It snuck up on us - virtually no symptoms until 2AM Monday morning, shaking, fever, high blood pressure. Today, he had a swallow study. They recommended a peg tube for feeding and informed us that he was aspirating when he ate. We hate to remove the feature of food in his life. He is 90, weak, and mentally unable to understand the change in body that feeding would bring. Any suggestions, warnings, words of wisdom are much needed and appreciated. We want Dad home with Mom, more time please!
Thank you for your ongoing kindness. It is so appreciated - I physically relax and breathe and smile a bit whenever I read your words to me as well as your posts to others. Kindness is the supreme medicine.
Thanks for the words of advice. We are currently working with the palliative team and social worker at this hospital to build a comprehensive plan for future decisions and events. However, Dad had NO symptoms this time, so they bit about chest X-ray by primary would not have applied. It may very well apply next time, so that you for bringing that up.
So many elderly folk pass with no guidelines, ie Advanced Directives for one. Your father may be ready to discuss AD for himself after this close call.
My mom never wanted to talk about her “end” so when she passed I was grateful that I had a sibling who thought the same as me. My other sibling was a jerk.
Make those decisions now while everyone can discuss and agree on the guidelines should your dad get terminally ill.
Also, remember that aspiration pneumonia often returns, as the person continues to aspirate small amounts daily. Undetected, the fluid just builds up and an exacerbation occurs.
Sit him way up (90 degrees) when he eats/drinks, thicken his fluids to nectar consistency & feed him in small amounts. Look for education handouts for Patients & Families suffferkbg with aspiration pneumonia episodes. Ask his ICU doc for care guidelines.
Discuss treatment of recurrent aspiration pneumonia with your father’s PCP to develop an action plan with your family/dad’s caregivers so that next time your father develops symptoms (SOB, coughing, fever), the PCP can give the patient/family a standing order for a chest X-ray for definitive diagnosis & then treat at home if necessary. He can avoid a hospitalization and hospitals are not necessarily the safest place to be. Does your dad use inhalers or nebulizers?
But again, aspiration pneumonia most likely progresses to frequent bouts of respiratory infections. Being vigilant & proactive helps everyone in a crisis & prolong a life.
Thank you. I think Veronica91 meant well, no pun intended,
This is hard, hard stuff, and my heart goes out to you and your family. I hope that dad pulls though and gets to have some more good times.
Let us know how you're doing. We care. Don't You forget to eat!
I was commenting on your last few words. about "many times patients are taken home when death becomes imminent" My mom did not have that choice to pass at home or hospital. They subtly suggested she would not make it home, even though it was not a long ride. She passed in hospital ICU. She had no more PEG feeding, yet the GI doc still "visited" up to the day she passed and billed insurance for those "visits".
Not necessarily. Some hospitals will subtly suggest that the loved one receive final care in the ICU. They don't want to be liable if the loved one passes before going home.
From what you have written he sounds as though he is comming to the end of his life as CM suggested.
I am assuming they are treating the pneumonia with IV antibionics, has there been any improvement? if not i would wait on placing a PEG tube because at the end of life artificial feeding will simply put a greater strain on the body. Someone can live without food for far longer than they can without water. Fliuds are being supplied with the IV so there is no concern about dehydration. His condition will not be made worse by holding off on the PEG for a few days.
If you really want him to go home this could be arranged with hospice care. Hospice would not recommend an IV at home although caregivers can be trained and IV antibiotics continued.
A dying loved one with a pre existing PEG tube will continue to be fed BUT they will slowly become unable to process the feed and it will be stopped at that point.
If you decide to take dad home it will not be something that Mom can manage alone. Other family members will have to be there the whole time. can the family arrange that or afford outside caregivers? This is a huge undertaking and not to be undertaken lightly but you can take a few days to work things out. In that time it will be clearer if Dad is showing signs of recovery. he does not have to stay in the hospital to die if the family has a strong desire to have him die at home. many times patients are taken home when death becomes imminent.
Who's that coming from, mainly? I mean, naturally the family would like Dad to recover and go home, of course. But I'm wondering if the main reason for prolonging your father's life is that your mother can't bear to let him go? How is she coping, overall?
Your father is in ICU and has been since Monday. I hate to be doing the warnings part, but I think I might be concentrating on helping mother prepare herself, just in case; and hold off on the PEG feeding decision until there was a little more clarity about how your father is likely to get on. Has there been improvement in his condition otherwise?
But at age 90? With dementia? Nope. I wouldn't do it. It doesn't eliminate the risk of aspirating -- we can aspirate on our own saliva. And very often with dementia the person keeps trying to take it out (not understanding what it is) and winds up being restrained. Bad situation.
BUT that is MY attitude. Do you know what your father's feelings are, or were before the dementia?
Tggator
Do you know your dad's wishes on these types of measures?
I hope they find a way to help you and your father. Tomorrow will mark 1 year since he passed, and I still struggle with it.