Expert: Paula Damgaard - 8/17/2010

Question
My mother-in-law is in late stage alzheimers. She recognizes her son any myself only some of the times.  She speaks a few cognzant phrases.  Her skin bruises and tears easily. Her doctor has her on Namenda and Exelon as well as other heart, blood pressure medications and some vitamins.   I was wondering at what point should we discontinue medication specifically the Namenda and Exelon.  She is currently in an assisted living facility that does an excellent job.  It is so difficult to see her slowly dying


Thanks,
Ann

Answer
HI Ann,
That is a hard question. While the Exelon and Namenda may not seem to be doing anything they may indeed be allowing her to continue in the Asst'd living cause it may be what is allowing her to maintain the functions that she has.

My question would be why are you keeping her on all the other drugs?  To keep her healthy?  So she can die longer?  Unfortunately the medical field is very in tune to keeping people alive longer.  We have stopped looking at the quality of life and are going full steam ahead for quantity and if you ask me that is the wrond direction!

You have options.  You can tell her doctor that you really are only interested in comfort care and that you would like her medications to be cut down.  Many times people are put on high blood pressure medicines earlier in life and now that they have no stressers they really don't need them, but no one ever checks.  Besides, my opinion again, wouldn't it be better if she had a stroke and died rather than more quantity?  

The other option you have is to ask him to call in Hospice. They will help you with this transition.  For patients with dementia, you don't have to have the "6 months of life left" rule to qualify.  This is a progressive disease and Hospice knows that they will continue to decline.  

Going back to the Exelon and Namenda, you can ask the doctor to hold them for one week (I wouldn't do both at the same time) and watch for the changes if there are none then stay off it, if there are put her back on.  I would start with the Namenda first.

Hope this helps.  I know this is hard.  But like you said watching it is so much harder.  Providing her with an easier way out is so much more loving.  Pneumonia used to be the "old people's" friend until we developed all these high powered antibiotics which cure them and make them live longer, no account for the fact that it also means their brains will continue to decline.  

Please let me know if I can help you with anything else.  I know I threw a lot at you.  Read it over a couple of times and please feel free to write again.  Take care of yourself first!  Paula