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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
Not everyone ages at the same rate - this is an individual thing best discussed with a dr who is familiar with the person involved - ask questions to show you care and are involved but that dr knows how the person has reacted in the past presuming the dr has had the person for some time
My mother is 93 yrs old. She is on hospice for chf. Hospice took her off her blood thinner meds and her statin meds, but kept her on the water pills (lasix) and her heart rhythm meds (metoprolol). She is doing much better now and more stable on a daily basis. While I was apprehensive at first, I agree with these decisions now that I see how she improved.
CNN reported that, in 2015, nearly half of physicians received some pharmaceutical payment. Anyone being prescribed a medication ought to know if it's truly necessary - one size treatment does not fit all - and if XYZ "illness" can be controlled some other way. Meds are a double-edged sword. They have side effects. They treat one thing and often cause another.
Yes. Often doctors receive 6% of the cost of the newer drugs from the pharmaceutical companies. It was thought that some years ago this practice was stopped by lawmakers. It was not.
Are you asking for an elderly parent or one that is terminally ill? My mother is 79 and has dementia and I made the decision to stop her mammograms. Why? Because if she did have breast cancer, I would not put her through chemo, radiation and or surgery. She is on cholesterol medication and I have not had a conversation with her doctor about stopping the statins yet, but plan to. I think he will fight me on it but... If she is in pain or uncomfortable, of course we act on it, but I no longer see the point of doing things that prolong her life. She would not want to live like this if she were in her right mind and I respect her wishes. To be clear, anything she needs to be comfortable we are doing. On the other hand I have a 98 yr old mother in law who is in great health, still lives alone, plays bridge, drives, etc.... she still has quality of life and I wouldn't dream of suggesting she stop any of her "maintenance drugs" or routine.
To answer your questions, I think it depends on the person, their quality of life and their wishes. No set rules here.
I have made the "mammogram" decision on my own at age 70. I am now 77. That knowing I have a history of aggressive breast cancer 31 years ago (found under my armpit by ME; negative mammograms). At that time I took 6 months adjuvent chemo with mastectomy; I refused radiation. At this point in my life, were I to have a recurrance of cancer, I would not treat it other than palliatively. Being a nurse I know there are many worse ways to go, and would ask for the "good drugs". I have zero fear of death; I do fear torture, and medical treatments can at some rare times amount to just that. I think these are all individual decisions we can make for ourselves while we are able, should discuss with families so that they can make them for us when we are no longer able. I so agree with you. There are no set rules here.
If I were you I would research each med that my loved one is taking and their age. I did that with my Mother's meds when she got into her 80's. Many elderly get weaker and don't eat as well as they used to. I figured unnecessary meds would do more harm than good. Sure enough, I decided to take my Mom off a couple and even talked to the PA about it and they agreed. Many people are afraid to question their doctors' advice. I never have been, plus I always try and research for information on my own to gain a better understanding. I can tell you I have saved myself from a couple of unnecessary surgeries had I not questioned the doctors. Many doctors are too quick to prescribe meds.
Yup, easy solution (however the laziness of many people probably contributed to this - too many take the "easy" way out rather than trying some alternatives such as life-style/dietary changes for type II diabetes, BP or cholesterol, OR just don't question the doc, s/he knows best!)
One doc immediately said cholesterol drugs rather than try to eliminate the issue with diet/exercise. When I finished my research on this issue (I did not eat the "typical" foods!) I brought a form for the gym, needing his signature. He STILL maintained that I wouldn't change my numbers with diet change. MANY years later, I still don't take those meds and my cholesterol is fine.
Another tried Fosamax for osteoporosis. After looking it up and reading much about it, no way!
I don't even do the flu shots or pneumonia shots - have never, ever had the flu and haven't had any kind of illness/cold in decades!
Please ask a doctor. That is his sight. If he has the money independent of your money, then I say yes. If it is a burden on you than again, I would ask a doctor how does this help his quality of life. As far as blood pressure medication and the like, those are life sustaining drugs. Would you not feed him? It's a tough situation to be in. I am glad you brought it up as I think it is a critical point. Wish you the best.
Depends. How long have you been taking all these meds? Is there one primary-care physician who knows everything you're taking, including vitamins and supplements?
Often as we get older, our metabolism changes. The dose that was needed and effective at 40 may be excessive at 60. The dose that worked at 60 may be too much at 75, etc.
Also, drug interaction can change. Two drugs that were fine together when we were active and eating three full, well-balanced meals every day may interact differently if we become more sedentary, eat only yogurt for breakfast (me), and find that we're only eating meat a couple of times a month.
It's not a number, but it's probably best to seriously re-evaluate your meds at milestone ages. Certainly re-evaluate every 10 years, maybe even every 5.
Also, watch for condition changes. Anyone who is having cognitive issues should have a serious meds review with their physician. Often the right thing to do is taper everything and watch closely for symptoms, then add back only the drugs that are actually needed now, by THIS body at THIS age in THIS condition (rather than the body you had at the time they were prescribed). Sometimes a person who exhibits early-dementia signs will have a significant cognitive improvement once the drug burden is reduced.
I work in Hospice, and when someone comes onto Hospice the first thing we do is reduce drug burden, discontinuing everything that is not directly reducing symptoms, because the whole point, now, is quality of life in the moment, not the longterm future.
Funny things happen. Someone who was diabetic in his 50s turns out not to need his (non-insulin) meds in his 70s, tapering off them without changing his blood sugar. Go figure.
Since all of those meds have side effects, quality of life can actually improve when the meds are discontinued. Maybe the patient hadn't needed those meds since he started doing most of his own cooking rather than eating in restaurants? Maybe his metabolism had started to wind down? Who knows.
Sometimes meds have been added to take care of side effects from something else. Maybe one medicine for a medical condition causes insomnia, so the patient gets something to help with sleep. Maybe another med causes stomach upset, so an antacid is prescribed. Maybe something causes nausea, so an anti-nausea drug is prescribed. (Maybe it's better to re-evaluate the original condition and change the original med? Just a thought).
Remarkably many of our patients arrive to us taking 20 or 30 drugs for various conditions (!). I am amazed that they can even swallow that many, and incidentally nobody has done double-blind studies on all those interactions together. Most of the time patients experience some improvement when most of those are discontinued, leaving only the ones that have significant impact on their condition NOW.
Bottom line: if you think you'd like to stop taking something, ask your doctor to help you taper it safely, and watch closely to see what happens.
"It's not a number, but it's probably best to seriously re-evaluate your meds at milestone ages. Certainly re-evaluate every 10 years, maybe even every 5."
I don't take any meds, thankfully, but if I did, I would want them checked EVERY year. Simple blood/urine tests along with BP check can identify how things appear to be going. Monitoring every year can catch changes sooner. If BP is lowered over time, perhaps BP meds can be reduced or eliminated. If cholesterol is now okay, perhaps try eliminating a retesting... Certainly this should be done in concert with the doctor, but waiting 5-10 years to re-evaluate? Even vets recommend yearly checkups (with those over 10-12 to include blood/urine tests, again to catch changes!)
Another note - your best source for medication information is usually the pharmacist (like ANY profession, not all are created equal, but they DO know more than MOST doctors about medications.)
As you can tell by the varied posts, there is no exact science to the meds issue. Consider all the advice but the most important input comes from yourself.
From what I have read (and experienced) from many pharmaceuticals, I decided to stop all of them. Mostly, I tapered them slowly. After I had been drug-free for a while my quality of life increased. I was able to go back to work. I can't believe I was ever on all those drugs. I can't believe I was talked into taking them. They were disabling to me.
I would think maintenance drugs would continue as long as vital signs and blood labs indicate they are doing what they are prescribed to do. Labs or sugar levels may signal a need to change dosages, but if you have faith in the prescribing doctor, I'm not sure why you would want to quit maintenance drugs. If the patient is in the final days or few weeks before death maintenance may no longer be appropriate.
My mom is 95 and still takes them. I have been pondering the same question myself. She complains about taking so many meds but the docs (several) all insist that she needs them. It is a very frustrating dilemma.
I agree with so many of the answers posted. It isn't an age... it is what a person's condition dictates. Most of us are told by our doctors that we will always have to take our medications for high blood pressure, diabetes, cholesterol, etc. Yet, my experience, as a nurse, working with the elderly, has shown differently. When folks retire, there may be a great reduction in stress (natural lowering of the blood pressure). Some folks will start exercising or eating better which may lead to weight loss or generally improved health. It just depends. In the 1980's, I believe, there was a study done in one of the Scandinavian countries showing that (in general) you can preserve the heart... or the brain. This is a generalization. But when blood pressure was controlled to help the heart last longer, there was an increase in dementia. Vice versa. When the blood pressure wasn't controlled so well, there was less dementia but more heart problems. This isn't an exact relationship...more a trend. If anyone is interested in exploring gerontology, you will find that the parameters used for us when we are younger, are less strict when we age. Blood pressure running a little higher, can improve perfusion of the brain. Not a bad thing. Tightly controlled blood sugar is less likely to be safe - allowing the sugar to run a little higher actually mirrors what our bodies do naturally as we age. Why take a chance on your sugar going too low and causing much worse consequences. These are not rules... these are items to be considered.
I think reviewing your current health (having a physical) and all of your medications is a great thing to do annually. Keeping records of what your numbers are at home (blood sugar or pressure), also helps your doctor, or other practitioner, see how to help you weed out what is not necessary.
Nan, but wouldn’t hbp drugs prevent stroke? I’m confused. My mother got dementia but was taking hbp drugs & she still got mini strokes which caused dementia.
How about the ads for all the over the counter stuff. One of my favs is Larry the cable guy selling a tummy med while knawing on some barbecue. Or the antacid ads where people are beating up on pizza and corn dogs. The theme being, go ahead, eat all this crap, we got ya covered.
Then there’s the big pharma ads. I can’t even keep,up with all the insulin meds but I have noticed the actors in the ads are starting to look like real people, a bit pear shaped and tubby. But in the ads they take whatever it is and are always doing all these very active things in beautiful settings. Many are talented musicians it seems.
After a particularly stressful trip about 3 years ago to deal with my parents many issues and crises, I noticed that my heart beat was kinda funny. Went through the local industrial medical cardio maze and it’s A Fib. So been on a small dose of whatever it is since. The symptoms have long since subsided but my doc tells me I should stay on the meds. Oh well, what the hell do I know.....
ill keep taking the stuff but I suspect it’s unnecessary. Maybe if I got of the beer and ice cream in the summer ? Nahhhh. That’s just crazy.
"The theme being, go ahead, eat all this crap, we got ya covered." THAT got a laugh out of me!!!
Yes, advertisements... WE will solve all your problems with the MAGIC pill!!! The radio/internet ads (thankfully there are dials and Skip Ads buttons!) rattle off so many side-effects/warnings, it comes out as gabble. Magazine ads, boast THIS, then follow it up with 2-3 pages of warning and side-effects!!! Yup, I WANT that.... Not.
"...always doing all these very active things in beautiful settings." I would do those things for a nice pay check, BUT I would have to BELIEVE in it first. If just getting paid to look active and cute, promoting some garbage I wouldn't even share a seat with? NOPE.
When you want those illnesses to kill you? I'm 54 and I'm on those medications, except that my diabetes is Type 1. I take a few others too. It sounds like you're asking when it's appropriate to commit slow suicide. The diabetes could be a little quicker, but you might lose a foot or two. I don't know what to tell you.
In one of my replies I mentioned this. Type I you really don't have a choice, you have to take insulin to live! Age isn't the determining factor in whether or not to continue taking ANY medications, quality of life is.
IF I were my mother, now 96 on BP meds with dementia and become bed-ridden, unable to talk, care for myself, hear, see, then sure, bring in hospice and take away the medications. They are not contributing to any kind a quality life. For now, she gets around, can still read, eat, use the bathroom, etc... so the BP meds continue. If we stopped those just because she reached a magical age, she'd likely have a serious cardiac event and suffer!
Type II, if it is Dxed early enough and one is dedicated to avoiding meds, life-style and dietary changes can lead to getting rid of it. Same with BP - unless it is high from birth and will always require meds, nipping it early with diet and exercise can reduce or eliminate the need for these meds!
Unfortunately sometimes taking one med leads to another, again , unavoidable in your situation. There was a woman where I worked who I believe was younger than me (probably in her 50s?) and she was on 7 different medications!! None of my business, so I didn't ask...
So, no, age is NOT a way to determine when to stop medications.
As I don't think one should be on these typical age poppers until the situations can no longer be managed by alternative means, (most can be avoided for many years with some dietary and lifestyle changes, and I would rather not start taking them.) I don't think there is an age you can quit taking them. However frequent monitoring of need and dosage is vital and may lead to being able to cut right down and in particular with BP meds stop.
"(most can be avoided for many years with some dietary and lifestyle changes, and I would rather not start taking them.)"
I'm hiding from them whenever I can!!! So far I have been able to avoid them... I don't even get flu shots or pneumonia shots. I have *never* had the flu in my entire life, and haven't even been sick with a cold in decades! Kids would bring home ailments but I wouldn't get them!
It really depends on their quality of life and how that benefits others.
I believe that aging confers an evolutionary benefit on the species, not individuals. Biogenic obsolescence (aging) is the way evolution makes room for new models by clearing out the old to create change. Evolution.
The only way a species becomes upgraded is by eliminating individuals.. we are such a selfish species that we blame survival instinct for not bowing out with some dignity and grace. We’re no longer capable of sex and reproduction so why do we get excited about things like the possibility of powerful new weapons against cancer, aging, cognitive impairment and so on?
sooooo my answer to your question is if you need to take pharmaceuticals for mostly preventable lifestyle diseases to ensure you stay alive please do yourself the dignity of passing away graciously IF you’re no longer contributing positive benefits to your next generation.
*many (when I was young) loved the idea of going to heaven to be with their loved ones again... what happened to that?
You aren't really saying that once we aren't capable of reproducing anymore we are no longer (or can no longer be) productive contributors to society and our families are you?
There is not a number since everyone ages differently.
I think it has to do with how a person is doing. If the person is not doing well and has a horrible quality of life with no possibility of improvement, then I think that it's time to consider discontinuing all meds not necessary for comfort care.
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.
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.
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.
If she is in pain or uncomfortable, of course we act on it, but I no longer see the point of doing things that prolong her life. She would not want to live like this if she were in her right mind and I respect her wishes. To be clear, anything she needs to be comfortable we are doing.
On the other hand I have a 98 yr old mother in law who is in great health, still lives alone, plays bridge, drives, etc.... she still has quality of life and I wouldn't dream of suggesting she stop any of her "maintenance drugs" or routine.
To answer your questions, I think it depends on the person, their quality of life and their wishes. No set rules here.
I did that with my Mother's meds when she got into her 80's. Many elderly get weaker and don't eat as well as they used to. I figured unnecessary meds would
do more harm than good. Sure enough, I decided to take my Mom off a couple and even talked to the PA about it and they agreed. Many people are afraid to question
their doctors' advice. I never have been, plus I always try and research for information on my own to gain a better understanding. I can tell you I have saved
myself from a couple of unnecessary surgeries had I not questioned the doctors.
Many doctors are too quick to prescribe meds.
Yup, easy solution (however the laziness of many people probably contributed to this - too many take the "easy" way out rather than trying some alternatives such as life-style/dietary changes for type II diabetes, BP or cholesterol, OR just don't question the doc, s/he knows best!)
One doc immediately said cholesterol drugs rather than try to eliminate the issue with diet/exercise. When I finished my research on this issue (I did not eat the "typical" foods!) I brought a form for the gym, needing his signature. He STILL maintained that I wouldn't change my numbers with diet change. MANY years later, I still don't take those meds and my cholesterol is fine.
Another tried Fosamax for osteoporosis. After looking it up and reading much about it, no way!
I don't even do the flu shots or pneumonia shots - have never, ever had the flu and haven't had any kind of illness/cold in decades!
money independent of your money, then I say yes. If it is a burden on you than again, I would ask a doctor how does this help his quality of life. As far as blood pressure medication and the like, those are life sustaining drugs. Would you not feed him? It's a tough situation to be in. I am glad you brought it up as I think it is a critical point. Wish you the best.
Often as we get older, our metabolism changes. The dose that was needed and effective at 40 may be excessive at 60. The dose that worked at 60 may be too much at 75, etc.
Also, drug interaction can change. Two drugs that were fine together when we were active and eating three full, well-balanced meals every day may interact differently if we become more sedentary, eat only yogurt for breakfast (me), and find that we're only eating meat a couple of times a month.
It's not a number, but it's probably best to seriously re-evaluate your meds at milestone ages. Certainly re-evaluate every 10 years, maybe even every 5.
Also, watch for condition changes. Anyone who is having cognitive issues should have a serious meds review with their physician. Often the right thing to do is taper everything and watch closely for symptoms, then add back only the drugs that are actually needed now, by THIS body at THIS age in THIS condition (rather than the body you had at the time they were prescribed). Sometimes a person who exhibits early-dementia signs will have a significant cognitive improvement once the drug burden is reduced.
I work in Hospice, and when someone comes onto Hospice the first thing we do is reduce drug burden, discontinuing everything that is not directly reducing symptoms, because the whole point, now, is quality of life in the moment, not the longterm future.
Funny things happen. Someone who was diabetic in his 50s turns out not to need his (non-insulin) meds in his 70s, tapering off them without changing his blood sugar. Go figure.
Since all of those meds have side effects, quality of life can actually improve when the meds are discontinued. Maybe the patient hadn't needed those meds since he started doing most of his own cooking rather than eating in restaurants? Maybe his metabolism had started to wind down? Who knows.
Sometimes meds have been added to take care of side effects from something else. Maybe one medicine for a medical condition causes insomnia, so the patient gets something to help with sleep. Maybe another med causes stomach upset, so an antacid is prescribed. Maybe something causes nausea, so an anti-nausea drug is prescribed. (Maybe it's better to re-evaluate the original condition and change the original med? Just a thought).
Remarkably many of our patients arrive to us taking 20 or 30 drugs for various conditions (!). I am amazed that they can even swallow that many, and incidentally nobody has done double-blind studies on all those interactions together. Most of the time patients experience some improvement when most of those are discontinued, leaving only the ones that have significant impact on their condition NOW.
Bottom line: if you think you'd like to stop taking something, ask your doctor to help you taper it safely, and watch closely to see what happens.
I don't take any meds, thankfully, but if I did, I would want them checked EVERY year. Simple blood/urine tests along with BP check can identify how things appear to be going. Monitoring every year can catch changes sooner. If BP is lowered over time, perhaps BP meds can be reduced or eliminated. If cholesterol is now okay, perhaps try eliminating a retesting... Certainly this should be done in concert with the doctor, but waiting 5-10 years to re-evaluate? Even vets recommend yearly checkups (with those over 10-12 to include blood/urine tests, again to catch changes!)
Another note - your best source for medication information is usually the pharmacist (like ANY profession, not all are created equal, but they DO know more than MOST doctors about medications.)
Yet, my experience, as a nurse, working with the elderly, has shown differently. When folks retire, there may be a great reduction in stress (natural lowering of the blood pressure). Some folks will start exercising or eating better which may lead to weight loss or generally improved health. It just depends.
In the 1980's, I believe, there was a study done in one of the Scandinavian countries showing that (in general) you can preserve the heart... or the brain. This is a generalization. But when blood pressure was controlled to help the heart last longer, there was an increase in dementia. Vice versa. When the blood pressure wasn't controlled so well, there was less dementia but more heart problems. This isn't an exact relationship...more a trend. If anyone is interested in exploring gerontology, you will find that the parameters used for us when we are younger, are less strict when we age. Blood pressure running a little higher, can improve perfusion of the brain. Not a bad thing.
Tightly controlled blood sugar is less likely to be safe - allowing the sugar to run a little higher actually mirrors what our bodies do naturally as we age. Why take a chance on your sugar going too low and causing much worse consequences.
These are not rules... these are items to be considered.
I think reviewing your current health (having a physical) and all of your medications is a great thing to do annually. Keeping records of what your numbers are at home (blood sugar or pressure), also helps your doctor, or other practitioner, see how to help you weed out what is not necessary.
How about the ads for all the over the counter stuff. One of my favs is Larry the cable guy selling a tummy med while knawing on some barbecue. Or the antacid ads where people are beating up on pizza and corn dogs. The theme being, go ahead, eat all this crap, we got ya covered.
Then there’s the big pharma ads. I can’t even keep,up with all the insulin meds but I have noticed the actors in the ads are starting to look like real people, a bit pear shaped and tubby. But in the ads they take whatever it is and are always doing all these very active things in beautiful settings. Many are talented musicians it seems.
After a particularly stressful trip about 3 years ago to deal with my parents many issues and crises, I noticed that my heart beat was kinda funny. Went through the local industrial medical cardio maze and it’s A Fib. So been on a small dose of whatever it is since. The symptoms have long since subsided but my doc tells me I should stay on the meds. Oh well, what the hell do I know.....
ill keep taking the stuff but I suspect it’s unnecessary. Maybe if I got of the beer and ice cream in the summer ? Nahhhh. That’s just crazy.
Yes, advertisements... WE will solve all your problems with the MAGIC pill!!! The radio/internet ads (thankfully there are dials and Skip Ads buttons!) rattle off so many side-effects/warnings, it comes out as gabble. Magazine ads, boast THIS, then follow it up with 2-3 pages of warning and side-effects!!! Yup, I WANT that.... Not.
"...always doing all these very active things in beautiful settings." I would do those things for a nice pay check, BUT I would have to BELIEVE in it first. If just getting paid to look active and cute, promoting some garbage I wouldn't even share a seat with? NOPE.
IF I were my mother, now 96 on BP meds with dementia and become bed-ridden, unable to talk, care for myself, hear, see, then sure, bring in hospice and take away the medications. They are not contributing to any kind a quality life. For now, she gets around, can still read, eat, use the bathroom, etc... so the BP meds continue. If we stopped those just because she reached a magical age, she'd likely have a serious cardiac event and suffer!
Type II, if it is Dxed early enough and one is dedicated to avoiding meds, life-style and dietary changes can lead to getting rid of it. Same with BP - unless it is high from birth and will always require meds, nipping it early with diet and exercise can reduce or eliminate the need for these meds!
Unfortunately sometimes taking one med leads to another, again , unavoidable in your situation. There was a woman where I worked who I believe was younger than me (probably in her 50s?) and she was on 7 different medications!! None of my business, so I didn't ask...
So, no, age is NOT a way to determine when to stop medications.
I'm hiding from them whenever I can!!! So far I have been able to avoid them... I don't even get flu shots or pneumonia shots. I have *never* had the flu in my entire life, and haven't even been sick with a cold in decades! Kids would bring home ailments but I wouldn't get them!
I believe that aging confers an evolutionary benefit on the species, not individuals. Biogenic obsolescence (aging) is the way evolution makes room for new models by clearing out the old to create change. Evolution.
The only way a species becomes upgraded is by eliminating individuals.. we are such a selfish species that we blame survival instinct for not bowing out with some dignity and grace. We’re no longer capable of sex and reproduction so why do we get excited about things like the possibility of powerful new weapons against cancer, aging, cognitive impairment and so on?
sooooo my answer to your question is if you need to take pharmaceuticals for mostly preventable lifestyle diseases to ensure you stay alive please do yourself the dignity of passing away graciously IF you’re no longer contributing positive benefits to your next generation.
*many (when I was young) loved the idea of going to heaven to be with their loved ones again... what happened to that?
I think it has to do with how a person is doing. If the person is not doing well and has a horrible quality of life with no possibility of improvement, then I think that it's time to consider discontinuing all meds not necessary for comfort care.