I am working with long-term care patients, and some hospice patients. One of my hospice patients is very confused, very tired, and is on hospice for failure to thrive and dementia.
Recently, as part of a standard assessment, she tested positive in a depression screen. I know before she was on hospice she had some anxiety issues, and her son said she has a history of mental health problems. In response to this screen, the physician started her on an SSRI. I brought it up to the DON. She frequently won't take pills and spits it out if it's crushed in applesauce or pudding, etc. She has a really erratic sleep schedule, and we usually just let her sleep if she wants to. Now she's only on a few medications, like the sublingual morphine and ativan. My DON was in agreement with the doctor, and said that if I have an order for an antidepressant, I have to give it.
I guess I'm concerned first about the practicality of giving a medication to her that should be given fairly consistently. But I also just don't know why an antidepressant in her condition. I'm certainly okay with medications for most patients, but I guess I don't see depression as the problem with her. I could see in someone who is alert and oriented and is depressed, possibly about their condition. With her, I mostly just want her to be comfortable and see if I can get her to eat and drink as much as I can. But then maybe she is depressed and it's causing other problems with her, like the sleeping.
In your experience, how are antidepressants handled in hospice dementia patients? Thanks for your input!