My 90-yr old cousin has Alzheimer's, she has stopped eating, became very ill with a UTI, and now she’s weak and cannot walk, and needs adult diapers. The hospital cured her UTI and sent her back to the mem care center. She signed dnr papers when she was in her right mind years ago. The very expensive mem care center she's in is now having hospice help with her care, they have prescribed appetite enhancement drugs, and they increased her antidepressants. My question is this: is this congruent with her wish to not be kept alive...?
If your cousin is indeed in hospice, the appetite stimulant seems contrary to what hospice would usually do, but if she is not in hospice, an appetite stimulant stimulant might be OK. I would add that when I prepared my end-of-life documents, my attorney had me complete a lengthy questionnaire about my preferences in many different near-end-of-life scenarios. However, whether I would want appetite stimulants in these scenarios was not included in the questions. I do not know much at all about appetite stimulants, but if your cousin is still eating and also NOT near death and/or not in hospice, I don't think appetite stimulants short-term would be contrary to her wishes. It's also NOT an extreme life-saving intervention.
It is common for Depression and appetite to be linked and therefor it's not too far of a stretch to put these to meds together at this point.
I'm 52 and have set up mine so if ever end up with this horrible disease and I can't feed myself any longer, I don't want to be hand fed at all. Just keep me comfortable and let me pass. I don't feel its right to force feed and prolong a patients life until they finally forget how to swallow. I think that's cruel. This has to be set up early so, I'm sorry, it wont help your cousin in this case, but many people don't know about this so I thought I would post it.
If you google "do not feed dementia patient if I can't feed myself" and see what you find. I don't believe this is available in all states but there are groups out there lobbying for it. This isn't for everyone, but I thought it could be good for some people like me to see. Take care.
It is normal and natural for a person to stop eating and drinking as they near the end of life.
A body will not process food or fluid so the food may cause vomiting that can cause aspiration pneumonia.
IV's should not be given as the fluid can migrate causing swelling and discomfort.
Keeping the mouth moist with swabs soaked in a bit of water helps with dry mouth and lips. Don't give ice chips as that can also cause aspiration pneumonia.
He has Parkinson's and was in a deep sleep as he sometimes does. They felt his neck and said it was stiff... duh he has Parkinson's which causes stiffness. I found out later they thought he might have meningitis. Fortunately within an hour or so later he was wide awake and no spinal tap was needed.
I had a friend say her father was not given O2 even though he was gasping for breath while dying. They told her it was because of his DNR. O2 is comfort, it does not prolong life.
I have been taken back at other instances that have happened with my father, my husband and friends regarding health professionals not understanding the simple purpose of a DNR. I am always there to advocate for my husband to be sure it won't be used before the proper timing. I told my doctor that I would like a DNR but I don't have any one person I feel would understand they need to step up to advocate for me in similar situations so I am concerned I will be denied proper care. She said she would make a note in the chart. I only hope someone will see when it becomes an issue for me... yes I know it is best to actually have one. However, I have talked to my family about it.
If your LO does not want to be kept alive and is on hospice, you should have a case manager or an LVN helping the family. If she wanted MAID, she cannot have it with a cognitive diagnosis even in a state where it's legal. However, you can make sure she is pain-free and advocate for additional morphine to support her comfort. The hospice should have a social worker assigned to your case and can help you understand the next steps.
If your LO is not on hospice, talk to her doctor for a hospice referral. Or, ask the staff in the MC which hospice(s) that come to their patients are the best. There is a difference. As how many visits she'll get and from whom, what supplies they provide, etc. Hospice doctors and nurses understand the balance of over-caring (keeping someone alive) and allowing them to die comfortably.
Edit since hospice is in play things are probably different but idk.
Hospice Care is suppose to keep her comfortable. I am sure your cousin's memory care is also charging for enhanced care even though she's in Hospice Care too. It's a racket. It's exhausting to advocate, but you must. Sorry for your situation. I am battling for my mom's care everyday. Staff and Administration is not on the same page.
Such as it is, they're following the rules of hospice care. There's not anything you can do about it. Visit your cousin and see for yourself how she's doing.
I highly disagree that a memory care that is high end would keep someone alive for profit. At least in my area they have long waiting lists. It is not my experience of at least the ones I am familiar with and my best friend is a DON at one in San Francisco.
If she is eating then the medication is working
If she was at EOL (end of life) the medications would NOT work as stopping eating and drinking is part of the natural way the body shuts down.
IV's and feeding tubes would NOT be permitted on Hospice. (a feeding tube is ok on Hospice if the person had one prior to getting on Hospice.)
A DNR is a document that states that no resuscitation is to be done. And if it is a newer form that states no feeding tube or intubation they are still following that directive.
Neither of these will keep an actively dying person alive.
Beneath your post is a link to DNR. Click on this and read the articles for a better understanding. Also click on Hospice if you would like more details.
Hoping your loved one has a decent end of life.
I'm not sure what you're trying to accomplish with questioning the care she's getting. She's at end-of-life, and she planned for it. Let those who are helping her keep doing what they're doing - it's not up to you to change things at this point. It seems like she's getting thoughtful, expert care. I am very sorry for your coming loss.
A DNR simply means Do Not Resuscitate if her heart stops by using CPR. Increasing antidepressants is intended to keep her from feeling miserable!
That's what is important at this time.
If you are the POA discuss with the MD the withdrawal, now she is on hospice (who will help with the withdrawal of unneeded medications) all medication to promote long life should be removed. The goal now is to understand that the loved one is actively dying and that comfort is an issue. If the anti depressants are on board for some time now then an abrupt withdrawal of them is NOT A GOOD THING. They can stay and they provide comfort.
Again, this is for the POA or next of kin to handle, to make it clear that the goal now is comfort EVEN if this comfort care and medication does cause death early by some moments, hours, days or even weeks. The POA needs to discuss medications with the Hospice personnel in charge and the MD in charge.
I am so sorry for the coming loss.