Fasting/Abstaining/Fall Risk. Any advice?

Your mom has Dementia. Use Therapeutic Lying to tell her that Lent is over.

Facing the same issue with my dear stepmom. Feeling your pain.

You sound as though you know what you think you should do (and have the POA to do it), but want to avoid unnecessary accidents and treatment mother would not want. If you accept that she may indeed wish to starve herself - and you do seem to be in tune with her wishes - then the question of how to avoid the accidents, talk over with the manager of the facility she is in how furniture protectors can be used to avoid edges and corners, and try to persuade her to use a walker to get around with more stability. Talk to the chef about adding high calorie food stuffs to go with her fish and that will stir into her breakfast, add butter to mashed potato, honey to porridge little steps that she may be willing to go with. Good luck, its a difficult one to ensure physical protection from falls etc.

Ask her staff to give her ensure or boost..& a multi vitamin...

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.

For me, as a Catholic, Lent is a journey, a solemn time of self-denial, prayer and waiting. Easter Sunday is a joyful release and celebration. Your mom is trying to keep Lent with her "rules", even though they are not what the Catholic Church now teaches. Since she has gotten this into her head, you will not be able to argue her into eating. Probably, she is becoming more stubborn the more you try.
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.

Does your mother currently take any medication? Perhaps they could slip in an appetite stimulant, either by mouth or in the food she does eat? That may not work, since you say she already indicates she is hungry, but refuses to eat more.

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.

How about members from her church coming to have lunch w/her and showing her what they eat/drink during Lent - older members. And the preacher that she may remember from her past.

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.

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.

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.

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.

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.

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.

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.

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".

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.

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

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.

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.

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.

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?

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.

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.

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.

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

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.

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.

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.

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.

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!

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.