Have you had 'care' by compassionate Hospice involving the Morphine-Ativan Cocktail? Did your loved one live or die?


Appreciate your comments! Thank you.

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Morphine itself may be causing the delirium.

Do not confuse grimacing and moaning from delirium or nightmares or drug-induced halucinations or delusions to be pain.

Neurological and neuropathic changes can cause twitching, kicking, grimacing and vocalizing that is easily confused with pain.

Here is an portion of an NIH study regarding the side effects of opiates at the end of life.

It has recommendations for options:


From the link: [ Reduction of opioid dose and/or rotation of the narcotic, i.e., a change to an alternate narcotic, initially at a lower dose equivalent, are reasonable treatment options.

For instance, a patient who becomes delirious with morphine may be switched to hydromorphone or methadone.

The benefit of opioid rotation is attributed to change in receptor activity, asymmetry in cross-tolerance among different opioids, differences in the efficacy of different opioids, and changes in toxic metabolites.22

When a narcotic is ineffective, the tendency is to give more drug. Lawlor cautions physicians to consider 5 reasons that a narcotic may not be working ]

My ex husband is In hospice from cancer
They were giving him morphine but he would wake up combative so they are now giving him a shot every hour
I just want his suffering to come to an end
It’s so sad but nobody wants to see their loved one suffering

yes, ma'am! Thanks for your insight.

Prolife wrote: [ Well, in my case theres more than enough money to handle all of this. The same money was available for my dad as well. Yes, over-medicating is a very last resort especially with Alzheimer's patients. Thanks for all this info. ]


You are welcome.

Yes, there is plenty of money already available for alternative pain relief methods.

People have to simply request them and use them. It's not about about being responsible, proactive and compassionate and paying attention to the side effects of pain and anxiety meds.

These methods work.

Also medications are extremely expensive, and perhaps more expensive than some of the alternative therapies.

Also, a lot of problems with elder patients are actually caused by over sedation or psychopharmaceuticals, too. Sigh!

I am glad that you are looking into these methods, as your initial approach.

I have used alternative pain relieve and anxiety relief with the person I am caregiving, too.

I agree about the smoking, it will alleviate a lot of pain, within a short time frame, if you mother can quit smoking.

Pain and anxiety medications should be a last resort.

There are so many medicinal foods and yes applications of normal things like exercise and massage. And music therapy..oh my gosh watching a man who otherwise could barely walk with a walker actually dance with his nurse barely holing on...music.

Well, in my case theres more than enough money to handle all of this. The same money was available for my dad as well. Yes, over-medicating is a very last resort especally with Alzheimer's patients. Thanks for all this info. My mom has turned so much over to my sister that I may have no power but im going to be working on that in coming weeks. My mom is having pain issues right now so maybe not the best time to discuss it. Snd yeah she wont do the first thing of quitting smoking...something that would actually help her pain. oh well.

Who will be doing the overseeing?
Who will be providing this highly skilled one to one care?
And who will be paying for it?

The authors set out... do they indeed. I've met my share of nicely turned out young graduates with their clipboards and their information folders telling everyone else how it's done. What I'd really love to see is one of these starry-eyed researchers after a night on duty in a care home doing the actual work.

Hi Prolife1:

I agree. It is peculiar to the USA that the first line of treatment is to over sedate and to warehouse old people, rather than keep them engaged, both physically and psychologically, in society.

Non drug methods however require time and patience.

Sedating a patient makes the caregiver more comfortable and makes their job so much easier.  They may convince themselves it is in the best interest of the elderly person, but new studies are showing that is NOT ALWAYS TRUE.

I am very concerned that anyone, in our society would  turn a deaf ear to valid research regarding alternatives to sedation and psychopharmaceuticals.

I am also very concerned that anyone would object to oversight regarding the appropriateness of drugging, based on each individual patient, and they would prefer drugging to at least first attempting more labor intensive proactive actions for their loved one

You mother is lucky to have you on her side, Prolife1.

According to the Harvard Newsletter drugs may NOT be the best choice at all for anxiety:


******Key points

Elderly patients with generalized anxiety disorder tend to experience more physical symptoms, and less intense emotional disruption.

Drugs may not be the best choice for older patients because they are more prone to side effects.

Cognitive behavioral therapy is a good first-line psychotherapy for treating generalized anxiety disorder in the elderly.

Non pharmacological, but more hands on methods to relieve pain are:

Also her are Physical therapy techniques, that are labor intensive, that can be used in pain control:

Massage: Touch is probably the oldest method of relieving pain and discomfort. Therapeutic massage using stroking and gentle kneading may be used to reduce muscle spasm, relieve pain, aid relaxation, and maintenance of joint range.

Cold/Heat: Where local skin sensation is normal and tissue is intact, local applications of heat and ice may be used to reduce spasm, for acute inflammatory conditions, and over myofascial trigger points.

Electrophysical Modalities: Transcutaneous electrical nerve stimulation (TENS) is the only electrical modality currently recommended for use in the presence of active neoplastic disease. Therapeutic ultrasound, interferential or pulsed shortwave diathermy relieves pain and muscle spasm and may be used over normal tissue and for non-cancer patients.

Exercise: Systematic reviews of observational and randomized controlled clinical trials conclude that there is strong evidence that participation in regular physical activity reduces the pain and enhances the functional capacity of older adults with persistent pain. Because persistent pain is commonly associated with prolonged physical inactivity, these effects may be partly due to the reversal of the physiologic consequences of reconditioning

Also here is a link citing a study for non drug methods for dealing with dementia, of course, again, it requires caregivers to be engaged with the patient.


****A new study is the result of two decades’ worth of research on drugs like antipsychotics and antidepressants, and non-drug approaches that help caregivers address behavioral issues in dementia patients.

The findings recommend that non-drug approaches that focus on training spouses, adult children, or staff in nursing homes and assisted living facilities should be the first choice for treating symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy, and delusions.


****GAO report

Coincidentally, a new report from the US Government Accountability Office, addresses the issue of overuse of antipsychotic medication for the behavior problems often seen in dementia.

It finds that one-third of older adults with dementia who had long-term nursing home stays in 2012 were prescribed an antipsychotic medication—and that about 14 percent of those outside nursing homes were prescribed an antipsychotic that same year.

The GAO calls on the federal government to work to REDUCE use of these drugs further than it’s already doing, by addressing use in dementia patients outside nursing homes.


*****The authors lay out five non-pharmacologic categories to start with based on their review of the medical evidence that have been shown to help reduce behavior issues:

Provide education for the caregiver.

Enhance effective communication between the caregiver and the person with dementia.

Create meaningful activities for the person with dementia.

Simplify tasks and establishing structured routines.

Ensure safety and simplify and enhance the environment around the patient, whether in the home or the nursing/assisted living setting.

It's just the culture of death. I don't take it personally. My sister is totally bought into it and it appears several people here are as well. We have to protect our loved ones from people like this.

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