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She has full blown dementia in assisted living. She is in the hospital now but will be released back to her assisted living care soon. she's going to rehab for 2 weeks first. She's had dementia for probably 6-7 years but she broke her hip twice 18 months and 2 years ago and has gone downhill fast since then. since the onset of the dementia her appetite has been poor. she's has been at an assisted living facility for 18 months and has been on ensure etc. she's hostile and nothing seems to soothe her. want to know what should be our next step, the dr. seems to think nature should take it's course. we don't know.

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The family has to make some decisions. If the family wants to force feed her, a tube can be placed by the doctor, but keeping tubes in, especially in Dementia patients, can be difficult. The question to ask, is that the way she would want to live? Remember, life and living are not necessarily the same and there are worse things in this world than death. You may want to see if she qualifies for Hospice services. Hospice is as much for the family as it is the individual and offers counseling and comfort.
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What I'm seeing from what you wrote is someone who is probably in pain from the falls and I guess surgeries and who has gone thru alot of changes and turmoil with going from AL, hospital. She has probably spent time in rehabs after the two hip incidences. And going to the rehab again soon will probably add more turmoil. I can see where she would be unhappy. Maybe give her time for her life to soothe out. Maybe just be gentle and supportive of her right now.

Don't know how old your mom is.
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Hi. I know what you mean here. This happened to my mom too. She just didn't want to eat anything anymore. But she did eat a tasty meal of corned beef and cabbage that I can recall then after that she refused food and drink. I thought she was channeling her own death but now I know it was the disease. As I look back I would agree with the doctor and let nature take it's course. And remember it's not YOU it's the disease. It's hard to face at least it was for me because we don't see things the way they do. I didn't understand this at the time but I do now so that is why I am replying to you to help you get through this. Take care and keep in touch with me again if you want. I need a friend too.
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Absolutely NO feeding tubes to Alzheimer's patient. Unless you can hire a caregiver just to watch that tube 24/7.
Yes, I agree with those who said your mother is agitated and suffering from all those hospital/rehab stays, from changes around her, from all the different people, from nasty food she is served... The appetite and agitation are just her way of telling everybody how uncomfortable she is. I can tell you right now that she has a horrible anxiety. Do not hope that bringing her back to "her" facility will make a trick and she will immediately calm down and start eating. Alzheimer's patients have no ability to learn new things: they forget very quick, and can't adapt to new surrounding fast enough. So, you need to bring your mom to a very small and very PATIENT place with attentive one-on-one care if you want her to gain her comfort back (which might never happen!)... I also guess her disease might be progressing fast now and refusal to eat could mean close end. Contact hospice to access her condition. Palliative program will give her long term comfort care she needs so much.
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Most doctors will tend to give up on patients with dementia because it is a terminal illness. There is not much you can do because this disease will just keep chipping away at your loved one. Be prepared, and know that there is nothing you can do, and let nature take its course. Ensure takes AWFUL and I wouldn't have an appetite after drinking it either. Try yogurt or pudding. At this point-in-time, let her eat anything she wants.
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Sounds like it's time for hospice. Did her doctor recommend that?
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The doctor thinks, let nature take it course, because why, the fact she is not eating? From my own experience with my Mom, she lost her appetite and had no interest in food, what so ever. I imagine, not feeling well, and having pain, no one feels like eating. There are meds out there, that help increase appetite. My Mother, found out some how, and no thanks to her doctor, who should have suggested something to help her, heard of a medicine, that helps with the appetite. What a miracle, after she had taken it. My Mom started eating, and I mean...constantly. She began to put on weight and enjoyed eating...again. My Mom was VERY upset, that her Doctor did not perscribe or even mention, that there was medication, that helps someone eat. Maybe you can check into this. The med my Mom was taking was called (not sure of correct spelling, but am spelling it like it sounds) Megace.
For a doctor to give up, and say, let nature take its course, without trying some thing, SHAME on him! There is some kind of hope, and obviously, you will have to investigate for yourself, or maybe, get another doctor!!
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My 94-year old mother has dementia. I've cared for her at home 8 years. She had no dietary restrictions and ate heartily, but she began chewing her food endlessly before swallowing even after I'd cut her food in tiny pieces and prepared soft textured food. After being hospitalized for a UTI and then released to a rehab center/nursing home, she was put on a pureed diet. Even then she ate very slowly. When I saw her strangling on water while sipping through a straw, she was diagnosed by a speech pathologist as having a swallowing disorder and a feeding tube (PEG) was recommended. A gastroenterologist concurred that she should have a PEG. She seems to be doing OK with the PEG. Later was hospitalized with pneumonia. I could tell from the doctor's tone of voice then that they did not did not expect her to make it. I told the doctor she might just surprise him. She beat pneumonia! The medical staff have all commented how physically strong she is for her age. I do not believe in a one-size fit all solution. You know your mother better than anyone. Yes, my mother is frail and has a PEG. My mother still responds to music. Her responses are weak but she'll hum along and smile. She says hello when I speak to her. She can tell you if she is in pain. There is life there, although not nearly the quality she once had. Even her weak responses to stimuli tell me that she is not ready to go. I hope and pray that I will know when my mother is ready. I know that's not the definitive answer you'd like. I just think despite what the professionals tell you that you must feel something deep within your bones -- your connective DNA, whispering to you whether your mother is ready to go or not. May God bless you and your family.
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If you choose to "force feed" your loved one you might ask yourselves - at what price to your loved one do you do this? What is the quality of life for this person? What would you want if this were you? It is difficult to answer these questions. You have spent a life time of love with this person and maybe the answer is to "let go" with love. Unfortunately the end stages of dementia and Alz cause our loved ones to lose their appetites. It is just the process. I am very sorry you are having to deal with these choices. They are certianly not easy. Sending hugs.
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My mother had dementia for 12 years and was at home for 12 years until her death. I moved in to her house and cared for her the last 8 years of her life. I have also worked in a Geriatric Longterm facility for 32 years. I spent 15 years on the units and 17 years in Research. I have seen your mother several times. We all know Dementia is a progressive disease that always leads to death. Your Mother has hard time, many bad thing has happened to her. Refusing to eat. Although people can live on Ensure. The doctor is trying to tell you your mother is letting go somewhere deep down. She has had enough of life. When the doctor says let nature take it course. He is correct, I hope you are not thinking of putting a feeding tube into your Mother. A person with Dementia it is cruel. You are just prolonging death and that is cruel. Families who do it, can't let there love one die. The medical definition is Failure to Thrive. The best think to do to for your Mother is to call Hospice and let her die with dignity. When the doctor says let nature take its course he is correct. Good luck.
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wyoung - it's now almost a week since your post, what changes have happened with your mom? Did her AL take her back and if so are they doing assisted feeding for her? or is she still in the hospital?

Has anyone with the AL or the hospital spoken with family about hospice? if so, and she qualifies then a lot of your questions & choices will be within what is allowed for by hospice. None of this is simple or easy or a set pattern. My mom was in IL for a couple of years and now in NH for a couple of years (she bypassed the whole AL stage), she is in her mid 90's too and fell in June and is now totally bedfast & on hospice. Yeah 10 months on hospice. Hospice has been a wonderful asset for her and the NH she is in works well with the different hospice providers. She gets as per both doctors orders (the MD medical director of the NH & the medical director of the hospice) "assisted feeding" and "mechanized protein" for her meals. Mechanized means the proteins (chicken, beef, whatever is cut smaller for her). Now there is only so much time that staff can spend on assisted feeding so she is loosing weight but so far so good as she will eat and still can do the bite / chew / swallow / drink sequence on her own without prompting. At her care plan meeting this month, her weight loss was discussed with dietary and they are switching her to soup & sandwiches. She can hold 1/2 a sandwich and seems to enjoy having some control which this allows. Now both hospice & I want her to stay on real foods as it keeps her mentally sharper and her brain working plus the nice interaction with staff for meals. Hospice felt strongly that she SHOULD NOT go to puree only and that is for those who are are in truly last stages of life. I agree. So please speak with the facility as to how they do feedings and how they dovetail their services with hospice if you choose hospice for her. You may find that the AL will not take her back if she is on hospice as her level of care is best at a NH or other long term care facility.

I would not do a feeding tube for my mom nor for anyone with dementia. There is no easy coming out of that rabbit hole if you choose that route.
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Force feeding is against the law in NH and hospitals and there is no dignity left when a family does this. I have seen the days of syringe feedings and the patient trying to push it back out the sides if their mouths. Life is about quality not quantity. I am a firm believer of no feeding tube it prolongs death. Dying from not eating and fluids is not a painful death.
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My mother-in-law had always had a very health appetite, and ate most things, as she did when she was in the earlier stages of Alzheimer's. When she had to go to a Dementia unit at a nursing home, after a couple of months, they had an increasingly harder time to get her to eat. My wife would feed her when she was there at meal time. They started putting her meals into a blender to make it easier for her to eat, but it wasn't very appetizing. She got to the point that she just refused to eat anything. My wife tried to feed her some foods she had always liked, like Jello, but she wouldn't taste any of it. About a week before she passed away, she locked her lips shut when my wife tried to coax her to eat just one bite of Mom's favorite food, ice cream. She hadn't known us for a long time, so the big surprise was that she addressed my wife by name. "I said No, Phyllis!" Shortly after that she went to bed and never got up. Not all Alzheimer's patients follow this pattern, thankfully. I've been told of some who, when not under constant care, just forget to eat., and others forget how to chew. Each case is different and each one is difficult to care for, because of the unpredictability.
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My mother had dementia, was in a nursing home where she got a urinary track infection along with fluid on lungs and heart. She was very weak and almost died at the hospital. The court appointed guardian forgot to fill out her Advance Health Directive (DNR), so the hospital kept her alive. They determined that Mom could not swallow properly and feeding tube was not an option. She was sent back to the nursing home where her health rapidly declined. She went with out food and water for about two weeks and passed away three weeks later. It seems cruel, but she had lost the will to live when she was put in the nursing home.
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My mom just passed in October from the same thing. After watching for months facilities trying to give her meds and nothing working I think my mom just gave up. She knew she was not the same person and I believe she just wanted to leave this life. She just all of a sudden stopped eating and at that time I knew in my heart she was ready to go. She was in the hospital at that time and I immediately had her transferred to hospice since I wanted her to be comfortable and pass with dignity. The day she was sent to hospice, my heart was at peace. All the struggling for years with dementia and anxiety and uncertaintly she endured was finally ending. It was wonderful to see her sleeping and peaceful. She passed 4 days later and I told her it was an honor to take care of her and she raised a strong daughter just and it was ok to go and see daddy and be happy. You will know in your heart and it sounds like you already do since you are asking the question, when it is time. Give her the dignity and respect she deserves to leave this life to proceed to the next one free of disease. God Bless you on your journey. You will do great!
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Been where you're at, with my mother with dementia. There are no easy answers with this issue and no "one size fits all" answer. You're in for a bumpy ride. In my experience with my mother, our family disagreed on how to respond to my mother's lack of eating, which added emotional stress to an already sad, confusing and stressful time. I would recommend you ask medical pros questions, evaluate options, pros & cons, and you and your family/mother's family talk about things. Ultimately you have to decide whether you're going to follow the doctor's opinions/suggestions or not.

I had a doctor tell me something that has stayed with me and may be of assistance to you. I'll share. "There is a difference between being alive, and living."

I wish you and your mother...peace.
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