Medications Should be Carefully Controlled as Alzheimer's Advances
While Alzheimer's specific drugs may help slow symptoms for some people, they also may increase the risk of hip fractures, fainting, urinary problems and other health issues. Most researchers now think that a time comes when many medications for the elderly are no longer beneficial and may be harmful.
According to an article in JAMA Internal Medicine, researchers at the University of Massachusetts Medical School in Worcester looked at 5,406 nursing home residents who had late-stage Alzheimer's or dementia with more than half of them being older than 85. The scientists found that 2,911 of the patients - nearly 54 percent - were taking at least one medication of questionable benefit.
An article from the Fisher Center for Alzheimerâ�™s Research states that non-Alzheimer's specific drugs that doctors often prescribed which are not necessarily recommended for those with advanced dementia included cholesterol-lowering drugs and blood thinners other than low-dose aspirin.
According to The Fisher Center, some drugs given are beneficial because they are helping to control diseases such as diabetes and high blood pressure, but others aren't needed and may actually worsen quality of life. Since many residents in nursing homes are receiving from five to 15 prescription medications daily, common sense would dictate that each medication be looked at separately to see if it is still beneficial as the patient ages. The same logic would hold for over-the-counter medications which also have side effects.
As the family caregiver for several aging relatives throughout many years, I can attest to the fact that in the later stages of any disease what most families want for their loved one is as much comfort and contentment as can realistically be expected.
Many times comfort means taking away medications rather than adding to them. I've known elders who have returned to better physical and mental health after the withdrawal of several medications that were no longer needed. I've also seen the addition of different drugs ease suffering, therefore the idea is to stop prescribing drugs once and then continuing them automatically. Drugs need to be routinely evaluated for patient benefit and discontinued when they no longer help.
Having witnessed the wonderful work that most hospice organizations do, I personally recommend hospice care during the late stages of most diseases. Generally, hospice will withdraw all drugs meant to extend life, only giving those which enhance the way a person feels. Patients are carefully monitored for times when they may need pain management or other treatment to help them live the remainder of their life with dignity and to accompany them through a peaceful death process.
Certainly, there is a place for curative drugs as well as drugs that may slow symptoms in diseases such as Alzheimer's. But there is a time to start withdrawing drugs that no longer work and may be causing discomfort or dangerous side effects. Eventually, there may be a time to withdraw all but pain management drugs. That is the nature of a terminal disease. Death is part of the life cycle. As life ends, comfort and contentment should be our focus.
Tija, J. MD MSCE
et. al. (2014, September 8) Fisher Center for Alzheimer's Research Foundation. In Advanced Alzheimer's, Too Many Medications.