Lorazepam lore-AY-zuh-pam reduces anxiety, agitation, shortness of breath, and insomnia. Commonly available under the brand name Ativan or Lorazepam Intensol, it comes in either a tablet or liquid and is taken by mouth. Lorazepam is the second most-prescribed hospice medication. It can be given alongside morphine described below if needed for comfort. Do not drink alcohol or use street drugs, which can also cause serious interactions with Lorazepam.
Symptoms of a dangerous drug interaction include unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Long-term use can make Lorazepam less effective. However, talk to you doctor before stopping this medication, as suddenly going off Lorazepam can cause worsening anxiety and other problems. Side effects of Lorazepam can include drowsiness, dizziness, tiredness, weakness, dry mouth, diarrhea, constipation, nausea, changes in appetite, restlessness or excitement, difficulty urinating, frequent urination, blurred vision, and changes in sex drive or ability.
Contact your doctor immediately if you experience any serious side effects, such as shuffling walk; persistent, fine tremor or inability to sit still; fever, difficulty breathing or swallowing, severe skin rash,. If you live in South Jersey and have questions about common hospice medications for your loved one, please call Samaritan at Haloperidol hal-oh-PER-uh-dol helps reduce agitation and nausea.
Known by the brand name Haldol, it also treats certain psychiatric conditions and hyperactivity in children. It should not be given to patients with seizure disorders, because it can increase the frequency or severity of seizures. The medication can also be dangerous for people with other conditions, so be sure to give your doctor your full medical history. Haloperidol is available in a tablet or a liquid to be taken by mouth.
Do not stop taking this hospice medication without talking to your doctor. If you suddenly stop taking haloperidol, you may have trouble controlling your movements, so your doctor will probably decrease your dose gradually. This medication may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position.
Send to a Friend. Does morphine make death come sooner? The following information explains why: There is no evidence that opioids such as morphine hasten the dying process when a person receives the right dose to control the symptoms he or she is experiencing. In fact, research suggests that using opioids to treat pain or shortness of breath near the end of life may help a person live a bit longer. Pain and shortness of breath are exhausting, and people nearing the end of life have limited strength and energy.
So, it makes sense that treating these symptoms might slow down the rate of decline, if only for a few hours. If a person has never received morphine, the initial doses given are low. After a few days of regular doses, the body adjusts to the morphine.
It would take a large dose increase over a short time to harm someone. Morphine doses are increased gradually and only as needed to maintain comfort.
The last dose is the same as the doses the patient has previously received and tolerated. Perhaps your mother has said she would like to be at home when she dies, while your father wants to be in a hospital where he can receive treatment for his illness until the very end.
Some people want to be surrounded by family and friends; others want to be alone. Of course, often one doesn't get to choose. But, avoiding suffering, having your end-of-life wishes followed, and being treated with respect while dying are common hopes. Generally speaking, people who are dying need care in four areas— physical comfort , mental and emotional needs , spiritual issues , and practical tasks. Their families need support as well. In this section, you will find a number of ways you can help someone who is dying.
Always remember to check with the healthcare team to make sure these suggestions are appropriate for your situation. At the end of life, each story is different. Death comes suddenly, or a person lingers, gradually fading. For some older people, the body weakens while the mind stays alert. Others remain physically strong, but cognitive losses take a huge toll. Although everyone dies, each loss is personally felt by those close to the one who has died. End-of-life care is the term used to describe the support and medical care given during the time surrounding death.
Such care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illnesses and need a lot of care for days, weeks, and even months before death. There are no other treatments for us to try. Nor does it end the involvement of family and friends. There are many ways to provide care for an older person who is dying.
Such care often involves a team. If you are reading this, then you might be part of such a team. Being a caregiver for someone at the end of life can be physically and emotionally exhausting.
In the end, accept that there may be no perfect death, just the best you can do for the one you love. And, the pain of losing someone close to you may be softened a little because, when you were needed, you did what you could. There are ways to make a person who is dying more comfortable.
Discomfort can come from a variety of problems. For each, there are things you or a healthcare provider can do, depending on the cause. For example, a dying person can be uncomfortable because of:. Watching someone you love die is hard enough, but thinking that person is also in pain makes it worse. Not everyone who is dying experiences pain, but there are things you can do to help someone who does.
Experts believe that care for someone who is dying should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse. Don't be afraid of giving as much pain medicine as is prescribed by the doctor. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Try to make sure that the level of pain does not get ahead of pain-relieving medicines. Tell the doctor or nurse if the pain is not controlled.
Medicines can be increased or changed. If this doesn't help, then ask for consultation with a palliative medical specialist who has experience in pain management for seriously ill patients see What Are Palliative Care and Hospice Care? Struggling with severe pain can be draining. It can make it hard for families to be together in a meaningful way. Pain can affect mood—being in pain can make someone seem angry or short-tempered.
Although understandable, irritability resulting from pain might make it hard to talk, hard to share thoughts and feelings. Breathing problems. Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. The doctor might call this dyspnea disp-NEE-uh. Worrying about the next breath can make it hard for important conversations or connections.
Try raising the head of the bed, opening a window, using a humidifier, or having a fan circulating air in the room. 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.
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 support their dying loved one. So, how do you find a hospice team that will excellent care to your older relative with dementia, and to your family?
I usually encourage families to look into all available hospice agencies in their area, including for-profit agencies. If you have the energy to do so, I recommend first being proactive right when the hospice care begins.
In particular, I recommend:. 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.
This will enable to nurse to better calibrate her care to the needs and preferences of your older loved one and your family. In truth, the concerns described in this question make me a bit sad.
I know that most of my colleagues 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. 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. Most of the time, they are doing their best.
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 hear your 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! Informed consent is certainly very important. In fact, whether patients should be informed when providers prescribe a medication off-label is currently a topic of debate: Informed Consent for Off-Label Use of Prescription Medications. Another challenge from the clinician side is recognizing the key family members to make sure all involved know the plan. My experience frequently has a lot of family members with slightly different expectations possibly getting and giving information to the clinical staff.
While hospice can assist families with the dying patient, they sometimes get caught in the communication cross fire of slightly different family expectations of care for the dying patient. I certainly have found myself struggling to manage communication issues, because it can take a lot of time and effort, especially when multiple parties are involved.
Thank you for your in-depth article, Dr. Kernisan, and to the person who so clearly described three relatives with dementia and their hospice care. Your article did help to refine my advance directives. My advance directives now specify no opiods be given unless I report pain and request them, and no benzodiazepines unless I demonstrate delerium or agitation.
Thanks again for your very thorough article. As a retired physician, I feel better prepared to defend myself from hospice over-care. One last thought. Yes, based on what I hear from people and occasionally observe directly , some hospice care is pretty cookie-cutter, which is unfortunate. But many of them seem to do their job well. So I worry a little about you specifying that you can only be given pain medication if you request it, because what if for some reason you end up in pain but unable to clearly express yourself?
Just a thought for you to consider…. Thank you so much Doctor for this excellent article. Your follow-up is especially appropriate. As a veterinarian, I am always an advocate for non-talking patients. I hope for myself that medical personnel in charge will assume that I am in pain if certain conditions are present and will medicate me accordingly. As a result of your article I am going to rewrite my healthcare support documents and will interview and pick a hospice group now.
Great article. Thanks for all the good information and your honest opinions toward the end. Much appreciated. My mother had dementia. Her assisted living recommended hospice. The hospice automatically put my mother on Atavan and morphine. She went drastically downhill, in no time flat. I did some research on the drugs that the hospice was automatically recommending, and discovered that those drugs hastened death in patients with dementia. I immediately got my mother taken off the drugs and she lived for well over a year longer.
It took very little online research to find out how morbidly destructive these drugs are. When I called the hospice and told them, they said denied it. The key is to be careful and thoughtful about how much is given.
But obviously you are right: families should be proactive about making sure that hospice clinicians are being attentive, and are using these medications judiciously.
It happened the same way with my Mom. They would not let her eat or drink. I thought she had a UTI and they promised to do a test there but delayed it.
The test was finally done five days later had to wait for doctor to order it , We got her to a hospital but infection, from the UTI was to bad to recover from. I know she had more time to live but their goal was death. This sounds very sad but honestly also a bit unusual. Also sounds unusual for them to refuse to let your mother eat or drink if she felt like it.
You may find it helpful to reach out to the hospice and share your concerns, perhaps some of this was due to miscommunication, and if not, they certainly should hear about your concerns and look into the care their staff are providing. I also hope you will be able to find some support in processing this experience and your grief.
Good luck and take care. I no wat morphines do to u. Generally, I think we are very lucky to live in a time when we CAN have morphine and other strong painkillers at the end of life, because prior to the modern era, a lot of people died in agony from cancers and the such. Now, whether your mother got more morphine than was strictly necessary for pain control is impossible for me to say.
People can decline very quickly from cancer at the end. It does sound like she was quiet and comfortable at the end. Plus you were there, which I believe means a lot to people. Take care. Thank you so much for sharing a very resourceful piece of information.
Hospice care is given by a team and not just one person. But what if seniors live more than six months or a year? Should the hospice support remains active until death or just for a specific period of time? You are right about questioning everything. Research and questions can keep family caregivers informed about the processes happening during hospice support. I am equally sorry to hear about the dreadful experience you had during hospice support.
I am sorry for your loss. After six months of hospice care, Medicare requires hospice agencies to reassess and recertify a six-month prognosis. This has to be repeated every 60 days. Some patients do improve, to the point that the doctors no longer believe they are likely to die within six months.
In this case, the person can be discharged from hospice. Hospice services can then be resumed at a later time, when the person once more appears to have a six month life expectancy. I agree that hospice is a valuable service that usually is very helpful to people who are dying and their families. Not only are some of the clinical questions open like use of benzos , but even structural ones, like ideal length of service, are unclear and mostly unmeasured. A couple of things might be good context — 1.
So the short terms and quick deaths that are mentioned are not unusal per se. Although, dementia is often thought to be a long-stay condition. While there are lots of complexities in hospice payments total caps, caps on hospital stays, etc.
So, it sounds more likely to me that some hospice clinicians are following their own values and preferences for end of life e. This is wrong, but not probably motivated by greed.
Chris, nice to hear from you and thanks for weighing in. Your site is an invaluable resource for family caregivers looking for information.
We cannot thank you enough for being so kind and accessible. I am a bit late to the conversation. I am hopeful that you will have a chance to address a concern of mine. My father who is 94 is in mid to late stage dementia and in the last year now lives at home with me, my husband and my mother.
He has never been formally diagnosed with dementia or treated for it but of course we knew he had some form of dementia. He is back home and is rapidly becoming more verbally aggressive and angry. We are working with trying to get him into hospice. They are concerned he may become physically violent and have mentioned the possibility of him entering a behavioral health program for several weeks to begin a supervised medication program.
My concern in brief: this sounds like he would enter as a dementia patient and exit as a zombie. The goal seems to be to make him more easily manageable. Thanks for your words of appreciation for the site. People lose the ability to be verbal in late-stage. I would consider it only as a last resort, after trying to manage the problem at home has failed. Among other downsides, an older person with dementia will be disoriented and stressed by admission to a new environment.
This will usually worsen behavior, and makes it very hard to manage the behavior without using medication. For this, we use chemical restraint as a last resort. We always start by trying to figure what might be triggering or aggravating the person. I explain an approach to managing difficult behaviors, including the role of medications, here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
For people with dementia who are on hospice or considering hospice, I generally start by trying pain medication.
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