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Old 07-01-2012, 11:41 AM   #1
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Am I dishonoring her wishes

I have legal guardianship of my former mother in law due to her being in the moderate to severe stage of ALZ...I have recently been reading her directive and she has it in there if she were diagnosed with a terminal illness she did not want life prolonging medications. She is on both Aircept 10mg and Namenda 10mg. Am I dishonoring her wishes by keeping her on these medications. Eventhough she has been on these meds for over 2 years I don't see any difference.

 
Old 07-01-2012, 11:55 AM   #2
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Re: Am I dishonoring her wishes

No of course not! Aricept and namenda can only delay the symtoms for 6 months at best and these med. are not cure!
What she is talking about is the stuff like artificial feeding, antibiotics when she is too sick, food IV, minor/major surgeries, artificial breathing machine and etc...

I thinks she is far from it. Once she has eating problem, or some major surgery issue, you will then decide for her not to proceed with aggressive treatments.

Aricept is far from being aggressive. However, the dementia drugs also have side effects. my FIL who has severe stage of AD no longer takes these drugs. He takes anti-depressant and antipsychotic drugs as well as some drugs for his heart and bladder.

There are a few guidelines in the internet about hospice or end-stage. You will find out what the conditions they are talking about. Mostly it is about no aggressive treatments.
This kind of directive is far from assisted suicide and that kind of things. Aricept only makes the caregiving better according to the doctor but my FIL was always confused. The dementia drugs made him perceptive and harder to be cared for!

Hugs,
Nina

Last edited by ninamarc; 07-01-2012 at 11:59 AM.

 
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Old 07-01-2012, 01:37 PM   #3
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Re: Am I dishonoring her wishes

It is so difficult to know what to do she is always confused also....I don't know if her meds need to be decreased or increased. The neurologist increased the aircept to 10mg over a month ago but I don't see any difference. She is also on Lorazapam, mirtazapine, and melatonion to help her sleep but that doesn't seem to working good anymore either. she wants to wandering in the dark in the middle of the night. If we take her to the store and come back she is so confused and doesn't know where the bathroom or her bedroom is..this is so sad...

 
Old 07-01-2012, 05:03 PM   #4
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Re: Am I dishonoring her wishes

His, your question is difficult but here are my thought... having been through the same with both my Mom and my Dad. I do not think the Aricept or Namenda qualify for extraordinary measures. I also don't think they do much good. The best they can do is slow the progression in a small percentage of patients and this only last for a short time. They are probably going no good... and if there are no significant side effects they are doing no harm. At the point your MIL is at I did stop those meds for Mom. Even if they were working ever so slightly, I knew she would not want the disease slowed when she was so very confused and unable to function.

The mirtazapine (remeron) is an antidepressant. It is possible that it is becoming less effective over time. This is common. A med that works may only work for a while. But this is one that is typically used for depression which does accompany dementia.

I am not sure what the dosage of Melatonin she uses but I have found it effective in helping Mom sleep. Given the same time every night, Mom is then put to bed within 15 minutes. If she gets up she is put back to bed. This is repeated a few times until she stays. Melatonin is not a sedative but a naturally occurring chemical that we all have which helps us sleep. As we get older the levels of Melatonin decrease. They decrease even more in dementia patients. Depending on what dosage she is on you might want to increase it to see if that helps. Beyond that most dementia patients go through a period of night wandering. They tend to get their days and nights mixed up or just wander at all hours. Know it is a phase that will pass. In the mean time leave a light on in the bathroom so she can find her way there. Sometimes they are searching for the bathroom and can't find it in the dark. Make sure there are not a lot of lights on or a TV on. Many times the lights make them think it is daytime or the TV (they have a hard time determining that TV is not real) is off. Avoid caffeine!! This includes chocolate, soft drinks, coffee, tea.. and other sources of caffeine. A sugar cooking and a glass of milk at bedtime may ward off the hunger that can wake them up. Also make sure their bedrooms are not too cool. This can also cause them to get up during the night. If all else fails just keep taking them back to bed and eventually they will go back to sleep.

Be careful of the Lorazapam (Ativan)!!!! I have known it for years but in recent studies, Ativan can have the opposite effect than intended on the elderly. It is an anti anxiety medication that can actually cause increased anxiety in elderly dementia patients. If she is getting Ativan at night and then wandering all night.... that may be the reason. I refused to give my parents this medication for this reason. I saw the opposite effect on them both. Just be aware of this phenomenon.... There are other medications that will calm that are better

Obviously the only medications your MIL is on (other than the Aricept and Namenda) are for her behavior. Having been on the dementia medications for over 2 years they have already done what they will do. You may want to discuss taking her off these meds. I would pay attention to the Ativan and when it was given related to her wandering. If she is given the Ativan and then the wandering starts, I would ask that the Ativan be discontinued to see if it is the cause of the wandering. Trazadone is a good alternative to Ativan that works better with the elderly. It also has a slight sedative effect so she may sleep better.

It is good of you to be responsible for your former mother in law and it is obvious that you want to do the right thing. Just know there are no cut and dry right and wrong in this disease... only shades of gray. I do hope you stay and keep posting

Love, deb

 
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Old 07-03-2012, 07:52 AM   #5
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Re: Am I dishonoring her wishes

Her directive is not specific. So I would go with the hospice guideline - no antibiotics but give her morphine and antidepressant to calm her down or stop the pain.

Like what Deb pointed out, the medications are tricky and some are good for her, some are not. My FIL wants antibiotics. Sometimes drugs can soothe the patient so it is not black and white.

You are nice to your former MIL. hope she is doing OK.

Hugs,
Nina

Last edited by ninamarc; 07-03-2012 at 07:53 AM.

 
Old 07-03-2012, 04:38 PM   #6
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Re: Am I dishonoring her wishes

sorry you have to go through this. but at this point i dont see any reason to take her off these meds. you will know when the the time comes. i wish you a lot of patience and prayer.

 
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