According to the National Hospice and Palliative Care Organization (NHPCO), dementia is the 3rd highest reason for a referral to hospice care. Alzheimer’s disease, a form of dementia, is the 5th leading cause of death in patients >65 years old. The most common diagnostic test for dementia is the mini-mental state exam. This is a scale of 0-30, with the higher score being less cognitive impairment. Initially, dementia is characterized by patients forgetting things, becoming disoriented, or altered behaviors. This is not considered a normal part of the aging process. There is irreversible damage to the brain that will eventually cause a decline in functional status to the point where patients are no longer able to perform their activities of daily living.
Medications for Dementia
Treatment of dementia is a multipronged approach of both mediations and lifestyle interventions to help maintain memory. The most common medications used for dementia are donepezil (Aricept) tablets or rivastigmine (Exelon) patches. Another medication that can be used is called memantine (Namenda). This medication is usually in combination with one of the other medications listed. It is important to remember that the medications do not increase a patient’s memory. They just slow the process of it declining. These medications are not without side effects. Cardiovascular effects are common, and these medications can decrease the heart rate, change blood pressure, and can increase the risk for seizures. While medications are helpful early in the disease process, late stage dementia is not helped by medications.
When a patient with dementia is enrolled in hospice, the typical course of action is to stop the medications designed to slow the disease process and focus on making sure the patient is comfortable. It can be difficult to assess comfort at the end of life as patients are usually unable to communicate. There are a few pain scales that can be utilized to determine how comfortable a patient is. At Hospice of Southern Illinois, our nurses use the FLACC pain scale. This scale assesses face, legs, activity, cry, and consolability for nonverbal signs of pain. As time goes on, more medications such as blood pressure and diabetes medications may be discontinued also. Discontinuing medications can help to decrease a patient’s pill burden and decrease risk of side effects that may be amplified by multiple medications.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.
By: Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois
October is American Pharmacists Month and we are proud to present to you an educational blog series throughout the month by, Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care. Our series will help expand your understanding of the use of medications at the end-of-life.