Q: A: Discontinuing Medications for a Resident with Advanced Alzheimer's Disease

There are no “typical” families of residents with advanced Alzheimer’s disease or dementia. Many family members will tell you that “Mom isn’t like other people with Alzheimer’s disease.” Concerned families are also quick to add “and she is our only mother.” Although discontinuation of medication is a routine part of medical care in long-term care (LTC) residents, it may not be perceived as routine, and may represent a highly emotional and sentinel symbolic transition for many families. These family decisions can be further complicated because family members rarely speak with one voice. Given this caveat regarding not generalizing, one can consider a specific clinical scenario presented here. Mrs. A is an 84-year-old widow living in a LTC facility, with a history of a progressive 7-year downhill course with Alzheimer’s disease. During the monthly rounds, the physician documents that her ability to communicate is severely impaired, and she is immobile, bed-bound, and requires total assistance with all activities of daily living. She has been losing weight during the previous 60 days, and often refuses to open her mouth for most foods, fluids, or medications. Mrs. A’s past medical history is significant for chronic hypertension, osteoporosis (without previous fractures), and an elevated serum cholesterol without previous significant cardiovascular complications. Although she has a Do-Not-Resuscitate order on her medical record, her son, a well known attorney living in another state, consistently insists that “everything be done” for her. She has two daughters who live locally and visit her often. One of these daughters is a nurse, who seems extremely vigilant about any perceived lapses in care. Q&A With the Expert on: Communicating with Families