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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.


Hospice goals of care focus on optimizing comfort and quality of life, rather than treatment and prevention. Anticoagulation therapy and monitoring are not aligned with comfort and quality of life, and can cause harm from bleeding. Anticoagulation does not provide comfort or control symptoms. For these reasons, anticoagulation is frequently discontinued.



Insomnia is defined as difficulty falling asleep, difficulty staying asleep, and/or having non-restorative sleep, and it is most often secondary to another cause or condition. Common causes of insomnia that can be especially common in the hospice population include the following: situational (e.g. interpersonal conflict/family dynamic issues); medical (e.g. cardiac, respiratory, pain, diabetes, GERD, epilepsy, Parkinson’s disease); psychiatric (e.g. depression, anxiety); and pharmacologic (e.g. beta-blockers, diuretics, steroids, SSRI antidepressants).  Whenever possible and as appropriate, it is recommended to treat and resolve the cause(s) of insomnia first, before adding a medication to treat the symptom of insomnia.

Diabetes is more common in older adults due to age-related physiological changes, such as increased abdominal fat, sarcopenia, and chronic low-grade inflammation that can lead to increased insulin resistance in peripheral tissues.  In the elderly, the diabetes guidelines recommend less aggressive glycemic control.  This is due to the fact that hyperglycemia generally does not cause any acute issues.  Hyperglycemia is harmful over time for the kidneys, heart, arteries, nerves, and eyes.  As patients get older and life expectancy decreases, those long-term risks are not as significant or applicable.


Ketamine shows promise as an effective option for hospice patients who have pain that does not fully respond to increasing doses of opioids. However, in all instances, this treatment option should be discussed and approved by the patient’s medical provider.  It may be especially useful for neuropathic pain that does not respond fully to usual pain regimens that may include, opioids, NSAIDS, certain antidepressants, anticonvulsants, and gabapentinoids.  Ketamine appears to be synergistic with opioids in patients who no longer have an analgesic response to high doses of opioids.   It is also reported to be opioid-sparing and appears to play a role in opioid potentiation.  Keep in mind the use of ketamine for pain is off-label and it can be very complex to dose, so coordination with the patient’s medical provide is critical.


ANCC Accreditation

ProCare HospiceCare is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.