cassestar Posted March 2016

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

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Heather10 Jun 30, 2018
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:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC353038/

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 ]
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Corinne1217 Jun 28, 2018
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
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Prolife1 May 30, 2018
yes, ma'am! Thanks for your insight.
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Heather10 May 29, 2018
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. ]

Prolife1:

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.
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Prolife1 May 28, 2018
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.
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Prolife1 May 28, 2018
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.
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Countrymouse May 28, 2018
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.
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Heather10 May 28, 2018
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:

https://www.health.harvard.edu/newsletter_article/Treating-generalized-anxiety-disorder-in-the-elderly

******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.

www.futurity.org/5-ways-ease-dementia-without-drugs-868592/

****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.

More....

****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.

More....

*****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.
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Prolife1 May 26, 2018
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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Heather10 May 26, 2018
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[ Prolife1 wrote
4 days ago
Gershun, maybe you dont want to have people cleaning you up but I want to see every one of my many kids before i die. its an individual decision that belongs to the individual. Choose your battles. YOUR battles, not others'. ]

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Prolife1:

I a so sorry you are being personally attacked here simply for stating your generalized opinion

I find it odd that anyone would object to oversight.

Oversight, simply ensures that family caregivers or others are abiding by the request of the elderly person and that no harm is being done for money or simply because the caregiver is exhausted and no longer wants the responsibility of caring for an elderly person.

Some here are automatically assuming that they are heroes because they prevented a miserable prolonged death.....Well, if that is true, the WHY WOULD THEY FEAR OVERSIGHT?

If a person is doing the right thing, they would certainly be open to others who feel that the parent was not treated properly and they certainly would NOT fear OVERSIGHT

The objection to OVERSIGHT is odd.

If someone knows they did the right thing, than why care about oversight?

I WELCOME OVERSIGHT, because I know without doubt or guilty conscience that I am truly looking out for the best interest and will of my charge. 

Prolife1, It should be, as you state, an individual choice, based on each unique circumstance.

But this much needed call for the right of the elder to choose keeps falling on the deaf ears of those who apparently wanted total control over their parent's end of life.

If the parent had a living will that stated, they wanted to be drugged or DNR, than, why would oversight be feared.

The person in charge of  caregiver oversight would certainly also abide by the elder's last recorded and stated wishes.

Why on Earth would anyone object to oversight over relative caregivers or paid caregivers to ensure that the elder person's wishes are being obeyed?

If the posters who are attacking you actually bothered to read the links I posted, then they would know that there is NO DOUBT that patients ARE dying and suddenly.

It is almost an epidemic.

It is much easier for caregivers to sedate their elder patient, rather than using other more hands on labor intensive methods of relieving pain or anxiety.

Sadly we hear complaints all to often....One day the elder person is sharp and the next day they are drugged into zombie hood, a few days later they are dead.

I think the people here have not thoroughly read the links I posted.

If they had, there would be no reason to object to your opinion.

Someone commented, and I paraphrase, on how they would not want to be in a nursing home having their life extended because the patients there look like zombies.

Well, if that is THEIR choice, than so be it.

But they might do well to consider that perhaps the reality is the elderly look like zombies in the care facilities because they are being over-medicated with chemical constraints. .... Or drugs that keep them sedated and less troublesome.

The other point is that even if it is the elderly person's choice be to be drugged into compliance, there are many other elderly who MAY prefer to remain alert, until the end.

It should be THE ELDER'S a choice. THAT IS WHY OVERSIGHT IS NEEDED.

It is needed to ensure that an alert elderly person is not being drugged against their will by paid lazy or overworked caregivers, or exhausted or greedy relatives.

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[ Prolife1 wrote
4 days ago
I love how you guys' "compassion" is all about taking people early rather than for those who went too soon and their kids. who didnt get to say goodbye. I am noticing a pattern. Not one of you certain few (and you know who you are) are a bit sorry for what actually happened exactly as Im stating. If someone came on here and said they hastened someones death youd trust them and feel sorry for them. Very telling. ]
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Prolife1, I agree and I think it is important to NOT encourage over drugging.  There are non drug methods to alleviate pain and anxiety.

You are right, too, that it seems that there is a steady drumbeat of support for over-drugging with the claim that it was ALWAYS DONE IN THE BEST INTEREST OF THE ELDER and as if it is always a heroic thing to do.

Well maybe it was. And, maybe it wasn't.

That is why oversight is needed, and anyone who objects to oversight, is exactly the type of person who MOST needs oversight.
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