control of a doctor and well managed for years. His ex-wive’s lies got him admitted to the hospice and he was admitted without being terminally ill.
Nicole Didyk, MD says
I’m so sorry you had such an experience. and sorry for your loss. I hope that your father’s medical team was able to assess his capacity and make sure that the decision making was done ethically.
Here’s an article about POA that might be helpful: https://betterhealthwhileaging.net/avoid-senior-incapacity-problems-durable-power-of-attorney/
Diane Atwood says
This is so good. Thank you. My husband is in a memory care facility. Still walking, interacting and we have such wonderful times together. The facility requested hospice because he is wandering more and exit seeking. Hospice immediately wanted to put him on lorazepam. I fought it because I don’t want him on a controlled substance. Had him moved to trazodone. My husband isn’t anywhere close to what you are describing in his stage with memory loss.
Nicole Didyk, MD says
It sounds like you’re a good advocate for your husband, Diane.
Most of the medications we use to manage behaviours like exit seeking have the potential to cause sedation and other side effects. Even trazodone can be a cause of falls and confusion. I’m glad it seems to be helping in your case. You might be interested to read Dr. K’s article about medications: https://betterhealthwhileaging.net/ags-beers-criteria-medications-older-adults-should-avoid-or-use-with-caution/