In the commentary, Dr. Homes and three of her colleagues propose a framework for discontinuing medications in the elderly who are near the end of their lives. The model examines four factors: the patient’s life expectancy, the time until a therapy will produce a benefit, the patient’s goals of care, and the treatment target.
Full Answer
Why should older people stop taking medicines?
They may become inactive. Some people with dementia want to live as long as possible, even if they are bed bound and can't think. Others may wish to stop treatment when they cannot function on their own. Everyone has the right to decide what treatment is right for them.
Is it possible to treat an older patient?
Take the 67-year-old woman with poorly controlled diabetes, a new diagnosis of dementia and a hemoglobin A1C of 13 per¬cent. When a medical student suggested a fasting lipid panel so the patient could begin statin therapy as an outpatient, a resident wondered aloud whether Dr. …
When should I end my time in therapy?
The majority of older people who require drug therapy take multiple medicines. Withdrawing medicines may be the best clinical decision. Factors to consider when deciding if a medicine …
What should I do if the medicine is being discontinued?
Apr 03, 2017 · 7 Answers. Mom2Mom, I agree that your Mom should be re-evaluated when it comes to her Medications. Some maybe interfering with others. Make an appointment with her …
How do you know when you need end of life care?
When is end of life medication?
Does comfort care mean death?
What are the signs that elderly are on the decline?
- drop in blood pressure, heart rate, and body temperature.
- labored breathing.
- difficulty swallowing.
- refusing food.
- no more bowel movements or urination.
- hallucinations, illusions, or delusions.
How long is end of life stage?
What is the end of life injection?
Why do doctors recommend palliative care?
When does someone go to palliative care?
What are the stages of palliative care?
What can a 90 year old do?
- Sports. As we've already mentioned, it's especially important for older people to stay physically active. ...
- Fitness Activities. Sports might not be your cup of tea, but that's alright. ...
- Gardening. ...
- Gaming. ...
- Social Media. ...
- Cooking. ...
- Jigsaw Puzzles. ...
- Reading.
Why do elderly stop eating?
What does it mean when an elderly person sleeps all the time?
Why do people stop taking drugs?
Patients might be discontinuing drugs because of costs, ad¬verse effects or other factors, but the point is that they’re willing to stop taking a drug when they think there is a good reason. That should persuade physicians everywhere not only that patients are willing to discontinue medications that aren’t appropriate, but that they as physicians have a golden opportunity to help guide that decision-making process.
What is the complicating factor for hospitalists who help patients decide to discontinue a medication?
There is another complicating factor for hospitalists who help patients decide to discontinue a medication: talking to primary care physicians. Dr. Holmes acknowledges that those conversa¬tions can be delicate, but she says that she’s found that it helps to approach the conversation as a specialist, not a generalist.
How many times should you take a CHF patient?
Take the patient who has been admitted for end-stage CHF with exacerbations four or five times in the last six months. Sit¬ting down with the patient to talk about life expectancy and goals is not only appropriate, Dr. Homes says, but often welcome by patients.
Do doctors worry about patients taking drugs they don't know about?
Physicians may worry that patients are taking drugs they don’t know about, she notes, but the bigger problem is that patients are prioritizing their medications on their own and stopping them without talking to their physician.
Can a primary care physician help patients discontinue medication?
Dr. Holmes admits that suggesting patients discontinue one or more medications may be easier for primary care physicians, who have an established relationship with patients. But she adds that hospitalists have an excellent opportunity to help elderly patients reassess their medication regimens precisely because they are new to the patient.
What is advance refusal?
A person can write an 'advance directive' or 'advance refusal', which informs doctors and relatives about their likely opinion about treatment. These documents can be referred to if the person is no longer conscious.
What to do when you are sick?
When people are ill they tend to go to a doctor, nurse or another health-care professional to ask for some form of treatment. The problem may be a sore throat, in which case the person may be hoping for a prescription for antibiotics. The issue may be more serious and the person wants to be referred to a hospital specialist.
Why would a doctor withhold treatment?
Sometimes a doctor may wish to withhold treatment because although the patient thinks he or she is ill, the doctor doesn't agree and believes that any treatment could be harmful. On occasions, friends or family of a patient may ask for treatment out of misunderstanding or fear.
Why is it important to cure?
To an extent, curing is about warding off death, because if illness is not stopped then a person may die. You could say that curing helps people to have a good quantity of life.
What is the purpose of medical treatment?
A medical treatment can have two basic functions. First it can aim to cure the person . This is the sort of treatment that we hope to receive when we visit our GP. Our desire is to go in, describe the problem, have a few tests and come away with the treatment that solves it.
Why would it be inappropriate to remove a gland?
In most cases it would have been inappropriate to operate and remove the gland because the procedure carries risks, would be costly and has a lengthy recovery phase. An operation would be unnecessary over-treatment.
Do you have to start treatment before diagnosis?
This is a complex process and can easily be misunderstood by the patient. In some cases, treatment may have to start before a diagnosis has been made. However, this carries the risk that the treatment may itself mask the true nature of the disease.
How to know if a medicine can be stopped?
One way of considering if any medicines are able to be stopped is to group them into two categories – those that improve day-to-day quality of life and those that prevent future illness (see Box below). Thinking about medicines in this way may provide a good starting point for talking with patients about the role and importance of each medicine. It may also allow a discussion about any variance between the goals of the doctor and those of the patient – the question is “what is the clinical and personal significance of this specific drug for this particular patient?”
What factors should be considered when deciding if a medicine can be stopped?
Factors to consider when deciding if a medicine can be stopped include the wishes of the patient, clinical indication and benefit, appropriateness, duration of use, adherence and the prescribing cascade. Only stop or reduce one medicine at a time.
What are the screening tools for older people?
Several screening tools have been developed to help identify potentially inappropriate prescribing in older people such as the Beers’ criteria and the more recent STOPP/START tools (Screening Tool of Older Person’s Prescriptions and Screening Tool to Alert doctors to Right Treatment). 10 Although widely used in research, these tools currently have limited value in primary care because they are not easy to use, time consuming and the Beers’ criteria in particular includes medicines that in some situations may be appropriate e.g. dipyridamole, oxybutinin and doxazosin. These tools should not be used as a substitute for careful clinical judgement. 11
How long does it take for benzodiazepine to stop working?
Benzodiazepine withdrawal syndrome can occur within one day of stopping a short-acting benzodiazepine or up to three weeks after stopping a long-acting benzodiazepine. 18. Successful discontinuation may result in improvements in cognitive and psychomotor function, particularly in older people.
When a patient presents with new symptoms, consider an adverse medicine reaction as a possible cause?
The aim is to avoid the prescribing cascade where additional medicines are initiated to treat adverse effects (both recognised and unrecognised) of other medicines.
What happens if you stop taking antianginals?
analgesics, thyroxine or anti-anginals. In some cases, if these medicines are stopped, the patient may become ill or unable to function. However, some drugs may be able to be stepped down, stopped or used on an as required basis (prn) e.g. a protein pump inhibitor (PPI).
Why do people stop taking statins?
For example, stopping may be justified in a person at relatively low risk of a cardiovascular event, who is also poorly compliant or experiencing troublesome adverse effects.
What is the starting point of treatment decisions?
This decision-making can be an ethical dilemma; however, the starting point is considering the patient’s wishes after providing accurate information about risks and benefits of treatment.
How many people are 80 and older?
According to the Census Bureau, 5.7 million people in the United States are aged 80-84 and 5.5 million are aged 85 and older. People are now living longer than ever before. In fact, the Hallmark Cards Company sells 85,000 “Happy 100th Birthday!” cards each year.
Is it difficult to suggest no treatment?
It appears it is just too difficult to suggest no treatment . The hesitation may be that no treatment is equated to “doing nothing,” which is not the case. When clinicians are fully informed about and comfortable with the principles of palliative care, there is much that can be done in the absence of cancer treatment.
Is cancer a problem for older people?
The numbers are growing, and with increasing age, come increasing medical problems. It’s not uncommon for an older patient to have heart disease, diabetes, arthri tis, and other medical disorders in addition to cancer.
When should clients consider ending their therapy?
Ryan Howes: Clients should consider ending their time in therapy when their goals have been met or when it becomes evident that they won’t meet them with this psychotherapist.
How to end therapy sessions?
Talk about it. Beyond the first session, it can be helpful to bring the topic of ending up from time to time. Let’s say you found yourself dreading therapy this week and had to drag yourself in. This can be great material to discuss and might help you develop your exit plan together. Maybe you can set a date for a final session and plan a good farewell in the meantime.
How to tell a therapist you are being exploited?
If you feel you are being exploited, if you feel unwanted romantic advances, if you feel like your boundaries are violated in any way, if you feel like therapy is going nowhere, make your next session your last. Tell your therapist you don’t feel safe and/or competently served and let them know this is your last session. If the violations are extreme or causing harm look into telling their boss or alerting the licensing board. Like physicians, therapists are ethically bound to “do no harm” in their therapy, and if you’re suffering harm there are avenues to stop the harm and find better treatment. You may feel it’s helpful for you to have a voice and tell your therapist about your complaints, or maybe not. As I’ve said many times before, it’s your time and your dime, you can have closure or choose to split with a voicemail. Whatever works best for your mental health.
Why is a positive ending so rare?
So why is this positive ending relatively rare? Sometimes therapists do stupid things that cause clients to leave prematurely. Sometimes clients don’t like saying goodbye so they split without notice. Many times, clients don’t even know there is such a thing as a “termination phase,” so they either ghost their therapist or fumble through the final sessions until they find a good reason to leave.
Why do people come to therapy?
But they also come to therapy to make a good life great by working on their relationships, finding meaning in their life, becoming a better parent, improving their communication, finding their ideal career, increasing their capacity for intimacy, enhancing their self-esteem, and so on.
What happens when illness clears up?
When the illness clears up, they make no more appointments with the M.D., and all is well. In the wellness model, a relatively healthy person decides they want to make their healthy body healthier, so they go to the gym. They work out regularly and achieve fitness goals and feel great about it.
How long does it take to get relief from phobias?
Generally speaking, people seeking relief from phobias, anxiety or depression find some relief within the first three to six months of therapy. People with deeper issues like trauma, relational issues, problems with core identity, sexual and intimacy problems require months to years of treatment.
What is immunotherapy before making a decision?
Before making a decision, he encourages you to explore all your treatment options — and the likely outcome of each one — with your doctors. Cancer treatments are advancing all the time. For example, immunotherapy has radically changed the outcomes for some types of cancers.
Is it easy to talk about end of life?
These conversations are not easy. But thinking things through carefully — and being clear about what’s important to you and your family as you face end-of-life decisions — will make a challenging time easier for everyone.
Clinical Decisions
Giving Treatment
- A medical treatment can have two basic functions. First it can aim to cure the person. This is the sort of treatment that we hope to receive when we visit our GP. Our desire is to go in, describe the problem, have a few tests and come away with the treatment that solves it. To an extent, curing is about warding off death, because if illness is not stopped then a person may die. You could say …
When to Withhold
- Treatments often carry risks, and a doctor needs to weigh up the balance between the potential for doing good and the potential for harm. People who are refused anti-biotics when they have a sore throat often feel let down, but the doctor has been weighing up the small chance of the drugs making any difference, against the very real risk that over-...
Respecting People
- Christians base treatment decisions on the fundamental principle of respect for the sanctity of human life. This is not altered if a person is very old or very young, physically able or has severe disabilities. For example, a recent discussion document from the British Medical Association says that the association 'finds unacceptable' the practice whereby people with conditions like Down'…
Best Interest
- One common guide is to look for the patient's 'best interest'. This can help when treating young children, or adults who are not fully conscious. In the past, best interest was almost always seen as prolonging life. However, a more complex assessment is needed now that medical technology can keep a person's body alive, perhaps inappropriately. Most people accept that there is no abs…
Double Effect
- Some doctors and lawyers argue that a treatment has a double effect. Pain-killing drugs given to cancer patients relieve suffering, but on occasions they also accelerate their death. This so-called 'double effect' is seen as being acceptable as the intention was not to kill the patient, but to reduce his pain. The phrase 'double effect' is unfortunate in that it suggests that two things were intend…
Laws and Guidelines
- The legal profession is increasingly being asked to give rulings about medical practice. While it is good that medical practice should be legally sound, there are dangers in having to get every difficult decision backed by a court ruling. To start with, in many cases the time taken to get a court decision would be too long and cause more harm than good. At the same time, doctors ar…