Q: Dear Dr. K,
With all the news about opioids and benzodiazepines, and their risk of death, I would love to hear your take on the use of these drugs in hospice.
We’ve had two family experiences now (my Mom and my Aunt) who were given these drugs right away when they went on hospice…without hospice trying anything else first that would be less dangerous. My Mom was up and about walking one day at her memory care facility, even laughing. The next day, when hospice put her on morphine and Ativan, she was in a coma. She died 13 days later without ever regaining consciousness. When I protested and asked why she wasn’t waking up, the hospice nurse said, “It’s not the drugs, it’s the disease.” (Mom had dementia.) The nurses wouldn’t let us give her fluids (“you don’t want your mother to aspirate, do you?”) or feed her (“you don’t want your mother to choke, do you?”).
With my Aunt, she had also been in the memory care facility and got to the point of needing a two-person assist. Her power of attorney (POA) was given the choice of moving my Aunt into a nursing home or bringing in hospice. Hospice immediately gave her morphine and Ativan, then backed off the Ativan and gave her morphine every two hours until she died 3 days later.
Now the third sister, also with dementia, has been in hospice for two months and counting. She is lucid most days, eating/drinking, comfortable—all without the opioid/benzo drug combo, because of our experience.
How can family members identify a hospice that doesn’t use this troubling combination of drugs from the start, without first trying something less dangerous, to make a patient “comfortable”?
A: Thanks for sending in this question. I’m very sorry to hear that your experiences with hospice have left you concerned.
It is indeed extremely common for hospice to use morphine and lorazepam (brand name Ativan) to treat end-of-life symptoms. That’s because many peopleon hospice are suffering from troubling symptoms that these medications can relieve, such as pain, shortness of breath, anxiety, and agitation.
Still, these medications are not always necessary. They are supposed to be prescribed and used as required to relieve the dying person’s symptoms, not by default. So the situation you describe with your mother and your aunt does sound potentially concerning. At a bare minimum, the hospice personnel should have done a better job of discussing their proposed care plan with your family.
Now let me be clear: I cannot say if the way they prescribed morphine and lorazepam was inappropriate or not, because it’s impossible for me to know the specifics of your mother and aunt’s medical situation.
Still, we can certainly review some basics about hospice care for people with Alzheimer’s and related dementias, as well as recommended best practices, when it comes to using opioids and benzodiazepine sedatives.
Here’s what I’ll cover:
- The basics of hospice
- Hospice for people with dementia
- How opioids can help at the end-of-life
- The use of benzodiazepines in end-of-life care
- How to choose a hospice provider
- What to do if you’re concerned about the care your relative is receiving during hospice
The Basics of Hospice
Hospice, as you may already know, is a package of palliative care services specially designed to support people who are dying, and their families. Medicare covers hospice services for older adults if a physician can certify that the person is likely to die within six months.
Hospice care usually includes the following:
- Clinical services to address the terminally ill person’s physical, emotional, social, and spiritual needs.
- This is provided by a multidisciplinary team, which usually includes nurses, social workers, counselors, and therapists. Other forms of support such as home health aides or specially trained volunteers may also be available. A physician oversees the medical care plan and can assist with particularly challenging medical issues.
- Special attention and expertise in managing difficult or uncomfortable symptoms.
- Hospice clinicians usually have expertise in managing symptoms such as pain, shortness of breath, anxiety, constipation, nausea, agitation, and many others.
- A focus on optimizing quality of life.
- Hospice teams are supposed to enable the dying person to have the best quality of life possible for the time that is left.Most hospice clinicians have been trained to talk to patients and families about what is important to their quality of life.
- Support for family members.
- Hospice care includes counseling and supportive services for the patient’s family members, who are often very involved in the dying person’s day-to-day care. Bereavement support is also usually available.
- Medical supplies and equipment, such as a hospital bed or wheelchair.
Medicare hospice services are provided by certified agencies or organizations. Sometimes they are part of a home health agency, a nursing home, or another bigger healthcare organization. They can be non-profit or for-profit.
Hospice services can be provided in the patient’s home, in assisted-living, or in a nursing home. They can also be provided in special inpatient or residential hospice facilities.
To learn more about hospice care, see:
- Kaiser Health News:Learning About Hospice Should Begin Long Before You Are Sick
- Medicare.gov: How Hospice Works
- NextStepInCare.org: Family Caregiver’s Guide to Hospice and Palliative Care
- National Hospice and Palliative Care Organization:
I find that families tend to find hospice services immensely helpful. That’s probably because hospice sends nurses and other healthcare providers to the home — so convenient for families! — and addresses symptoms and difficulties that primary care providers may not be equipped to assist with. Hospice also usually provides a 24 hour/day number that you can call, if you have concerns or need help.
Hospice for People with Dementia
Hospice services are intended to provide support and assistance, regardless of what illness a person is dying from.
That said, in the early days, hospice especially served people dying of cancer, rather than people dying from a slow terminal illness such as Alzheimer’s disease. It’s probably for this reason that some features of Medicare’s hospice benefit, such as the six-month prognosis, are better suited to cancer diagnoses than other terminal illnesses.
Today, it’s become more common for people with dementia to use hospice services at the end of life. In 2014, 15% of hospice admissions were for dementia.Research shows that in people with advanced dementia, hospice usually improves care and symptoms at the end of life.
One challenge in beginning hospice services for people with dementia is that it can be quite hard todetermine when the person has reached a “six-month prognosis” (i.e. is unlikely to live more than six months). That’s because Alzheimer’s and other dementias usually progress much more slowly than advanced cancer does.
Medicare’s guidelines on hospice coverage for people with Alzheimer’s disease
Medicare does provide some guidance to clinicians, to help them determine when a person with dementia may have reached a six-month life expectancy. Here is an excerpt from Medicare’s Hospice – Determining Terminal Status Guide (LCD L33393) :
Patients will be considered to be in the terminal stage of dementia (life expectancy of six months or less) if they meet the following criteria.
- Patients with dementia should show all the following characteristics:
- Stage seven or beyond according to the Functional Assessment Staging Scale;
- Unable to ambulate without assistance;
- Unable to dress without assistance;
- Unable to bathe without assistance;
- Urinary and fecal incontinence, intermittent or constant;
- No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words.
- Patients should have had one of the following within the past 12 months:
- Aspiration pneumonia;
- Decubitus ulcers, multiple, stage 3-4;
- Fever, recurrent after antibiotics;
- Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin < 2.5 gm/dl.
(For more on the FAST scale for dementia, see .)
Of course, people with dementia do often suffer from other serious illnesses, such as cancer, advanced heart or lung disease, or end-stage kidney disease. So older adults often become eligible for hospice care before their dementia has reached very advanced stages.
But in the absence of such advanced other diseases, if a person with dementia is eligible for hospice, then this usually means that he or she has severe dementia. In this stage of dementia, a person will have lost the ability to speak meaningfully, and will no longer be able to walk.
How Opioids Can Help at the End-of-Life
Research shows that certain symptoms and difficulties are common in people with very advanced dementia (whether or not they are on hospice). These include:
- Aspiration and other swallowing difficulties
- Shortness of breath
Most people know that opioid medications such as morphine are effective pain-killers. For this reason,they are often used to treat pain at the end-of-life.
But people sometimes don’t know that opioids have also been shown to help relieve shortness of breath.So in hospice, a drug like morphine can be used to provide relief from two common end-of-life symptoms: pain, and/or shortness of breath.
Now, opioids do have some downsides. We don’t usually worry much about addiction in people who are terminally ill. (I worry more about whether someone else in the household might want to use — or sell — these drugs.) But opioids do cause other problems and side-effects, such as constipation.
One of the biggest concerns about opioids is that they can slow a person’s breathing rate. This is a problem because if a person’s breathing gets too slow, they end up with too much carbon dioxide and not enough oxygen in the blood, and this can cause death. (This is how people who overdose on narcotics can die.)
Now, people on hospice are expected to die. But that doesn’t mean we want to be rushing things along with medications; they are supposed to die of their illness, not because we overly medicate them.
To walk this fine line, palliative care clinicians are supposed to focus on treating the distressing symptoms with just enough medication to provide adequate relief. With careful attention and titration of the medication, it’s usually possible to provide relief without lowering a person’s respiratory rate too much. (I usually don’t worry too much as long as the person’s breathing rate is at least 10 breaths/minute. People who are terminally ill often fall asleep when we treat their pain or shortness of breath, but that’s often because they are finally getting some relief from their symptoms!)
Since people with advanced dementia often do seem to be experiencing pain, at the end of life it’s often reasonable to treat this pain with morphine or another opiate painkiller. However, the dosing should be carefully monitored, and it’s essential to manage any associated constipation or other side-effects.
The American College of Physicians covers the use of opioids at the end of life here: Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline.
Benzodiazepines in End-of-Life Care
Benzodiazepines such as lorazepam (brand name Ativan) are very commonly prescribed in hospice. Usually, the order says to administer a certain dose, at a certain interval, “as needed” for anxiety or agitation. Benzodiazepines may also be prescribed to treat symptoms such as nausea, insomnia, or seizures.
Curiously, although benzodiazepines are very commonly used in hospice, there is actually not a lot of clinical evidence on how to use them beneficially, especially in older adults dying of dementia.
A very interesting study published in 2016 surveyed hospice clinicians regarding their use of and attitudes towards using benzodiazepines in hospice. The authors also conducted an extensive review of clinical research on benzodiazepines in palliative care.
The authors found that most hospice clinicians use benzodiazepines frequently, despite there being little clinical evidence of benefit and potential for harm (especially for elderly hospice patients).
The authors also noted that hospice clinicians reported using benzodiazepines to treat delirium, even though clinical research usually suggests that benzodiazepines can cause or worsen delirium. (If medication is absolutely needed for delirium, geriatricians often prefer to try a low-dose of antipsychotic, as I explain here.)
In short, although benzodiazepines are very commonly prescribed and used in hospice, it’s not clear that their use is always strictly necessary, or even the best choice for managing certain symptoms.
How to Choose a Hospice Provider
Hospice care is ultimately like all medical care, in that it’s best provided by clinicians who:
- Have been properly trained and provide care grounded in the latest best practices,
- Are able to tailor the care plan to a patient’s needs and symptoms (rather than always resorting to a default set of medical orders),
- Are able to skillfully communicate with patients and family members.
Death and dying become quite familiar to hospice clinicians. But it’s usually new, frightening, and emotionally fraught for the watching family. So ideally, hospice clinicians should be able to help families understand why a certain approach may be a good way to help the patient attain his or her goals.
In the question, you mentioned that the nurses didn’t let you give your dying mother fluids or food. This may have been medically reasonable, but if so, they should have been able to give you better explanations, so that you felt better about this course of action.
For instance, dying people often need less fluid and food than their family wants to give them. That’s because the increased fluid and food may not improve their comfort or dying experience, but might indeed cause some choking and distress.
In my own experience attending on a hospice unit, I found that families were often very anxious to feel that they were doing things to help and supporttheir dying loved one. They also usually needed reassurance that they — or the hospice team — weren’t harming or letting down their loved ones.
So, how do you find a hospice team that willexcellent care to your older relative with dementia, and to your family?
Here’s what I recommend:
- Do a little research on the hospice agencies that serve your area.
- Use a worksheet to make sure the hospiceagency is accredited, and to get important questions answered. The National Hospice and Palliative Care Organization has a good one here: Choosing a Hospice.
- Ask friends and family members about their experiences with local hospice agencies.
- If others felt the hospice agency was responsive and caring, that’s usually a good sign.
- Ask your usual doctors for a recommendation.
- This can be especially useful if your primary care doctor is of the attentive and caring type.
- But bear in mind that busy doctors may not get around to hearing feedback on how the hospice agency treated their patients. Many doctors simply refer to whatever provider is most familiar or convenient for them.
- Consider whetherthe hospice service is non-profit versus for-profit.
I usually encourage families to look into all available hospice agencies in their area, including for-profit agencies. But I do think it’s important to be aware of the concerns that have been raised regarding for-profit hospice agencies.
What to do if you’re concerned about the care your relative is receiving during hospice
If you have the energy to do so, I recommend first being proactive right when the hospice care begins. In particular, I recommend:
- Asking to see what medications are being ordered, and under what circumstances they’ll be given.
- Bringing up any concerns you might have regarding the use of opioids or benzodiazepines.
- Clarifying your family’s goals and priorities regarding use of the medications.
- For instance, you could specify that although pain management is indeed important, you’d like to minimize sedation and have your loved one remain as alert as possible.
- Given that benzodiazepines often aren’t the best way to manage people with dementia, you could consider asking that those be minimized.
You should also know many hospice agencies use pre-made templates to prescribe medications. Such templates will often include orders to provide morphine as needed, and also lorazepam as needed.
You can view a hospice order template here:Initial Hospice Admission & Comfort Med Orders.
As you’ll see if you view the order template, “as needed” orders often give the nurses quite a lot of latitude in how much morphine and lorazepam they can give. So it’s important to bring up your goals and priorities regarding medication use right away. This will enable to nurse to better calibrate her care to the needs and preferences of your older loved one and your family.
If you’re concerned about the hospice care provided
If you find yourself concerned once hospice care has started, here are some things to try:
- Bring up your concerns to the nurse. You’ll want to give him or her a chance to better communicate with you, and perhaps make some changes to the care.
- Ask to speak to the supervising physician.Hospice agencies will have a medical director. This person can help get the care back on track. You can also try speaking to your loved one’s usual doctor, especially if that physician has remained involved or has a background in geriatrics.
- Share your concernsin writing with the hospice agency. Concerns in writing can carry more weight than those expressed verbally. This can help you get the extra attention you might need for the agency, in order to resolve a communication issue or other problem.
- Switch to a different hospice provider. According to Medicare.gov, you have the right to change your hospice provider once during every benefit period. (Hospicebenefit periods are initially 90 days, and after 6 months switch to 60-day periods.)
- Consider filing a complaint with state or federal authorities. Thisis less about improving the care of your own family member, and more aboutreporting an agency which might be providing poor care to other. You can find a list of agencies to consider contacting here:Making A Complaint About A Hospice.
Sobering Truths Reflected in this Q&A
In truth, the concerns described in this question make me a bit sad. I know that most of mycolleagues in healthcare are really trying hard to help the patients and families they work with.
But, it remains absurdly common for patients and families to encounter sub-optimal healthcare. Health providers often aren’t able to communicate and partner with families as well as we want them to. And they may not be up-to-date on the latest clinical evidence or best practices.
In short, healthcare usually involves good intentions but frequently flawed execution.
It’s important to not fault individual health providers too much for this. Most of the time, they are doing their best. But, they are stuck working within a system that just doesn’t provide them with the support, resources, and time that they need to do better.
So, if you’re a patient or family caregiver, remember: If you can muster the time and energy to do so, it’s often a good idea to do a little homework and ask questions about the healthcare that you or your older loved ones are getting.
Hospice is an important and valuable service for those who are dying and for their families.A good hospice team should welcome the opportunity to hearyour questions, your concerns, and your priorities.
Please note: I will no longer be approving or responding to comments on this article.Thank you for reading, I hope you found it helpful!
Medication for advanced dementia
Memantine is also recommended for people in the later stages of Alzheimer's disease, or in the moderate stage of Alzheimer's where drugs such as donepezil cannot be taken. It can slow down the progression of symptoms including difficulties with everyday activities and disorientation.
Considering the slow decline of a patient with dementia, it can be difficult to determine when the time is right for hospice. In general, hospice patients are thought to have six months or less to live. Only a doctor can make a clinical determination of life expectancy.What can hospice do for dementia patients? ›
Examples of the care hospice teams provide include: Medical care to alleviate symptoms and pain (including medications and medical equipment) Counseling about the emotional and spiritual impact of the end-of-life. Respite care to allow caregivers relief.How medications are handled by hospice? ›
Do I Have to Stop Other Medication If I'm in Hospice? When you begin hospice care, medication and other treatments to cure or control your serious illness will stop. For example, if you are receiving chemotherapy that is meant to treat or cure your cancer, that must end before you can enter hospice care.What medication can worsen the symptoms of dementia? ›
Narcotics such as hydrocodone, oxycodone and morphine; muscle relaxants such as cyclobenzaprine, carisoprodol; NSAIDs such as ibuprofen, naproxen should be avoided if possible.Is there medication to calm down dementia patients? ›
Anxiolytics, also known as anti-anxiety drugs, can be used to calm dementia patients. They may be used as a sleep aid as well. Similarly, antipsychotic medications are often prescribed to address aggression, hostility, delusions, and hallucinations.What are the signs that a dementia patient is near death? ›
- deteriorate more quickly than before.
- lose consciousness.
- be unable to swallow.
- become agitated or restless.
- develop an irregular breathing pattern.
- have a chesty or rattly sound to their breathing.
- have cold hands and feet.
Patients with dementia or Alzheimer's are eligible for hospice care when they show all of the following characteristics: Unable to ambulate without assistance. Unable to dress without assistance. Unable to bathe properly.What is the most common cause of death in dementia patients? ›
The most common cause of death among Alzheimer's patients is aspiration pneumonia. This happens when, due to difficulty in swallowing caused by the disease, an individual inadvertently inhales food particles, liquid, or even gastric fluids.What is the 5 word memory test? ›
Administration: The examiner reads a list of 5 words at a rate of one per second, giving the following instructions: “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember.
In the end stages of dementia (in the last few months or weeks of life), the person's food and fluid intake tends to decrease slowly over time. The body adjusts to this slowing down process and the reduced intake.Do you give morphine for dementia hospice? ›
Since people with advanced dementia often do seem to be experiencing pain, at the end of life it's often reasonable to treat this pain with morphine or another opiate painkiller. However, the dosing should be carefully monitored, and it's essential to manage any associated constipation or other side-effects.What are the four end of life drugs? ›
The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility.Who manages medications in hospice? ›
The patient's hospice team will educate family caregivers on the hospice medications being prescribed or discontinued and will train caregivers on how to administer all medications. Medication and medical supplies used to treat symptoms of the patient's terminal illness are covered 100% by Medicare.What triggers dementia to get worse? ›
other long-term health problems – dementia tends to progress more quickly if the person is living with other conditions, such as heart disease, diabetes or high blood pressure, particularly if these are not well-managed.What is the best medication for aggressive dementia? ›
Antidepressants. Antidepressants such as sertraline, citalopram, mirtazapine and trazodone are widely prescribed for people with dementia who develop changes in mood and behaviour. There is some evidence that they may help to reduce agitation – particularly citalopram.What are 3 most commonly prescribed drugs for dementia? ›
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.What is the first line treatment for agitation in dementia? ›
The bottom line
To decrease agitation and aggression in people with dementia, nondrug options are more effective than medications. Physical activity, touch and massage, and music can all be used as tools to manage agitation related to dementia.
Hallucinations are caused by changes in the brain which, if they occur at all, usually happen in the middle or later stages of the dementia journey. Hallucinations are more common in dementia with Lewy bodies and Parkinson's dementia but they can also occur in Alzheimer's and other types of dementia.How do you calm a dementia patient at night? ›
Try to identify activities that are soothing to the person, such as listening to calming music, looking at photographs or watching a favorite movie. Take a walk with the person to help reduce their restlessness. Talk to the person's doctor about the best times of day for taking medication.
Providing the person doesn't appear to be uncomfortable or distressed, then sleeping more during the day isn't normally a reason to be worried. However, if a person is lying down in bed and asleep for most of the time they will need to be looked after to make sure they don't develop any physical health problems.How do you know when someone is transitioning to death? ›
Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease. There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry.What stage of dementia is bowel incontinence? ›
As Alzheimer's disease progresses, it is common for incontinence of the bladder and bowels to occur, particularly in the middle and late stages.What is fast 7 criteria for hospice? ›
Stage 7 is broken down into smaller stages as laid out in the table above: Limited ability to speak (typically 1-5 words a day,) loss of intelligible vocabulary, inability to self-ambulate (walk), inability to sit up independently, inability to smile, and inability to hold up head independently.How do you know when it's time to call hospice? ›
You should call hospice if your loved one is experiencing any of the symptoms below: frequent visits to the ER or hospital admissions. a decline in their ability to perform daily tasks including eating, getting dressed, walking, or using the bathroom. an increase in falls.When do dementia patients need palliative care? ›
Palliative care is for anyone diagnosed with a life-limiting condition, including dementia. It focuses on making a person's quality of life as good as possible by relieving discomfort or distress. A person can receive palliative care for any length of time, from a few days to several years.What form of dementia is a rapidly fatal disorder? ›
Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast.What are fatal complications of dementia? ›
Alzheimer's and Parkinson's diseases, frontotemporal disorders, and Lewy body and vascular dementia all cause a gradual loss of thinking abilities. They damage brain and nerve cells and can lead to pneumonia, stroke, falls, infections, and malnutrition that are often fatal.What is the deadliest dementia? ›
Creutzfeldt-Jakob disease (CJD) is a rare and fatal form of dementia, caused by abnormal prion proteins that are toxic to the brain.What is the 3 word memory test? ›
The Mini-Cog test.
A third test, known as the Mini-Cog, takes 2 to 4 minutes to administer and involves asking patients to recall three words after drawing a picture of a clock. If a patient shows no difficulties recalling the words, it is inferred that he or she does not have dementia.
The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function.What is the 30 question test for dementia? ›
The Montreal Cognitive Assessment (MoCA) is a tool that helps healthcare professionals detect mild cognitive impairment and Alzheimer's disease in people. A 2021 study found that it is a better measure of cognitive function than the MMSE. It consists of 30 questions that take 10–12 minutes to accomplish.What it means when a person with dementia says I want to go home? ›
Often when a person with dementia asks to go home it refers to the sense of 'home' rather than home itself. 'Home' may represent memories of a time or place that was comfortable and secure and where they felt relaxed and happier. It could also be an indefinable place that may not physically exist.Do dementia patients eyes look different? ›
Many people with Alzheimer's disease have visual problems, such as changes in color vision, and past studies have shown retinal and other changes in their eyes.Why do people with dementia not want to eat? ›
Tiredness and concentration – tiredness can cause people with dementia to not eat or give up partway through a meal. It can also lead to other difficulties such as problems with concentration or with co-ordination. People with dementia may have difficulties focusing on a meal all the way through.What meds are given for agitation in hospice? ›
The patient will commonly be started on a small dose of sedative (such as a benzodiazepine like midazolam or lorazepam). They may also be given an anti-psychotic (such as haloperidol). Medicines are usually given as injections or through a syringe pump (also known as a syringe driver).What is the best sedative for dementia patients? ›
Lorazepam (Ativan) Lorazepam is a type of benzodiazepine. Doctors prescribe it for its positive effect on anxiety and its sedative effects. Benzodiazepines work by binding to γ-aminobutyric acid receptors in the brain, which helps produce a calming effect.Why would they give a dementia patient morphine? ›
Morphine and similar drugs are used to relieve severe pain, which is a vital aspect of maintaining the comfort and quality of life of the person as they approach death.What are the top 5 hospice regrets? ›
1) “I wish I'd had the courage to live a life true to myself, not the life others expected of me.” 2) “I wish I hadn't worked so hard.” 3) “I wish I'd had the courage to express my feelings.” 4) “I wish I had stayed in touch with my friends.” 5) “I wish I had let myself be happier” (p.What I wish I knew about hospice? ›
“ “The ONE thing I wish people knew about Hospice is that it is NOT a death sentence but the KEY to live life to the fullest without any inhibitions. It is an honor for us working in hospice care to help our patients mend relationships, realize their dreams, and come to peace with their lives.
Additionally, certain medications such as those used for non-palliative reasons such as cancer treatment, organ transplants and fertility treatments are typically not covered by a hospice program. Patients who require these types of treatments and medications should seek out other healthcare providers for coverage.What is the injection given at end of life? ›
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.What's in the end of life cocktail? ›
A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg.What is a hospice comfort kit? ›
A hospice comfort kit, commonly called a Hospice Emergency Kit or E-Kit, is a small supply of medications kept in the home so that they will be available to rapidly treat symptoms that may occur in a patient with a terminal illness.Should you wake a hospice patient for medication? ›
Don't try to wake them. Let them sleep and wake on their own. Talk to your loved one.How are medication handled by hospice? ›
Do I Have to Stop Other Medication If I'm in Hospice? When you begin hospice care, medication and other treatments to cure or control your serious illness will stop. For example, if you are receiving chemotherapy that is meant to treat or cure your cancer, that must end before you can enter hospice care.How do you treat end stage dementia? ›
- Make sure the person is in a comfortable, upright position. ...
- Adapt foods if swallowing is a problem. ...
- Encourage self-feeding. ...
- Assist the person with feeding, if needed. ...
- Encourage fluids. ...
- Monitor weight.
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.
- Antidepressant medications.
- Antianxiety medications.
- Antipsychotics. (These should be used with caution as they have long-term risks of stroke.)
- Melatonin to help with sleep.
- speech limited to single words or phrases that may not make sense.
- having a limited understanding of what is being said to them.
- needing help with most everyday activities.
- eating less and having difficulties swallowing.
Feeding tubes are not recommended for patients with end-stage dementia. Comfort feeding by hand is preferable. Use of parenteral hydration might be helpful but can also contribute to discomfort at the end of life.What is the first line treatment for agitation in dementia patients? ›
The bottom line
To decrease agitation and aggression in people with dementia, nondrug options are more effective than medications. Physical activity, touch and massage, and music can all be used as tools to manage agitation related to dementia.
Aggression usually starts in the mid-stage of dementia. This is the time when other behaviours, such as hoarding wandering, and compulsive behaviour are also prone to develop. In most types of dementia, the aggressive symptoms occur when the patient becomes more dependent with daily activities.What triggers aggression in dementia? ›
Some reasons why a person with dementia might be aggressive include: The person might be feeling unheard or misunderstood. The person might be feeling threatened or frightened. The person might be feeling embarrassed, frustrated or annoyed because they need help to do things they used to do independently.Why is melatonin not recommended for dementia patients? ›
Melatonin secretion decreases in Alzheimer´s disease (AD) and this decrease has been postulated as responsible for the circadian disorganization, decrease in sleep efficiency and impaired cognitive function seen in those patients.How do hospitals treat sundowning? ›
Sundowning: A Common Form of Delirium
Many hospitals have protocols in place to prevent sundowning, a form of delirium, in the elderly. One good idea is light therapy, in which rooms are kept bright during the day, with curtains open, and are darkened at night.