My first assumption is that this is a "hypothetical question"? The age I think is irrelevant. If one is thinking of refusing crucial meds such as those that control very high blood pressure or out of control diabetes, then it is essentially saying you wish for palliative care only and are ready to face your demise. You are saying that you wish to be kept comfortable and that you recognize that you may be/are probably close to the end. Many young people with serious end-stage disease make this decision. And many elders do. Generally it is an individual decision by an individual with possible discussion with family members, and has little to do with age. An interesting book by the woman who wrote Nickled and Dimed, Barbara Ehrenreich, is her latest, Natural Causes. She advocates for not continuing to take all the testing and medications in a desperate attempt to live forever. The thing to consider is that "not taking medications" doesn't always lead to our comfortable demise. Not taking medication that controls very high blood pressure, for instance, may lead to a stroke. The stroke doesn't necessarily kill; it can also debillitate. There is much to think about in refusing meds and tests, and it is best to talk at some length with your doctor. Not always easy in a day and age when insurance companies allow them average 10 minutes with each patient.
"There is much to think about in refusing meds and tests, and it is best to talk at some length with your doctor." Can't hurt to do some research and discuss with family as well. Age really isn't a deciding factor. Overall health and prospects for a quality future are better to consider. Mom with dementia, etc, no surgery at this point is to be considered. If she were earlier stage, maybe, but at 96, HBP, hearing loss, macular degeneration, refusing to walk now... no invasive treatments. But, we do continue the BP meds and eye treatments, for now.
I don't think there's any one age. I honestly think this is a decision you need to make in consultation with your physician. If your maintenance meds are maintaining your blood pressure, blood sugar, etc., and your quality of life is good, then I say carry on. Having said that, I think this is a very personal decision, because you would have insight into your quality of life.
All good answers here. I read that statins are not recommended for people over 80 now. I would continue the meds for hypertension and diabetes to prevent strokes. Antibiotics are a toss-up. UTIs are devastating to elderly people and antibiotic-resistant intestinal infections are worse. It's OK to question the doc to see what the meds are really for.
I am over 80 and have stopped blood pressure and statin drugs. Surprisingly my blood pressure is normal but cholesterol is around 350. I really fear dementia, as I have one copy of apoE4 for late onset Alzheimer's and it is in my family. I have been everywhere I want to go and seen everything I want to see. Both my children know my wishes and have agreed. Their father, my first and ex husband has been in nursing home unable to walk or understand anything for three years. He doesn't get meds either, but soon will run out of the money to pay for the NH. I do not ever want to be in that position.
No magic age. When the risks/negatives outweigh the benefits/pluses. If a drug no longer works or its side effects diminish quality of life, then I'd stop. If they are working and they are allowing for a person to function and enjoy life in some way, then I would continue. I would never stop all at once. With my doctor's guidance, I would cut back on one and see how it goes, slowly easing off. It seems that Type 2 diabetes and cholesterol could be adjusted lower with dietary changes, perhaps? I know people who have completely come off of diabetes medication with lifestyle/dietary changes.
Only come off meds though by a doctor’s instructions and do it the way he/she says. Otherwise, patient could go into withdrawal and you may not even realize it if their behavior is erratic due to their illness. Very tricky.
We moved my mother-in-law in with us after a fall and hospitalization/rehab. She had moderate dementia, probably vascular. We involved the local non-profit Hospice soon thereafter, as we learned how inadequate to the task we were. Hospice wanted to discontinue most of her maintenance meds. We chose to keep her on most of her meds, especially her blood pressure meds and her anti-depressant. We were frankly terrified of tempting a stroke that would make it impossible for us to care for her. Also, the thought of her without her antidepressant was terrifying. Trust me. Our view was that the fewer changes, the better at that time. She was 92.
For some reason, after his last fall, the hospital took my father off his 325 mg aspirin he had been taking as successful stroke prevention under the guidance of his doctor for several years. He went in the hospital with a simple UTI and should have been released that day back into memory care but the memory care wanted him to be able to transfer himself. He went into rehab. They continued the hospital program by withholding the aspirin. He had a stroke and never recovered. I never got an adequate answer from the hospital or nursing home as to why they withheld his aspirin. (His own doctor had retired.) The purpose of the glaucoma drops is to keep the eye pressure down. Escalating eye pressure can be very painful and result in the destruction of the optic nerve. I would continue it.
Why would one EVER remove maintenance meds from someone's regimen? Unless the person has chosen to do so, that could be seen as a form of elder abuse. Age has nothing to do with it. I would never remove my husband's maintenance meds unless it had some benefit and it was ordered by his physician.
When the person quits breathing. This is Not age related.
Stopping "maintenance drugs" is not the way to go. My mother stopped all her medications without telling anyone and she suffered greatly her last 6 months of life. That is Not the way to do it.
For my Dad and my DH, Hospice was when I stopped the medications. Both were expected to pass within 2 weeks. Both passed in less than a week. I maintained the memory & pain medications for my father after he quit dialysis. My DH had already quit eating so his last few days were without medications.
Hospice patients in the end days of life are typically taken off maintenance drugs. Other than that, that is up to the patients doctor. I think that is a question you should ask him/her rather than ask on a message board.
I think it should be up to the patient rather than the doctor. I stopped maintenance meds two years ago at age 80. I have lived long enough, and if I have to give up traveling I know I don't want to live!
Many think that "Quality of Life" should determine our decisions as we age. Those who think that are just wrong, imo.
Many are misinformed or uninformed. Consider the parameters (or written guidelines) judging a person's QUALITY OF LIFE. They are the same as written in the book: "Nazi Doctors".
There is one arbiter of each person's quality of life, and that is God.
Think about the case of Terry Shaivo, whose husband had life support disconnected after a lengthy court battle with her parents who wanted her to live. Husband had moved on, living with a new woman.
When we first decide to look at our quality of life to determine whether we should take a medication or not, that is only one step on the slippery slope to euthanasia.
I am saying, do not try to judge whether one should take a medication or not based upon quality of life as determined by the society in which we live.
I do not take a few medications prescribed to me because I need to be alert to drive my husband to work.
Believe it or not, many medications can or do make a person's condition worse. Calling something a "maintenance" drug does not change that fact. That is why prescriptions should regularly be revisited.
Definitely revisit the med list from time to time to see if there are things being taken that really aren't helping or are no longer necessary. My mom, for example, has a lot of pain and I wonder if some of the drugs are redundant. A couple of her stomach meds I have questions about. Or 3 of X a day. Would there be any difference if she took 2 a day instead? I am always thinking of how/if we can reduce her meds without making her feel worse.
BUT when she gets to the point that end of life is becoming obvious and/or she gets put on hospice, I would work with her doc on reducing/eliminating as much as possible that does not bring her pain relief.
I am saying this all for my mom but it is what I would also want done for me, my husband, etc.
Speak with the doctor about this before you do anything. They will decide which meds can/ should be eliminated to avoid suffering. Remember that taking someone off of pain meds cold turkey could result in seizures!! Removing BP meds abruptly could cause a stroke. Removing anti-anxiety meds can also cause seizures. I am not guessing on here. Mom’s family physician and I checked with my own doctor on a regular visit and he confirmed the same. So will it bring comfort or more suffering and trips to the ER? It is scary to think that others will be in charge of my last days. Ha! Educate yourself and just asking folks on here is not the go-to answer. Talk to a doctor who cares.
The OP brings up a great point. They put my mom on a statin along with the baby aspirin. They increased baby aspirin from one to two as a ‘stroke prevention.’ She does not have high cholesterol, never has. Her labs are great.
She is a parkinson’s patient that already has mobility issues. The statin caused muscle aches. I asked them to please remove the statin and she is doing so much better.
When she went to the ER awhile back because of not feeling well. It was discovered that she had low blood pressure. She never had high blood pressure to begin with so why was she even on those meds. The ER doctor took her off of them and said Parkinson’s patients run low blood pressure and shouldn’t be on high blood pressure meds.
There are so many docs now, Needs help with Mom, who will write prescriptions for meds because they are being studied as possibly helpful, ie statin for Alzheimer's. And without proof that they work at all. I have yet to hear of an Alzheimer's drug that actually works, yet they give an amazing amount of them. Statins are something I have refused lifelong after they creamed my foot muscles, and despite massive high cholesterol in my family and self. When I worked cardiac all those years I saw more familial correlations with history of MI in parents, rather than high cholesterol. Just took my best guess. As the docs say "anything but an exact science. I am 77, so guess if I bump on off tomorrow no one will be out there muttering "Oh, my, she died so young and beautiful". There has even been one study of patients removed from all of their many meds improving without them. We assume they are helpful. They often are not and cause more harm than good. As I said somewhere else, I think everyone does the best they can with the information they have, but we know too little.
So actually my opinion is to see a Geriatric doctor that specializes in elderly they really know BEST example...when my dad started seeing a Geriatric doctor he informed us that gilbride can make an elderly person's blood sugar too low for a much too long period of time...and took him off of it ,but I would NEVER stop anything that necessary without the advice of a Dr. This decision needs to be medically monitored there can be serious side effects to stop medication may need to slowly be weaned down ect.....
I would say speak to a geriatric nurse practitioner. Reconciling medications - determining which meds are necessary, which aren't, and which should be tapered down or off - is best left to an NP. Doctors rarely take the time anymore to do much beyond signing the Rx pad.
The OP does bring up a good point because there is over medicating of patients. Meds should never be stopped cold turkey though. That can be dangerous.
I think NY made a good point too. Doctors aren’t always as aware as nurse practitioners or even pharmacists.
My aunt was a kidney patient. She went into a coma and died shortly afterwards. The pharmacist told my mother that the drug that she took should never have been given to a person with kidney failure plus it was four times the strength it should have been.
He told my mom that she had a legitimate reason to sue. My mom said that it wouldn’t bring her sister back and wasn’t interested in suing.
She was in shock. Her sister was only in her forties. My mom and dad raised her kids, my cousins. Over medicating has been a problem. My grandpa used to say, “Doctors bury their mistakes.”
When you are not able to go on any longer or do not have the capacity to make that decision. Otherwise, continue taking them until the medical doctor says otherwise.
It depends on the drug, the disease and the patient. Carefully research these factors and consult with competent professionals before stopping anything so you don't cause harm.
I used to be a pharmaceutial rep for a worldwide company but eventually got so depressed over my work and the industry that I had to quit before I walked into the path of a mac truck. I saw that many prescriptions weren't necessary or that lifestyle changes were just as effective as drugs in some cases. There were doctors who prescribed a certain drug because its rep was their fishing buddy or because a particular company invited them to sumptious dinners or took them on luxurious trips or because they liked the gorgeous rep with xyz company. Doctors are taught to prescribe drugs for everything, trained not to question what they're taught and to follow rules. They also fear lawsuits if they don't follow "Standard of Care" guidelines laid out for diseases and conditions. They are smart and work very hard but they are not gods. You can research the situation and in consultation with a physician make a good decision.
It is easy for doctors to inadvertently over-medicate elderly patients. The usual doses given younger or middle-aged patients may well be too much for an older person (who may have several different disease processes going on). It is important to describe a patient's behavior as well as their complaints to the doctor. Hopefully, the older person can describe for themselves what bothers them most (and make sure the doctor listens to them).
My mother would complain to me about various things, but when the doctor would ask her directly, she'd reply "oh, I'm fine, really," thinking her interaction with the doctors was mainly a "social" one. Sometimes I would have to remind her of things the doctor didn't think to ask.
As far as the kickbacks go from pharmaceutical sales, my friend who is a nurse says that it isn’t only in dollars, per say, but often in things like playing golf at the most expensive country clubs and expensive dinners, etc.
I've heard same. And they've gotten clever about how to take the kickbacks into the shadows. My husband's cousin works for a maker of psych drugs. He throws parties at his house for his "business associates" and most of his guests are doctors. The doctors bring their spouses and kids, and the kids are set up around the pool with a lifeguard, drinks, food, towels, pool toys, etc. And it gets more intricate from there. His cousin's wife owns a decorating company, and she drums up lots of business from these parties. When she does, they wine and dine the couple on her business account and there's no more trace of the doctor getting anything from pharma.
My mother been taking the same type of medication for years, I keep telling her doctors I think some medicines are making her blood pressure to be very low, but they will not take her off. Her life now is very slow she’s not as active as she was when she was in her 50’s and 60’s. She’s now 86, not much activity now. But am still going to try to talk to her doctor again, she lives with us,
My mom hasn’t had a seizure since 1996. Her neurologist said she could get off meds. She freaked out so much he told her that it was fine to stay on them. She’s freakin paranoid about having another seizure. I know people who got off of their seizure drugs but she won’t even consider it.
The only other drug she takes is Sinamet for her Parkinson’s disease.
ALWAYS, with doctor’s approval but we as caregivers are the ones that are witnessing side effects of drugs and it’s our responsibility to report them to have the best possible care for our loved ones. We see our loved ones on a daily basis and doctors only see them every four to six months and don’t often don’t hear what is accurate because they put on a front to the doctor. I’ve been through this for a bazillion years to be able to describe the situation.
I've heard same. And they've gotten clever about how to take the kickbacks into the shadows. My husband's cousin works for a maker of psych drugs. He throws parties at his house for his "business associates" and most of his guests are doctors. The doctors bring their spouses and kids, and the kids are set up around the pool with a lifeguard, drinks, food, towels, pool toys, etc. And it gets more intricate from there. His cousin's wife owns a decorating company, and she drums up lots of business from these parties. When she does, they wine and dine the couple on her business account and there's no more trace of the doctor getting anything from pharma.
While I was studying to be a pharmacy tech (and already a working R.N.) I was invited to a few of such parties hosted by pharmaceutical companies. No children attended, but most of these "parties" were held at a restaurant where alcohol was available and were paid for by a drug manufacturer. Educational information on their product and others were the only "entertainment".
It was a sales effort plain and simple. However, the medical professionals were given results of peer-reviewed studies in which several products were compared. The professionals asked complex questions and had ample information and experience to critically evaluate the information.
What a "cousin's wife" discussed afterward is anyone's guess. Despite the claims of some alternative medicine proponents, reputable medical doctors are seldom so poor or unscrupulous that they participate in kickback schemes.
It is easy for physicians to inadvertently over-medicate elderly patients, as they are generally more sensitive to drugs than younger or middle aged patients. In my experience, this is especially true if elderly behavior is difficult for care givers.
My concern would be if the person could stroke out. Medicine is certainly keeping my mother alive. She has so many issues. Her medication is administered at the AL she resides in. She is ambulatory although has real mobility issues. In her case stopping medication would likely cause a change but it could be one that puts her in a nursing home,bedridden. Obviously I would prefer that not to happen. I don't know that simply stopping medication will bring about a quick end that is not prolonged. I think there are so many factors involved with each individual.
Some doctors take elderly off blood pressure meds if theirs has gone too low. My aunt would pass out when she stood up, and we have a BP machine to show how low it went. She said it happens often with elderly.
Since it was determined that my aunt had Vascular Dementia, I took her off the just-in-case-Alzheimer's med the hospital had tried her on. Same with the anti-depressant a hospital psychiatrist put her on after talking with her only once. Slowly weaned her off with her doctr's knowledge. Thyroid she took till her last week alive. I still take my antidepressant, but it gets increased in the winters.
Maggieb said, 'This body, at This age, and in This condition", which makes such perfect sense to me! I know that with my FIL, at around age 82, his Dr began slowly eliminating his "maintenance" meds one by one as he had lost significant weight and had slowed down considerably, and also, the majority of his meds were low dose and only treating minor symptoms according to his physical findings and his lab results.
His Dr d/c'd his low dose BP pills first, then his Cholesterol meds, followed by his Type 2 diabetes meds and finally the Glaucoma eye drops. He continued to follow his condition closely via lab work, and there were never any significant changes that warranted him "re-prescribing" any of these meds, and we were always comfortable with the Drs decision. He did keep him on a baby aspirin and his Centrum Silver multi vitamin and that was it for the remaining years until his death from Lung Cancer at age 88.
Talk with your doctor about the possibility of discontinuing meds that may no longer be necessary, it might surprise you. It is important that the previous conditions be monitored and that follow up labs are done, but thankfully my FIL did well, and without repercussions.
The age I think is irrelevant. If one is thinking of refusing crucial meds such as those that control very high blood pressure or out of control diabetes, then it is essentially saying you wish for palliative care only and are ready to face your demise. You are saying that you wish to be kept comfortable and that you recognize that you may be/are probably close to the end.
Many young people with serious end-stage disease make this decision. And many elders do. Generally it is an individual decision by an individual with possible discussion with family members, and has little to do with age.
An interesting book by the woman who wrote Nickled and Dimed, Barbara Ehrenreich, is her latest, Natural Causes. She advocates for not continuing to take all the testing and medications in a desperate attempt to live forever.
The thing to consider is that "not taking medications" doesn't always lead to our comfortable demise. Not taking medication that controls very high blood pressure, for instance, may lead to a stroke. The stroke doesn't necessarily kill; it can also debillitate.
There is much to think about in refusing meds and tests, and it is best to talk at some length with your doctor. Not always easy in a day and age when insurance companies allow them average 10 minutes with each patient.
Stopping "maintenance drugs" is not the way to go. My mother stopped all her medications without telling anyone and she suffered greatly her last 6 months of life. That is Not the way to do it.
For my Dad and my DH, Hospice was when I stopped the medications. Both were expected to pass within 2 weeks. Both passed in less than a week.
I maintained the memory & pain medications for my father after he quit dialysis.
My DH had already quit eating so his last few days were without medications.
Those who think that are just wrong, imo.
Many are misinformed or uninformed. Consider the parameters (or written guidelines) judging a person's QUALITY OF LIFE. They are the same as written in the book: "Nazi Doctors".
There is one arbiter of each person's quality of life, and that is God.
Think about the case of Terry Shaivo, whose husband had life support disconnected after a lengthy court battle with her parents who wanted her to live.
Husband had moved on, living with a new woman.
When we first decide to look at our quality of life to determine whether we should take a medication or not, that is only one step on the slippery slope to euthanasia.
I am saying, do not try to judge whether one should take a medication or not based upon quality of life as determined by the society in which we live.
I do not take a few medications prescribed to me because I need to be alert to drive my husband to work.
One is never "too old" to stop taking their maintenance drugs.
If I had high blood pressure, why would I want to stop taking the meds that control it and end up dealing with a stroke.
Definitely revisit the med list from time to time to see if there are things being taken that really aren't helping or are no longer necessary. My mom, for example, has a lot of pain and I wonder if some of the drugs are redundant. A couple of her stomach meds I have questions about. Or 3 of X a day. Would there be any difference if she took 2 a day instead? I am always thinking of how/if we can reduce her meds without making her feel worse.
BUT when she gets to the point that end of life is becoming obvious and/or she gets put on hospice, I would work with her doc on reducing/eliminating as much as possible that does not bring her pain relief.
I am saying this all for my mom but it is what I would also want done for me, my husband, etc.
I love your answer, very caring, thoughtful and sensible!
The OP brings up a great point.
They put my mom on a statin along with the baby aspirin. They increased baby aspirin from one to two as a ‘stroke prevention.’ She does not have high cholesterol, never has. Her labs are great.
She is a parkinson’s patient that already has mobility issues. The statin caused muscle aches. I asked them to please remove the statin and she is doing so much better.
When she went to the ER awhile back because of not feeling well. It was discovered that she had low blood pressure. She never had high blood pressure to begin with so why was she even on those meds. The ER doctor took her off of them and said Parkinson’s patients run low blood pressure and shouldn’t be on high blood pressure meds.
I think NY made a good point too. Doctors aren’t always as aware as nurse practitioners or even pharmacists.
My aunt was a kidney patient. She went into a coma and died shortly afterwards. The pharmacist told my mother that the drug that she took should never have been given to a person with kidney failure plus it was four times the strength it should have been.
He told my mom that she had a legitimate reason to sue. My mom said that it wouldn’t bring her sister back and wasn’t interested in suing.
She was in shock. Her sister was only in her forties. My mom and dad raised her kids, my cousins. Over medicating has been a problem. My grandpa used to say, “Doctors bury their mistakes.”
I used to be a pharmaceutial rep for a worldwide company but eventually got so depressed over my work and the industry that I had to quit before I walked into the path of a mac truck. I saw that many prescriptions weren't necessary or that lifestyle changes were just as effective as drugs in some cases. There were doctors who prescribed a certain drug because its rep was their fishing buddy or because a particular company invited them to sumptious dinners or took them on luxurious trips or because they liked the gorgeous rep with xyz company. Doctors are taught to prescribe drugs for everything, trained not to question what they're taught and to follow rules. They also fear lawsuits if they don't follow "Standard of Care" guidelines laid out for diseases and conditions. They are smart and work very hard but they are not gods. You can research the situation and in consultation with a physician make a good decision.
My mother would complain to me about various things, but when the doctor would ask her directly, she'd reply "oh, I'm fine, really,"
thinking her interaction with the doctors was mainly a "social" one.
Sometimes I would have to remind her of things the doctor didn't think to ask.
As far as the kickbacks go from pharmaceutical sales, my friend who is a nurse says that it isn’t only in dollars, per say, but often in things like playing golf at the most expensive country clubs and expensive dinners, etc.
The only other drug she takes is Sinamet for her Parkinson’s disease.
ALWAYS, with doctor’s approval but we as caregivers are the ones that are witnessing side effects of drugs and it’s our responsibility to report them to have the best possible care for our loved ones. We see our loved ones on a daily basis and doctors only see them every four to six months and don’t often don’t hear what is accurate because they put on a front to the doctor. I’ve been through this for a bazillion years to be able to describe the situation.
It was a sales effort plain and simple. However, the medical professionals were given results of peer-reviewed studies in which several products were compared. The professionals asked complex questions and had ample information and experience to critically evaluate the information.
What a "cousin's wife" discussed afterward is anyone's guess. Despite the claims of some alternative medicine proponents, reputable medical doctors are seldom so poor or unscrupulous that they participate in kickback schemes.
It is easy for physicians to inadvertently over-medicate elderly patients, as they are generally more sensitive to drugs than younger or middle aged patients. In my experience, this is especially true if elderly behavior is difficult for care givers.
Since it was determined that my aunt had Vascular Dementia, I took her off the just-in-case-Alzheimer's med the hospital had tried her on. Same with the anti-depressant a hospital psychiatrist put her on after talking with her only once. Slowly weaned her off with her doctr's knowledge. Thyroid she took till her last week alive. I still take my antidepressant, but it gets increased in the winters.
His Dr d/c'd his low dose BP pills first, then his Cholesterol meds, followed by his Type 2 diabetes meds and finally the Glaucoma eye drops. He continued to follow his condition closely via lab work, and there were never any significant changes that warranted him "re-prescribing" any of these meds, and we were always comfortable with the Drs decision. He did keep him on a baby aspirin and his Centrum Silver multi vitamin and that was it for the remaining years until his death from Lung Cancer at age 88.
Talk with your doctor about the possibility of discontinuing meds that may no longer be necessary, it might surprise you. It is important that the previous conditions be monitored and that follow up labs are done, but thankfully my FIL did well, and without repercussions.