The Benefits of Deprescribing Medications in Hospice: A Guide for Patients, Families, and Hospice Nurses

Published on November 3, 2023

Updated on November 25, 2023

Introduction: Understanding Deprescribing in Hospice Care

I know just how important it is to provide comfort and support during this challenging journey. One aspect of that often raises concerns is medications. In this article, we'll explore what is and why it can be beneficial for patients nearing the end of life.

What is Deprescribing?

Why_PolyPharmacy_Is_A_Huge_Concern

Deprescribing is the process of thoughtfully and carefully reducing or discontinuing medications that may no longer be necessary or could potentially cause harm as patients reach the end of life. It involves a collaborative effort between healthcare providers, patients, and families to ensure the best possible quality of life during this time.

Addressing Concerns About Stopping Medications

It's completely normal for patients and their families to have concerns about stopping medications that were previously deemed essential for managing their health conditions. You may wonder if these medications are keeping the patient alive or providing some significant benefits. Let's address some common concerns:

  1. Statin Medications: Statins are often prescribed to manage cholesterol levels and reduce the risk of heart disease by an absolute of less than one percent! While they may have been beneficial during the earlier stages of the disease, their benefits may not be as relevant in the terminal phase. Additionally, can cause side effects that impact comfort.
  2. Medications for Dementia: Drugs like donepezil and memantine are used to improve cognitive function in early to mid-stage dementia. However, in the terminal stages of dementia, these medications may not offer significant benefits, and they could even cause adverse effects or .
  3. Feeling Guilty: It's not uncommon for families to feel guilty about stopping certain medications. Please know that deprescribing decisions are made with the patient's best interest at heart, aiming to provide comfort and improve the quality of life.

The Beers Criteria: Identifying Inappropriate Medications

The Beers Criteria is a valuable resource that provides guidelines on potentially inappropriate medications for older adults. It helps healthcare providers, including hospice nurses, in evaluating medications that may no longer be suitable in the terminal phase of life. Here are some key points to consider:

  • The Beers Criteria identifies medications that may cause harm or have limited benefits in older adults, especially those with multiple health conditions.
  • Deprescribing based on the Beers Criteria can reduce the risk of adverse drug reactions and improve overall well-being.
  • Discussing deprescribing with patients and families is crucial. It's essential to engage in open conversations, addressing their concerns and explaining the rationale behind each decision.

The STOPP and START Criteria: Another Tool to Guide Informed Decisions

STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria are valuable tools that can us in making informed decisions about medication management in hospice care.

Understanding STOPP and START Criteria

STOPP criteria are designed to identify potentially inappropriate medications that may need to be stopped or deprescribed in older adults. On the other hand, START criteria help healthcare providers identify medications that should be initiated when necessary.

Applying STOPP Criteria in Hospice

Stopping Unnecessary Medications

  1. Medications Without Indication: STOPP criteria can help us identify and discontinue medications that no longer serve a purpose or provide benefits in the context of terminal illness. This includes medications that were prescribed for conditions that are no longer relevant.
  2. Medications with High Risk of Adverse Effects: In hospice care, it's essential to minimize the risk of adverse effects. STOPP criteria can us in stopping medications with a high potential for harm or , especially when the benefits no longer outweigh the risks.
  3. Drug-Drug Interactions: Patients in hospice often take multiple medications. STOPP criteria can help us identify potential interactions between drugs, allowing us to deprescribe those that could lead to adverse outcomes.

Utilizing START Criteria in Hospice

Initiating Necessary Medications

  1. Symptom Management: START criteria can assist us in identifying medications that should be initiated to manage specific symptoms common in hospice patients, such as pain, , or nausea. This ensures that patients receive appropriate relief when needed.
  2. Preventing Common Conditions: In some cases, it may be necessary to initiate medications to prevent common complications in hospice, such as pressure ulcers or . START criteria can guide us in making these decisions to enhance patient comfort.

Incorporating STOPP and START criteria into hospice care allows us to provide more personalized and patient-centered medication management. By deprescribing unnecessary medications and initiating essential ones, we can improve the overall quality of life for terminally ill patients while minimizing potential harm.

The Benefits of Deprescribing in Hospice

Now, let's dive into why deprescribing can be so beneficial for patients nearing the end of life:

  1. Enhanced Comfort: By reducing the number of medications, we can minimize potential side effects, drug interactions, and unnecessary treatments. This leads to improved comfort and well-being.
  2. Improved Clarity: With fewer medications, patients may feel more alert and present, fostering meaningful connections with loved ones in their final days.
  3. Better Symptom Management: Deprescribing allows us to focus on symptom management for comfort, rather than managing multiple medications.
  4. Reduced Burden: Patients may feel overwhelmed by the number of medications they take. Deprescribing can lessen the burden of medication management, making their final days more manageable.
  5. Respect for Patient Wishes: Deprescribing aligns with the philosophy of hospice care, which aims to honor patients' wishes and provide person-centered, compassionate support.

Conclusion: Embracing the Journey Together

As a , I understand the complexity of deprescribing decisions. It's essential to remember that each step we take is guided by the desire to offer the best possible care and support for our patients and their families. Embracing this journey together, we can create an environment of comfort, love, and understanding.

If you have any questions or concerns about deprescribing, please don't hesitate to reach out to your hospice care team. We're here for you every step of the way.

Resources

Tips for Deprescribing in the Nursing Home

How Deprescribing Can Mitigate the Problem of Overmedication

Deprescribing at the End of Life: When Less is More

Deprescribing in palliative care

Hospice Medication Deprescribing Toolkit

Hospice Deprescribing and the Top Five Medications to Reevaluate

Understanding the Beers Criteria Is Essential

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

How to Use the AGS 2015 Beers Criteria – A Guide for Patients, Clinicians, Health Systems, and Payors

American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

The basics of the STOPP/START criteria

STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress

Implementing the STOPP/START criteria to prevent polypharmacy in older adults

Use of the STOPP and START criteria to address polypharmacy for elderly patients in University Hospital Lewisham Clinical Decisions Unit

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation 

Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

Oh hi there 👋 It's nice to meet you.

Sign up to receive updates on new articles to your inbox.

The emails we will send you only deal with educational articles, not requests to buy a single thing! Read our privacy policy for more information.

Share your love