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He has high blood pressure and we have been working with his Dr to get it stabilized. Last few weeks his memory has deteriorated to about 20 seconds. His decline is quite rapid and its mind blowing! Is it wrong to stop the blood pressure meds and just let it be? Let him go as he has requested? And what do I do about his dr when they call? Will I be reported to CPS for it? And if he has a heart attack and lives how will it affect him?

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Since the general discussion of Advance Directives has come up...
One of my clients created an app (for clinics, providers and doctors) that make it easier for their patients to consider and complete an Advance Directive (including digital notary). To write their website I had to read the research they provided to me.

What I learned is that we must understand that many doctors consider most ADs to be basically worthless. The reason being the patients fill it out with an attorney and not an actual doctor. You need to make an appt with your physician and go with the AD form in hand and have a discussion. They're happy to do this if you tell them in advance this the point of the meeting. I think there's now even a billing code for this type of appointment.

Your physician can better advise you since they know what pre-existing issues you have and therefore what interventions (or not) would give you your desired wishes. Most doctors thinks most ADs are too vague and are not updated as we advance in years and then begin to have medical problems. As we age we should plan to review these documents more often and make changes that will comport with our desired care. You should certainly have yours review by an attorney and notarized properly and then handed to your medical PoA and a copy to ALL your doctors, but you should definitely fill out the AD in the presence of your doctor so you can know without a doubt that what you think you're instructing will actually result in what you are wishing for your end of life.
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Reply to Geaton777
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Advanced directives depend on the wording. Some are actually do not resuscitate orders and others are about long term care. You need to carefully read it and his doctors need a copy as well. Then, everybody has the same understanding and follows the same protocols. His doctors will know from the wording of the document which type of legal document you are dealing with. A lawyer can also let you know which type of document you are dealing with. The best ones are drawn up by lawyers so there is no misunderstanding.

Do not resuscitate orders usually state in the event that the heart stops or breathing stops, do not perform CPR, do not place on mechanical ventilation, and/or do not place on mechanical circulation. People with these DNRs DO get medical treatment for their conditions including medication, IVs, fluids, tube feedings if required, oxygenation as long as it is not invasive, and other therapies. You can not arbitrarily decide to stop medical treatment.

Advanced directives usually state that is the person is in a vegetative state (coma) or unable to make decisions for themselves. These documents outline specifically the types of treatments allowed and not allowed. If it is not outlined in the document, you may consider that the treatment must be continued.

Power of attorney for medical allows the person named in the document, the representative of the patient, to decide on the types of care to be given to the patient. So anything is possible with this one. It is like giving people a blank check in regards to managing another's health.

I would like to mention hospice since it seems this is an idea you are thinking about. Hospice doesn't seek to cure disease but to provide comfort care to a person that has a terminal condition. A doctor will need to determine that patient is terminal, usually within 6 months, and will need to write a specific order for a hospice referral. In this case, most medications can be discontinued except for those that provide comfort and relieve pain.

I hope this helps clear up some misunderstanding.
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Reply to Taarna
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My plan would be keep any oral meds Dr prescribed - while safe to swallow them. After that, work with hospice to have meds administered as recommended.

At some point the priority changes from *active treatment* to *comfort care*. This line is not always obvious or even discussed. I would ask for honesty from his medical team - I've found some hint, use jargon, leave empty pauses or just pop in with nothing much to say.

If you want the truth (as they see it) ask for it. Hopefully it helps to make your own judgement of which side of the line you are on.

(((Hugs)))
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Reply to Beatty
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As long as drs are treating him, let it be. If doctor tells you they've done all they can do, that's when dad's wishes are played out. You won't be reported to CPS because they doctor will lead you down the path of what he can do to help and when he can no longer offer further help.
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Reply to my2cents
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Dropping his blood pressure meds? NO. You will end with someone with a stroke, kidney failure or any other of a multitude of ills that will not kill, but willl prolong his misery. Speak with MD about Palliative care. Be certain he has a recent UTI checkup and urinalysis if this is a sudden change.
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Reply to AlvaDeer
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There is a big difference in stopping medications and medical intervention.
To me medical intervention would be:
CPR (devastating if done correctly it will break sternum and pretty much all your ribs..if it works there is a long recovery from that)
Feeding Tubes
Ventilator
Medication does not to me equate to an intervention.
This is a discussion to have with you dad.
Ask him what exactly he does not want done. Here in Illinois and other states have different names is a POLST and it is detailed on what can be done, for how long if at all. this is the information you need.
No one likes talking about this but it is important to understand what he wants and what he believes "interventions" are.
Your other option now would be to contact Hospice and get their help. They will help ease confusion.
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Reply to Grandma1954
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Beatty Apr 22, 2021
Great advice.
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You have to go by his directive. My dad actually had low blood pressure so that's the reason he went off the BP meds, but his memory got very short. You can't be reported when you are following his rules, and I remember when Palliative care helped my dad make out his living will - they said, as hard as it is, this is YOUR decision only and your children will have to do what you say. He could have an infection or - as my dad had - a stroke so mild that it was not even noticeable. Might be a good time to call in palliative care to keep checking on him and get another opinion.
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Reply to LivingSouth
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Blood pressure medications is not medical intervention. In general that term refers to things that keep you alive artificially as you're dying, like CPR, ventilators, and feeding tubes. If your dad has a heart attack, you decide whether to do CPR, but you don't just ignore it if it can be treated with, say, a blood thinner. It's your choice, though, if you have that authority.

My mother is on hospice care and still taking diuretics, BP meds, and pretty much everything else she was taking when she wasn't on it. The difference is that now we won't rush her to the hospital if she starts to die, we treat what ails her where she is, and if it doesn't work, then she's clearly ready to go.
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Reply to MJ1929
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disgustedtoo Apr 23, 2021
Exactly - see my reply to JoAnn29
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If he was on B/P meds before his advanced directive, then I don't think thats what he means by "medical intervension". An Advance directive is done either because we are already suffering from a terminal illness or in anticipation of one or just old age/Dementia.

I don't even think Hospice takes away B/P meds. Your Dad could have a stroke that will kill him or incapacitate him where he will need even more care. It will also effect an already Dementia brain. Personally, I would not remove it. If he is on a Statin for Cholesterol, I may remove that. Statins do cause cognitive problems.

I would question his rapid decline and have him checked for a UTI or anything physical that might be causing this decline. It could be his potassium levels if on water pills. Could be Thyroid or diabetes. Labs will show any problems. Then levels can be adjusted. I don't see this being "medical intervention". For me "medical intervention means, no resuscitation, no feeding tube, or breathing tube that is the only thing keeping him alive. Not being used to get over the hump.
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Reply to JoAnn29
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disgustedtoo Apr 23, 2021
For me "medical intervention means, no resuscitation, no feeding tube, or breathing tube that is the only thing keeping him alive.

That's how I interpret it as well. My parents both filled out multiple pages indicating their wishes for various conditions/treatments. For some reason these were not included in the "package" with the other documentation (will, POAs, trust, etc.), but I was aware of them.

It would really refer to going to extraordinary means to keep one alive or correct a serious medical issue. No transplants, no resuscitation, ventilator, etc. Treatment for minor issues would continue, such as antibiotics for UTIs, wound care for an injury, etc.

The problem with not giving him BP meds (assuming all other checking is done, blood work to check for imbalances, urine culture for potential UTI, etc.) isn't so much a heart attack, although that in itself could be a horrible way to go, or even leave him alive but more debilitated. It is more likely going to cause a stroke, which if it doesn't kill him can leave him really disabled and miserable!

My mother was on BP meds for a long long time. We continued these after moving to MC. While it was clear she had dementia, we never did any testing to determine what "kind." It was most likely vascular, given her symptoms and progression, in addition to the high BP (tended higher than normal even on meds.) It's even possible she had some TIAs prior to showing signs of dementia - she lived alone, so no one would be there to observe her.

I didn't find out until after her stroke around Labor Day that she had been sometimes refusing the medications. Had I known this, I would have asked the pharmacist sooner about putting the contents of the capsule in ice cream or pudding. She was having trouble prior to the stroke swallowing those pills. One is time-released, so any crystals chewed wouldn't be useful, but how much chewing would there be? ANY medication would be better than none.

The stroke impacted her dominant side, swallowing and speech. She refused the EMT and I honored that. They tried PT to help strengthen her so she could still feed herself and help with pivoting (she was already in a wheelchair, mainly due to her own fear of falling.) It was only a matter of time, IMO, that she would have another by refusing the medications. Several months later, that is indeed what happened.

If at all possible, I would try to get these medications into him, even if it is via food. It won't prevent his eventual demise, but it could prevent some serious debilitation on the way.
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Has he been checked for a UTI just to discount that the rapid decline in his abilities isn't due to an infection? Have you considered hospice care for him? His doctor would be the one to discuss this with. You dad's Advance Directive must be respected. Again, further questions as to when it "kicks in" (aside from your dad not having the cognitive abilities to make any decisions) can be discussed with his doctor. I wish you peace in your heart as you move through this with him.
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Reply to Geaton777
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When my LO was diagnosed with Covid in her very good MCU, I said “no hospital unless she couldn’t be made comfortable on site, no extraordinary measures of any kind, and ABSOLUTELY NO breathing assistance EXCEPT oxygen by nasal cannula”. I have total confidence in the physician who takes care of the residence, and he upped her nutrients but nothing “extraordinary”.

I further stated that I wanted her to be kept comfortable with the lowest level of intervention(s) possible.

She’s still here, and I believe I did exactly what she’d have wanted.

If you’re fully informed about what he needs to be kept comfortable, and your decisions honor the request(s) he has left for himself, and made with your love and respect, it sounds as though his legal document is pretty specific.
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