My brother questioned his Primary Care doc who just blew it off basically. Said procedure to stretch esophagus risky but he successfully had a pacemaker replaced this year. Should he have an eval with a specialist?
If I was 93 with Alzheimer's and dysphagia, I'd want hospice to be called in immediately because nothing but death would set me free from the horrors of life at that point. When my mother was 93 and living with dementia, I prayed daily for God to take her and for her to have peace.
I have a bit of a different viewpoint. Were your father‘s wishes ever discussed before his Alzheimer’s diagnosis? Do you think he would want a feeding tube to prolong his life or an invasive procedure to stretch his esophagus? I believe these are important questions to ask, and it’s perfectly valid to not seek further testing if it’s in someone’s best interest or you know what they would want. Hard decisions for sure and I wish you the best.
This isn't a problem with esophagus, but a normal thing that happens at the end of life with the swallow reflex; it also is worsened with many dementias. Dysphagia is quite common. Even without dementia. Look up "dysphagia and aging" and you will see this. He needs a swallow evaluation. He may NOT be eating a lot anymore and you may be looking at choices of hospice or feeding tube. I agree that he is way too elderly and fragile for the stretching procedures which don't work well in any case.
Time for asking for a gerontologist, a geriatric specialist. A swallow eval is easily done by an OT person. They will then recommend diet. If this isn't addressed safely your father will be swallowing food into his lungs and getting aspiration pneumonia.
I am sorry. This is one of the progressions in aging that can happen. You may likely have some decision making soon.
If it were me, a feeding tube would NOT be on the table (so to speak) at 93. I'm "only" 87, but if I had a single brain cell remaining, I'd opt for Palliative Care or Hospice. My healthcare directive spells that out as does a personal letter that I've updated periodically for many years (probably should be every 6 months now!). I probably wouldn't need a swallow test. If I'm no longer able to swallow normally (more or less), I'm done. Comfort care only!
Honestly, it sounds like it's time to bring hospice on board and let your father live out his days as comfortable as possible. If any of his food or drink goes into his lungs he will develop aspiration pneumonia and it is in most cases fatal.
My late husband who had vascular dementia developed aspiration pneumonia in Nov. 2018 and he came so close to dying with his BP at like 48/26, and would have died if I hadn't asked the doctors to try and save him. Well they saved him, but he developed sepsis and septic shock and came home completely bedridden, under hospice care, and was never the same, and he died in 2020. And he had to have thickened drinks and pureed foods for quite a while until he eventually could eat some soft foods as well. His neurologist said that because of my husbands dementia that his brain was forgetting to tell his throat to close when he ate or drank, thus allowing both to go into his lungs. I can only guess that this is what's going on with your father. I wouldn't continue to let him suffer. There is no happy ending with dementia. Bring hospice on board sooner than later. God bless you as you travel this difficult road with your father.
I do wish that doctors would explain the reasons for why treatments are done or not done. Without any information, it can feel like our concerns are "blown off".
However, I think that it is likely that intervention may not be in your father's best interests. Would intervention increase your father's quality of life, or just the quantity of his life? There's a lot to be said for comfort and dignity, which is what I want for my mum, as well as for myself in my old age.
So true, doctors use us as guinea pigs for treatment and results without ever considering if the treatment is in our best interest or just to prolong the experiment.
We all need to make our wishes known and have an advocate when dealing with the machine of medicine.
IMO a PCP/GP no a little about everything and alot about nothing.
Your father needs a swallow test. Food can be aspirated and cause pneumonia.
Your Dad is 93 with Dementia. His brain is dying. Not being able to swallow is the first sign his body is shutting down. The body loses weight because food is no longer being absorbed into the body correctly. I would not go the way of a feeding tube for a 93 year old. You may want to talk to the Doctor about Hospice.
Going through this with my mom. She will be 90 in July. She has had pneumonia on and off since Dec. She had two hospitalizations in Jan and feb, was sent to a rehab for 3 weeks and is now back in the hospital. The rehab ordered the swallow test and it showed she has "silent aspiration" they did an endoscope yesterday took some biopsies. We will be discussing hospice with someone this afternoon. (She refused a feeding tube.) We are bringing her home. She has vascular dementia, but understands most of what is being said. She said she does not want to do this anymore, but then implies she wants to do PT and try to get back to where she was before she went to the hospital. Hospice does not offer PT. She now needs assistance going to the bathroom, transferring to her chair and with bathing. She wants me to make the decision.
My daughter is an RN and does not recommend feeding tubes to sustain a life of an elderly person, especially suffering from Dementia. She had a patient who I think had a sever stroke that left her bedbound. The family had a feeding tube inserted to sustain her life. Poor woman could do nothing but move her eyes. And once the tube is inserted it won't be removed because that would starve the person if they do not have the ability to swallow. Only Hospice gets the tube removed.
Horror!! That expresses my thoughts (speaking for myself only) when it comes to sustaining "life" (existence) in the very elderly (which includes me at 87) via tubes and other such devices when our bodies have shut down or will do so soon--if allowed to. IMO, there is a huge difference between placing a temporary tube in a basically healthy 50 Y/O who has a recoverable medical condition vs. an 80+ Y/O who is very ill, weak, perhaps in pain, debilitated, possibly with dementia, and highly unlikely to recover any kind of functional life.
Hopefully, ALL elders can be strongly encouraged to set forth in writing and verbally what their wishes are in respect to "heroic measures" at or near EOL. Some may want "everything done"; others will opt for minimal intervention and comfort care; still others' wants will be somewhere in the middle. Anyone who questions my wishes can read my posts on this website--they're here in writing as well as in my attorney-prepared healthcare directive and a personal letter.
I am not medically knowledgeable, but I do know my brother has , pre cancerous espogus, he is only 48, he has to have his espogus scraped every month or so, for probably a year. I now it's extremely uncomfortable, and painful. He is miserable that week. Can't eat at all. It's really hell for him. I'm not sure if the procedure is anything like what my brother goes through. But I will say if it's any where's near what my brother deals with I would never put a 93 year old though that.
I'm sorry, I know how hard this is, but it may be time to see about hospice.
See a specialist /get a 2nd opinion it could be something else they’re missing - test for C
I imagine thick shakes would be hard to swallow it sounds like something more be tactful but don’t accept one persons opinion the medical world are full of missed signs that if caught early could have helped
My mother developed dysphasia over some time as a consequence of a horrific hemorrhagic stroke. For a while she had a puréed diet mostly supplemented by a feeding tube directly into her stomach. A swallow study, called a video fluoroscopy, was done using live X-rays while having her swallow various degrees of thickness liquids. It proved that absolutely nothing was safe for her to swallow. Everything was being at least somewhat aspirated into her lungs. It was heartbreaking to realize after so many losses she’d never experience the simple joy of tasting food again. She was only tube fed the remainder of her life. Get the swallow study done, it will let you know where to go next. I’m sorry you and dad are on this path
Best of luck.
Time for asking for a gerontologist, a geriatric specialist. A swallow eval is easily done by an OT person. They will then recommend diet.
If this isn't addressed safely your father will be swallowing food into his lungs and getting aspiration pneumonia.
I am sorry. This is one of the progressions in aging that can happen. You may likely have some decision making soon.
If any of his food or drink goes into his lungs he will develop aspiration pneumonia and it is in most cases fatal.
My late husband who had vascular dementia developed aspiration pneumonia in Nov. 2018 and he came so close to dying with his BP at like 48/26, and would have died if I hadn't asked the doctors to try and save him.
Well they saved him, but he developed sepsis and septic shock and came home completely bedridden, under hospice care, and was never the same, and he died in 2020.
And he had to have thickened drinks and pureed foods for quite a while until he eventually could eat some soft foods as well. His neurologist said that because of my husbands dementia that his brain was forgetting to tell his throat to close when he ate or drank, thus allowing both to go into his lungs.
I can only guess that this is what's going on with your father. I wouldn't continue to let him suffer. There is no happy ending with dementia.
Bring hospice on board sooner than later.
God bless you as you travel this difficult road with your father.
However, I think that it is likely that intervention may not be in your father's best interests. Would intervention increase your father's quality of life, or just the quantity of his life?
There's a lot to be said for comfort and dignity, which is what I want for my mum, as well as for myself in my old age.
We all need to make our wishes known and have an advocate when dealing with the machine of medicine.
Your father needs a swallow test. Food can be aspirated and cause pneumonia.
Your Dad is 93 with Dementia. His brain is dying. Not being able to swallow is the first sign his body is shutting down. The body loses weight because food is no longer being absorbed into the body correctly. I would not go the way of a feeding tube for a 93 year old. You may want to talk to the Doctor about Hospice.
Hopefully, ALL elders can be strongly encouraged to set forth in writing and verbally what their wishes are in respect to "heroic measures" at or near EOL. Some may want "everything done"; others will opt for minimal intervention and comfort care; still others' wants will be somewhere in the middle. Anyone who questions my wishes can read my posts on this website--they're here in writing as well as in my attorney-prepared healthcare directive and a personal letter.
I am not medically knowledgeable, but I do know my brother has , pre cancerous espogus, he is only 48, he has to have his espogus scraped every month or so, for probably a year. I now it's extremely uncomfortable, and painful. He is miserable that week. Can't eat at all. It's really hell for him. I'm not sure if the procedure is anything like what my brother goes through. But I will say if it's any where's near what my brother deals with I would never put a 93 year old though that.
I'm sorry, I know how hard this is, but it may be time to see about hospice.
it could be something else they’re missing - test for C
I imagine thick shakes would be hard to swallow
it sounds like something more
be tactful but don’t accept one persons opinion the medical world are full of missed signs that if caught early could have helped
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