My mother, who has moderate dementia has, since the beginning of Lent, decided that she needs to Fast/Abstain EVERY day. She grew up Catholic, and has expanded these "rules" to mean that she eats:
-a small breakfast
-ONLY fish and vegetables for lunch and dinner
-no snacks
-no liquids between meals
Again, this is every day.
She is in a Memory Care facility that offers beautiful snacks, a varied menu, and the ability to reject all offerings and have the chef make something completely different.
My mother has lost 10 pounds since the beginning of Lent.
I have printed out the "rules" for Lent. They are not this strict, according to her church. Plus, she is too old to be required to participate.
She, of course, will not listen to any attempts to get her consume more than this. Not from the care staff, the doctor, family, or the chaplain. She also says that she will not change this once Easter is over.
Mom is now dizzy and unsteady on her feet. She is now down to 106 pounds at 5'7.
I see possible falls in the future. She has ZERO padding on her body, and I am concerned about broken bones, or a broken hip.
Dementia has been one surprise after another. I don't want to go into the unknown world of hospitals/rehab/nursing home without SOME kind of plan.
My mother has been wanting to die for some time now. I'm thinking that her refusal to eat a regular diet is from wanting to end her life. She is on anti-depressants and is under the treatment of a geriatric psychiatrist. I do not want to prolong her life unnecessarily.
If she were to end up in the hospital after a fall, how do I make sure that the hospital does not do anything that would be life-extending, but provides her with comfort, only? She is under palliative care from Hospice, but they are not going to be with her 24/7.
I have Medical and Financial POA.
Any advice?
Thank you.
If she ends up at hospital, you can talk to them about the palliative care at that time. I doubt any dr would argue to providing comfort only.
She never did think very highly of priests, and was VERY dismissive of them. She would resent one telling her what to do, and would then forget what he said, 5 minutes later.
I am perplexed, as you must be, reading this answer. Dementia. Sigh.
Since she is eating "a small breakfast" and "...fish and vegetables for lunch and dinner...", it is perplexing that she is losing weight. Our caloric intake/need is often less as we become older and less active. Is it possible something else is going on, which is leading to weight loss?
I would agree that reduced fluid intake could lead to be dizzy and unsteady on her feet. If possible, when she does drink, perhaps try something like Gatorade, which has more electrolytes than plain water or other beverages. Would she allow any blood draw, so they can determine if anything is out of whack, such as potassium? My mother was actually drinking too many fluids when she was still living at home (before any signs of dementia.) I called on my way to work one day and she seemed so out of it and befuddled, I detoured to her place. Several hours later in the ER, they determined that her levels were out of whack, esp potassium. She was admitted with an IV and by that evening she was back to her normal nasty self, demanding to be taken home! My plan had been to leave her overnight and bring her home in the morning, esp after she told the nurse she was okay staying the night. I was at work late, due to arriving so late, and during a call to check on her she was SO nasty and demanding, that I called my SIL and asked her to take mom home.
Since she is eating some vegetables, she may be getting potassium, but low fluid intake can impact that. I would, if possible, have that level checked before resorting to getting more potassium into her.
Otherwise, strict rules during early years combined with dementia are going to override anything we can say or do. Odd that she plans to continue this abstinence after Lent is over, but with dementia, all bets are off.
She can, and perhaps should, refuse transport if she falls or becomes weaker. My mother had a stroke around Labor Day and the nurse called for an ambulance. Mom refused to go. They tried to get me to authorize transport. My initial take was this is mom's decision, but let me talk with one brother to get his input. We agreed so I called back and left it with the EMT - if YOU can convince her to go and if THEY can get her to cooperate with testing, fine, but NO hospitalization. She's 97, has dementia, almost no hearing, is already in a wheelchair (she had been for a while, refusing to stand and walk, mostly out of fear of falling.) What exactly are they going to do for her? If I say take her, you are still going to have to take her kicking and screaming, so what's the point? She didn't go. After the EMT left, mom started asking who called them. The nurse admitted (silly woman!) to it and mom got angry and tried to kick her! It did impact her dominant side, so they brought in PT to try to improve ability to feed herself, pivot, etc, but she began picking at food, lost weight and several months later, another stroke finished her.
Sometimes we just have to let them "decide" what it is they want. Dementia does lie to them, but nothing we say or do can change that. If your mother does fall or become bed-bound, perhaps they can get some fluids in via IV? If not, perhaps it is her time to move on. We can't force our LOs to do what they are refusing to do and can only do so much to prevent the inevitable. If it's her time, may she pass in peace and may you not harbor guilt for not trying extraordinary measures to prevent further decline.
However, can you walk with her through into Easter? Make a big deal of Easter Sunday. Watch an Easter Mass on computer. (Her home church is probably live-streaming Masses with music that would be familiar to her.) Bring her Easter lilies, dyed eggs and foods that you have traditionally eaten at Easter. Bring her a tempting Easter basket of candies that she can get into when no one is looking?
My sister once mentioned casually to my mom that she was trying to lose weight by eating half-portions. It took me a month to convince my mom that she didn't need to eat less too. I remember something my mom said when I got too pushy. She said that when we scolded her, she couldn't swallow even though she was hungry, so I tried not to scold or argue.
My 94 yo mother with dementia today is refusing everything...meds, food & drink except for small sips. Funny thing..yesterday she ate a lot of what she loves! Stuffed cabbage & egg barley w mushrooms...& for breakfast, French toast! But since she refused her meds, it affects her appetite. So I left her in bed all day & told her it’s not Yom Kippur...just Passover! Well, anyway her private pay caregiver comes tomorrow...hopefully she’ll feel better.