Is it normal for hospice to stop all medications?

A fellow caregiver asked...

My mother-in-law is in hospice. They have told us that they are going to stop giving her any of her previous medications. Is this normal to stop all medications?

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

Thank you for asking this question. It allows me to clarify what our goals are when a patient comes onto our service.

First, it is important to understand that hospice care is comfort care as patients approach the end of their lives. (All patients need to have their primary care physician state their life expectancy is now 6 months or less.) Comfort care is also for patients who have completed all therapies"”and in whom cure is now futile. It is also important to understand that while cure is not an option, caring always is.

Secondly, most patients"”especially older patients"”are taking many medications and have for a long time. Hospice care does not "stop giving patients any previous medications", but rather, eliminates many that are no longer appropriate. By that I mean, those that really are not helping keep the patient comfortable. Some may even be causing more problems rather than solutions.

What is important now is maintaining a quality of life"”a reason to live. Hospice concentrates on managing pain and controlling distressing symptoms. Therefore, most medications now will be for pain and symptoms. Some other medications that were previously taken can be continued as determined by the interdisciplinary team; and, generally, if a patient wants to continue taking medications not related to their terminal diagnosis, they can do so.

As patients progress in their illness course, many changes are occurring in the body. Food may be unappealing, difficult to chew, swallow or to digest. This is normal. Fluids can also be a problem, and some patients are at risk for aspiration (into the lungs) that can cause pneumonia. This is one reason for weight loss. So too, all those medications that may have been important for your mother-in-law before, are no longer appropriate, or difficult for her to swallow. This is what I mean by goals of care are changing.

Talk to the hospice about your concerns. Generally, a little education for the patient and family help clarify these new goals, and puts everyone at ease.