Any experience with "deprescribing" as part of hospice care?

Crazy, Alva is a nurse. I am talking from experience. It really does not matter why she needs iron. She is on Hospice because she will die from whatever is wrong with her. Its an end of live service. If the iron is causing problems and there is a need for a laxative I think it would be good for everyone to discontinue it. 2 less pills she needs to take.

I want to thank everyone for taking the time to respond, share your experiences and thoughts, both for and against. It's been valuable. Thank you!

I was ASKED when my Husband went on Hospice if there were medications that were unnecessary.
We, the Hospice Nurse and I, went over the meds and for the most part I agreed that they were unnecessary at that time.
Actually the only 2 medications he was on at the time was a Cholesterol medication and Aricept. Both at that point could be discontinued.
Hospice did not "force" the issue and I am sure the Cholesterol medication would have been covered if I had wanted him to continue on with it.

This is your decision Hospice will cover some "formulary" medications but ones that might not be could be filled at the drugstore.

In your case the Vitamins, probably really not being absorbed as efficiently as they should be. The low dose aspirin again is your choice to continue or stop. Does she have a high risk for a heart attack or stroke?
And I hate to be a "debbie downer" but what would you want done if she did have a heart attack or stroke?
If she survived a heart attack the CPR would probably be difficult to recover from (if she is has CPR done) as it will most likely break ribs, crack the sternum and puncture a lung.
Recovering from a stroke is difficult at any age but 99?

There is no right or wrong on this

Hospice suggested my mom stop vitamins, aspirin, calcium, etc. They said with the little she was eating she probably wasn't even absorbing them. However, mom wanted to continue taking them and did right until the end. I don't think it made any difference either way.
Definitely don't stop anything needed to keep the bowels moving. Best of luck to you and your family.

She is on end of life care.
I cannot imagine why either giving or withholding would make the slightest difference.
I am very surprised that anyone in a Hospice situation would suggest that the goal is "improved health outcome" because the REAL goal for hospice is/should be comfort care for end of life process.

I have never heard the word before "deprescribing", so that's a new one on this RN, but time has marched on since my retirement. Looking it up I found the following online:
https://www.aafp.org/pubs/afp/issues/2019/0101/p7.html
It says that deprescribing is exactly what you just said it is. But as I said, I don't get it.
And to be honest, in end of life Hospice situation I cannot imagine what difference it makes whether she takes the meds you mentioned or not. I doubt an ASA or vitamin is prolonging her life, or making it more uncomfortable, or improving it EITHER.

I would ask specifics:
What medication do you wish to withdraw?
What HARM do you believe this medication is doing?
What is your GOAL in removing this medication?

For me, removing the ASA makes her a bit more prone to stroke, but the ASA itself makes her more prone to a bleed anywhere.
I cannot see what good or harm a medication is doing other than that iron in a vitamin may be constipating.

I just don't get it. So I would ask questions.

Vitamins are basically food, and the baby aspirin helps relieve pain. They’re both comfort items, which is the whole point of hospice.

"improved health outcomes by reducing exposure to medications that are potentially either harmful or no longer required). Specifically, they wanted to remove things like her daily 81mg aspirin, daily multi-vitamin, and a Vitamin C with iron)"

Medications usually discontinued are lifestaining prescription drugs. I don't see where taking her aspirin and multi-vitamin would be lifestaining. My DH takes an 81mg aspirin for his heart because of AFib he has every so many years. Since she has been taking these things for years, I see no problem in continuing them if she wants to but they are really no longer needed. The Vit C with iron, I would discontinue. Iron did a number on my Mom BM wise and its hard to clean them up. The sodium-bicarb may not be needed if you drop the iron.

I have never been asked to take DH aunt off of anything and she has been on hospice for several years now. I’m not trying to see her out or keep her here. I just want her to be comfortable.

Just remember that your mom or whoever is her POA has the final say as to what hospice can remove and what they can't when it comes to any medications or supplements.
I personally see no harm in allowing her to take her aspirin, daily vitamin and her vitamin C with iron, while she's under hospice care.
My late husband was under hospice care for the last 22 months of his life and he took a butt load of medications for various reasons(mostly for his seizures), and there were several times when hospice tried to get me to discontinue some of his medications. Most of the time I didn't agree with them and he remained on them. The only time I agreed was when it was his cholesterol medicine. He also took a 81 mg aspirin and multi-vitamin right up to the start of his dying process.
So don't forget, just because hospice "recommends" something, it doesn't mean that you have to go along with it.
You do what you feel is best for your mother.

My dad’s unneeded medications were discontinued when he began hospice. We all understood this, as hospice is designed as end of life care and not prolonging life, the meds that had been prescribed to manage conditions that were no longer being treated along with supplements that only might be of benefit made sense to stop. The focus had changed

When my mom began hospice they told us that she would only be taking drugs that were absolutely necessary.

Hospice focuses on comfort care rather than prevention.

My mother wasn’t interested in prolonging her life. She didn’t fear death and was ready to die.

Anytime hospice suggested removing meds that were no longer necessary, we agreed. If they added meds to keep her comfortable such as morphine, we agreed to it.

Wishing you peace as you continue on your caregiving journey.

The first thing hospice asked me about was discontinuing unnecessary supplements, and I agreed. Once end of life approaches, only comfort care is required....everything else is superfluous. The last thing I had in mind was trying to extend moms life, at 95, with advanced dementia. Do as you wish but ask yourself what purpose these supplements serve?

My MIL was on a few medications that Medicare considers treatments to improve health, such as Metformin and statins, also some supplements, that were discontinued pretty much immediately when she went on Hospice. That still left quite a few that were to keep her comfortable; pain relief and anti-anxiety and the like. The main issue in your case, I think, is that Medicare won't cover the cost of these things. However, the actual care will be in your hands and they won't know if she wants to take supplements and pays for them. If she's at the point of hospice, there is probably not much value to these things and as she declines further, she may not want to bother. But I don't believe they would stop her from taking them.

My husband took a lot of medication, but when he went on hospice I had no problem with discontinuing supplements and things like his statin, which was no longer necessary. Unless something had an immediate benefit such as his sleeping/anxiety or BP meds, he didn’t really need it. I will add that his life expectancy was short because he was declining quickly and chose to discontinue dialysis a week later, but we would still have stopped a lot of medications just to make life easier. If your mom requests her supplements and it comforts her, I would say keep going with them, otherwise I wouldn’t.

Gees I would think your mom could continue her supplements. I used Hospice at the end with My brother who had stage 4 cancer and Knew the cancer had spread to the brain and consulted with the head doctor at Dana faber and a well Known Psychiatrist and had a wonderful social worker so we Knew it was time . Hospice didnt actually do much My brother was in a good nursing Home . Trust your instincts and go with your gut .