Fasting/Abstaining/Fall Risk. Any advice?

Question

Fasting/Abstaining/Fall Risk. Any advice?

Follow

Share

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.

Diet & Nutrition End of Life Hospital

This question has been closed for answers. Ask a New Question.

37 Answers

Most
Helpful Newest
First Oldest
First

1 2

She's probably dehydrated more than anything. Her diet isn't especially limiting, and I assume she isn't terribly active, so she isn't burning a load of calories each day. It's the lack of fluid intake that's messing her up and will continue to do so. My mother hasn't eaten since mid-December, but she drinks Ensure each day, and will drink water, so she's still hanging on.

If she goes into a hospital, then she'll be taken off hospice care because that's one of the rules of hospice -- you aren't going to the hospital any longer. If I were you, I'd talk to the hospice folks and ask about how to arrange for comfort care at her nursing home. She might need to be bumped up to full hospice care, not palliative care.

Helpful Answer (2)

Report

Oh my gosh! I grew up Catholic and a practicing Catholic.

You are right, the fasting stipulations are not this strict.

Besides that, seniors aren’t even required to fast, nor is anyone of any age who has a medical situation that fasting would harm.

I think it is great that you have printed out the fasting rules.

Some people go overboard and your mom is in that category.

I would suggest having a nun, priest or deacon speak with her about what fasting means in the Catholic Church.

Best wishes to you and your family.

Helpful Answer (2)

Report

Falls happen no matter what. They are a curse of old age. Does she respect a priest enough to listen to his guidance? If it’s end of life she wants, he may also help with this conversation. Sorry you’re dealing with this, how frustrating.

Helpful Answer (3)

Report

I am so sorry you are going through this!

Maybe, since she's already undergoing palliative care with Hospice, speak to them about your concerns if she ends up in the hospital...I'm sure they will be able to guide you on what to tell the hospital personnel so that mom gets comfort care only.

Helpful Answer (3)

Report

Your mother's diet doesnt seem so extreme to me. If she were skipping a meal every day, or actually fasting (as in not eating for an entire day) I might have a different opinion.

Have you had the staff dietician look at how much she is eating each day?

I would not argue with her about this. Arguing with people (age 2 and up) only engenders digging in of heals.

Have you considered a hospice evaluation?

Helpful Answer (5)

Report

It's her choice to eat or not eat, so here's the NEXT hurdle for you to worry and fret over. If possible, don't lose any sleep over it, either. These women make choices we disagree with but there's nothing we can do about it. Her new diet is extreme enough that it led to a 10 lb weight loss on an already thin body!

So if she falls and breaks a bone, you'll deal with that crisis when it happens. I assume she has a DNR in place, but if she's taken to the hospital for a broken bone, hospice takes a back seat to necessary medical care. In fact, even hospice sends their patients to the hospital for broken bones to be set or repaired, normally. What can be refused is rehab and PT. She can choose to go back to MC afterward and forego further medical intervention. If she becomes bedridden as a result of a fall, then it's time for permanent placement in a SNF.

Unfortunately, you need backup plans for everything with stubborn mothers like we have. We had to take away my mother's "slippery" pants after 69 falls, the last one on Friday out of her wheelchair bc she found ANOTHER pair of slippery pants in the back of her closet. Today at the window visit, I found her wearing ANOTHER pair of slippery pants with a large hole in the leg she fished out of the donation bag! She spilled coffee on herself at lunch, went back to her room, found them, and changed herself! She knows these pants lead her to fall out of her wc, but she insists on wearing them. The CG went in there and cleaned out her closet today, making sure there were no more pairs hiding out! 🤐

Wishing you the best of luck coming up with Plan B C and D for your mothers next levels of care.

Helpful Answer (4)

Report

The weight loss is how she is qualifying for hospice’s palliative care. Failure to thrive. They have seen her for an initial evaluation, and have been back for an x-ray of her bowel, because of some pain. The hospice doc has seen her twice for that.

Lea, thanks for the hospice/hospital explanation. That’s exactly what I’m looking for-help formulating a future plan!

I don’t think that having a priest or a nun or a deacon would help change her mind about her “Lenten Obligations”. Mom can’t remember 5 minutes ago. So, she would not remember them trying to explain things to her. She was not even that strict a Catholic for the past 30 years or so. Yep. It doesn’t even make sense.

Helpful Answer (3)

Report

It certainly doesn’t make much sense at all.

You or anyone else probably won’t be able to convince her.

(1)

Report

Hello,
The facility should send your mom’s chart with her if they whisk her off after a fall. That should include the palliative care plan with the hospice, and your contact info.
Follow up with the nursing director about the process, too. If there is a specific hospital that they will send your mom to and she’s used that healthcare system before, can you access or create an online chart for her? That way you can scan in her advance directives regarding palliative care, your POA, etc so that if she ends up there it’s available to the staff when they register her.

Helpful Answer (0)

Report

My mom is skin and bones now. I see quite a lot of people get old and super skinny. I am not sure why it happens, if it is age or metabolism, or just eating less. When my grandmother got older she would eat a boiled egg for lunch. That was her entire lunch.

My mom is 95. She told me something years ago that I questioned her about because I thought it was a bit odd.

I had asked her if she was hungry for lunch. She said, “Honey, I haven’t really been ‘hungry’ in years. So, I said, “So, you’re eating just because you have to eat to live?” She told me, “Yes, we all need food and water.” She doesn’t have the feeling of hunger like she did before. Interesting, huh?

I know whenever I have bought wrist watches with links I have to remove four of them so the watch doesn’t fall off. I bet my mom would have to have the jeweler remove five or six links to fit her.

Mom is fully aware that she doesn’t have to follow any restrictions due to lent.

My mom’s neurologist did testing on mom before entering hospice and her dementia is very slight, so she remembers most things. If your mom won’t remember what others say then what’s the point in telling her anything about it.

It’s sad what you are going through with your mom.

I have noticed that my mom stopped eating certain foods. She completely lost her appetite for them.

She was never a finicky eater. In her younger days she was an excellent cook and cooked a wide variety of foods.

At her hospice house they let them eat whatever they want. I bought single serving ice creams for her to enjoy. The aide told me that she had ice cream for breakfast today!

Helpful Answer (2)

Report

Elizabeth,

Thats a great idea! Thank you! I will put a call into the DON at the MC. Exactly the kind of thing I’m looking for.

NHWM, part of my issue is that my mother says over and over that she is soooo hungry. She says this in such a way that I know that she is suffering. She asks about the paper where I had written out the “rules”, and her being too old. She then reads it out loud. And in the next breath, her hands start to shake, as she hands the paper back to me, and she says that she just can’t violate the rules that are in her head. It’s just so hard to watch. She is truly starving herself.

Mom also asks when the next meal is, EVERY five minutes. She is CONVINCED that the staff will forget her. Which they won’t. It’s maddeningly difficult to watch.

Helpful Answer (1)

Report

I'm sorry you are having to see your mother like this. Even though you don't think she'll remember a priest's visit, I think it is something you should at least try. He may be able to speak to her on a level that she'll accept.

(1)

Report

I don't know how old your mom is and I'm sorry you are experiencing this. Before my father died at age 91, for a couple of years he was ready to go. As for falls - oh my. I was worried he was falling - not especially on purpose - but at the same time I wondered. At one time he told me he was not falling on purpose to hasten his demise. Falling, my father fell all the time - I swear he fell at least once a week. I cringed every time the phone rang early in the morning or late in the evening, knowing dad had fallen yet again - at the end though it was more sliding down than an actual tumble.

My father also didn't eat much and his liquid was limited due to CHF - though I doubt he ever got to the cut off limit at the end. His non-eating wasn't for religious reasons, he just wasn't hungry. The hospice nurse said it was normal for someone that age and condition - He did lose a lot of weight before he died. The big thing in your mother's case is to keep her liquid intake at adequate levels.

Because of the alzheimer's and vascular dementia, once dad got something in his mind nothing was going to change it or divert him; there was no reasoning, no arguing; his mind was working the way it worked and there was nothing to be done about it. I would visit his world; visit his delusions and give the answer that made him happy and calmed him.

Talk to your mom's hospice nurse. The hospice provider we used for dad was wonderful, the nurse answered any questions I or mom had. I called their cell several times with questions and they were always helpful.

Both my parents signed DNRs, make sure if she gets transferred to a hospital because she broke a bone that they know not to do more than what is medically necessary and for comfort.

Best wishes to you and your family.

Helpful Answer (1)

Report

Lent is almost over, hopefully she will return to her previous diet. In the mean time there are high protein supplements that she can be given as part of the meal she eats. It can be a liquid or semi frozen like a shake or fully frozen so it is like an ice cream.
If she is on Hospice the facility will not transport her to the hospital unless Hospice directs them to do so. If Hospice does direct them to transport Hospice will provide the hospital with the documentation that this is a Hospice patient and the appropriate steps to take. Discuss the possibilities with the Hospice Nurse or Social Worker they will let you know what the procedure would be.

Helpful Answer (1)

Report

She REFUSES to eat anything but what she is eating, unfortunately. Supplements are angrily waved away. Also, liquids other than with meals. Dehydration is definitely going on.

To her, this is what she is supposed to be doing. Sigh.

Thanks for the hospice hints. I have a call into them.

(1)

Report

I suggest that you ask her what does she think will happen if she breaks her rules for lent. And try reasoning with her from there. I like the idea of having a priest speak to her.
Easter is almost here. See if you can change her eating habits for after Easter. Ice cream and milk shakes may entice her or some childhood comfort foods.
Best wishes.

Helpful Answer (1)

Report

Reasoning with a person with dementia is akin to banging your head into a wall. Leaves you hurt and accomplishes nothing

(12)

Report

See 1 more reply

Ask the dietician for practical tips that will satisfy her nutrition needs while possibly adhering somewhat to her Lent devotion. Salmon and other oily fish have calories. Add in starchy veggies such as sweet potatoes and hash browns cooked in olive oil for nutritious calories. Will she eat beans? Black beans and white beans are very high in potassium and will stave off dizziness. Three-bean salad has oil and sugar. A lunch salad can be a big plate with an olive oil salad dressing for nutritious calories, with dark greens for vitamins. A grated apple in the salad provides fiber that will help to hold her for the afternoon. My mom is 98 and she's not really interested in eating, because so many of the social cues around eating, such as cooking, friends and companion, and even having favorite foods around, are gone, along with many other structures. My mom says she's in her childhood again. Are there Catholic prayers that center around blessing and offering of food during Lent? Are there youtube videos of Lent menus that might pique her interest in eating? In the below link, check out the recipies, the one by the priest, and the one, "Why I don't fast during Lent": https://www.youtube.com/results?search_query=catholic+lenten+menus

Helpful Answer (2)

Report

I don't know about cxmoody's mother, but your menu suggestions are making me hungry!

(1)

Report

I write this from the perspective of an Early Onset ALZ patient and lifelong Roman Catholic. I am in my early 60's. The requirements of Fast and Abstinence changed at the time of the Second Vatican Council in the late 60's. We are now only required to Fast and Abstain on Fridays during Lent and Senior Citizen's are exempt from those regulations. We used to have to abstain every Friday of the year. Yes, some Roman Catholic's choose to continue to abstain and fast during the entire year. that is a choice, it is no longer required year round. Now, if Mother has one of the Dementia's it may be a losing battle, however, Lent will be over in two more days as this is Holy Thursday, and the Easter Vigil's will begin at 830p on Holy Saturday.

I'll be sure to remember you cxmoody, and your mother and family throughout the final Solemn Days of the Easter Triduum.

Helpful Answer (4)

Report

jfbctc:
I'm a 79-year-old "cradle Catholic" and my understanding of the rules for Lent is that anyone 59 over older is exempt from the FASTING requirements, but not from the requirement to abstain from eating meat on Fridays during Lent. Wanting to make sure that my understanding is correct, I just checked a Catholic website (The Catholic Telegraph, February 16, 2021) and this is what I read:
Ash Wednesday is one of two yearly days of obligatory fasting and abstinence for Roman Catholics, along with Good Friday. According to the United States Conference of Catholic Bishops, the norms of fasting are obligatory from age 18 until age 59. Fasting means a person is permitted to eat one full meal. Two smaller meals may also be taken, but they are not to equal that of a full meal.
However, the rule of ABSTINENCE FROM MEAT is binding upon Catholics AGED 14 AND ONWARD.

Additionally, the United States Conference of Catholic Bishops' Questions and Answers about Lent page states these non-age related exemptions.
“THOSE THAT ARE EXCUSED FROM FAST AND ABSTINENCE OUTSIDE THE AGE LIMITS INCLUDE THE PHYSICALLY OR MENTALLY ILL INCLUDING INDIVIDUALS SUFFERING FROM CHRONIC ILLNESSES SUCH AS DIABETES. ALSO EXCLUDED ARE PREGNANT OR NURSING WOMEN. IN ALL CASES, COMMON SENSE SHOULD PREVAIL, AND ILL PERSONS SHOULD NOT FURTHER JEOPARDIZE THEIR HEALTH BY FASTING.”

I mention this not to nit-pick your excellent answer to cxmoody, but to try to clarify the confusion over these rules. I have several friends over 59 who erroneously think it's OK for them to eat meat on Lenten Fridays. All this being said, at 5'7" and 106 pounds, and suffering from dementia, jfbctc's poor mother would certainly be excused from all regulations. I hope somehow, someone can convince her of that.

(1)

Report

jfbctc,

Yep, and we had fish sticks in the cafeteria every Friday for lunch at my Catholic school.

The nuns were very strict. We had to eat every bite of food and there was no talking allowed during lunch.

Helpful Answer (1)

Report

Hello. Im sorry to say this but it sounds to me that your mom is ready to die and feels, consciously or unconsciously, that she can let herself go with religious conviction.

Helpful Answer (4)

Report

I think this is exactly right. But, she also says that she is soooo hungry, and asks when the next meal is, EVERY FIVE MINUTES. It’s maddeningly difficult to watch.

(3)

Report

Cx, the thing is, if your mom is esting 3 meals a day (with fish and vegetables for lunch and dinner), WHY is she so hungry?

My mom would "fast" for 3 hours on Good Friday every year, meaning that she would abstain from all food and drink. She would have to lie down while doing this, she was so "weak".

In my community, we have a complete fast of 27 hours on Yom Kippur and very few people "rest". They pray vigorously and take walks in the afternnon. Once in a while, someone faints. Not often.

So WHY does your mom feel so hungry? Has her blood sugar been tested? Is this hunger "in her head" or is her stomach growling?

Helpful Answer (3)

Report

The key word is common sense.

This was many years ago, one time my husband’s grandmother freaked out over eating meat on a Friday.

She was eating lunch at a friend’s house with a group of women.

The hostess was not Catholic, nor were the other ladies.

The hostess served roast beef. My husband’s grandmother did not want to offend her friend so she ate her roast.

Later, she went to confession and the priest told her that she did the right thing by eating the roast that her friend lovingly prepared.

Helpful Answer (3)

Report

Meat is part of a dead animal. We should freak out even from a thought of consuming that horror.

(0)

Report

See 2 more replies

This is Holy Week. Many Catholics offer up acts of charity during lent.

Maybe you can ask her to say additional prayers for Holy Week in lieu of fasting so rigidly.

Helpful Answer (2)

Report

I don’t know if this will be a help or not but here goes.

One thing that I have always appreciated and feel is absolutely beautiful about the Catholic Church is our art. The stained glass windows in our churches are incredible.

All of our imagery that is represented in art form is spectacular.

Many find comfort in just holding rosary beads. I make rosaries with beautiful gemstones. I find that it’s truly special to make special pieces that I know someone will pray with.

Years ago, I made a special rosary for my mom.

When my mom was placed in hospice I went to a Catholic bookstore and gift shop and purchased really pretty prayer cards. I bought the 23rd psalm and a couple of others with her favorite Saints.

Even if her eyesight is going and she can’t read the prayers, the imagery is beautifully done and very comforting to look at.

Helpful Answer (1)

Report

I'll offer a viewpoint from another direction--the Bible doesn't command or even mention Lent, so this should be of some consolation.

Helpful Answer (1)

Report

Is she capable of any understanding at all? Because if so you need to realistically explain to her all you told us about fall risk. Tell her that if she becomes dehydrated she will fall, and if she falls she will break someone. If her attitude is "nearer my God to thee" then I suspect there is little you can do about her misguided actions. It is not worth the threat of force feeding which is the only other option I can see if she cannot understand or comply.
Dehydration certain will contribute to a fall, but the honest truth is that in her fragile state, and given we ALL lose balance with age, at some point she WILL fall, and that is whether it is lent or not. As an atheist I am uncertain when lent will stop. If it stops at Easter, then we are almost there. I sure do wish you good luck, but I cannot imagine what you can do. We almost never change the minds of those whose actions are being dictated by their religious beliefs.

Helpful Answer (2)

Report

Yes, Lent does end with Easter. But the OP's mom is not correct about fasting and abstaining rules. I'm 75 so I do have experience with the "old days" - I believe it was always OK to keep up hydration. Drinking clear liquid between meals was/is OK. But the deal is that after you are 60 the rules are suspended. And they were always suspended when a person had medical issues no matter their age. It sounds to me like dementia talking here - perhaps some hazy memory of Lent from the past? But I'm not clear whether this lady is actually observant or only clinging to cultural customs. It would make a difference, I suspect, as to whether she would listen to a priest about the modern rules.

(0)

Report

There are clear protein drinks that look and taste like herbal teas/regular tea. Instead of her normal drink during lunch you could swap this out to help supplement her calorie count. I drank these before a colon procedure they taste okay and do help you feel "less hungry".

Helpful Answer (4)

Report

I understand your worry and it all sounds like a lot of stress. You've done all you can, and the staff there seem to be doing all they can also.
Once you've assured yourself that her end of life desires are protected, if she goes to the hospital, take some deep breaths. Take care of your stress levels!
She is doing something that feels important to her. It isn't rational, no. I wonder if it connects her to her God. Perhaps she feels she's preparing herself for passing. End of life is so mysterious. Blessings to you through this as you give so much loving care.
Here's an idea: Since she doesn't remember or track things well....Can you tell her she's right, it's meal time again, and feed her a meal of fish and veggies every time she asks? Even if you have to pay more to the facility, or bring the meals in, perhaps ask to keep them in the freezer, and then to microwave?
Good wishes to you and your your mom.

Helpful Answer (5)

Report

Your mother was raised to Abstain And it is very hard to change her. It will not hurt her to miss A meal . Ovisious she u derstands and remembers her upbringing. Let her do as she wants if she is dying her body starts to shut down and doesn't need as much as when younger.

Helpful Answer (0)

Report

Does she have a trusted priest or religious leader she can talk to to? She may listen to someone like that before you or her doctor.

Helpful Answer (1)

Report

According to the Catholic Church over I think 60 or 65 the fasting etc does not pertain :) Can a priest or chaplain or religious sister speak with her? She may respond to them, but if her dementia is advanced she may not have the short term memory to remember. Thankfully Lent is over this weekend and she can go back to normal meals.

Helpful Answer (0)

Report

First of all, she may have dementia but is aware that the end is near and wants the end to come soon. I would respect her wishes in every way - leave her in peace. As far as forcing her to eat, etc., get a medical power of attorney so you can put into place the "rules" to be followed when she gets to the final stages to prevent being forced to take on medical treatments that will prolong her life (and suffering) vs. letting her go. You need to talk with an eldercare attorney who can help you with the legal documents you need to protect her wishes, and yours as well.

Helpful Answer (5)

Report

Imho, since you are the Medical agent for your mom through PoA, it is IMPERATIVE that you see that your mother eats more food AND drinks fluids, irregardless of her faith or not. She will get dehydrated, which can be very serious. Her BMI is very low. Also, her fall risk is high and if a bone is broken, it is going to take significant measures to recover.

Helpful Answer (0)

Report

Mom refuses to increase her liquid intake.

Short of a feeding tube, which I will not do, there is no way that either I or her MC can do to make her understand the importance of not becoming dehydrated. That has been a battle for YEARS. ☹️

(3)

Report

See 1 more reply

1 2

This question has been closed for answers. Ask a New Question.

Fasting/Abstaining/Fall Risk. Any advice?

37 Answers

Recent Questions

Popular Questions

Related Questions