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In the 1980s, Britain began the first hospice program. I’ve heard that was a time when Britain’s socialist medical system was cutting corners to save money. It’s true hospice would save money and basically cut down on length of suffering but why not leave the dementia medication in place. The IDEA of hospice was to provide opportunities for family to spend they’re last meaningful time together. How can that happen when the patient has gone bonkers in one week’s time?
I was hospice (an oncology RN) before it had an official name in the US, and what I’m hearing IS pretty well not the intention of hospice. Do they send all ‘dying’ patients home? The family is not equipped for that!
For Physicians
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Although the precise mechanism of action of rivastigmine is unknown, it is thought to exert its therapeutic effect by enhancing cholinergic function. This is accomplished by increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by cholinesterase. The effect of rivastigmine may lessen as the disease process advances and fewer cholinergic neurons remain functionally intact. There is no evidence that rivastigmine alters the course of the underlying dementing process.
For Patients
Some patients will not benefit from treatment with Exelon Patch. Exelon Patch does not cure Alzheimer’s disease. All patients with Alzheimer’s disease get worse over time.
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Isn't it interesting that no one knows exactly how the drug works?
There is no evidence that any current dementia drug alters the course of the underlying dementing process. The dementia continues at its inexorable pace. Because certain symptoms are reduced (no one knows how) the dementia may not seem to be advancing, but behind the scenes it is. As there are fewer intact cholinergic neurons in the brain as the disease progresses, the drug has less and less to work with and loses its effectiveness. Then the progression that has been going on all long shows up.
Maybe the patch was still effective for your mother, helpingmom1, but it would eventually have stopped being effective.
Next, people on hospice are expected to get worse. Why did the doctor recommend hospice? What were the symptoms or conditions? Hospice is only recommended for persons who are thought to be near the end of their life journey. Did the doctor think the dementia put her there, or was it some other condition?
Also, people with dementia get worse. Always. And they get worse on their own schedules. For some it is gradual, for others it is abrupt. It can be a steep slope or a mild slope or not a slope at all but steps from one level to the next. What kind of dementia does your mother have, do you know?