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Alz has been getting much worse later and quality of life isn't there along with poor physical condition. This is tough on everyone (but I don't think I can blame him for his decision) so we are struggling- is there pain in taking this path? We just got hospice involved and they are providing some help in the last few days.

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Friendlybedguy, this is completely natural. Your father's time is probably near and I am glad that he gave you the chance to prepare. My father shut down like this progressively during the last couple of months of his life, and stopped eating almost completely the last week or two. Right before he died, he ate a big meal like he really enjoyed it. I guess it was his last enjoyment of earthly things. He died a couple of hours later.
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When a friend opted not to get a feeding tube, the medical professionals indicated that lack of food/hydration was not painful. Between the ALZ and physical condition, I wouldn't bet that there was a conscious decision to not eat or drink. I'm with Jeanne (as I often am) and bet his entire body is shutting down. I just went through this with someone. She was in SNF and was in rehab one day and the next stopped eating/drinking. She passed in about a week. Bring vaseline for his lips and creams for his hands when you visit. Rubbing his hands gently is very soothing. Ask for straws and drop water (truly by drops onto his tongue. (Aides can show how) and ask for glycerin swabs for the inside of his mouth. Bring music that he would enjoy and play it softly for him during your visits (and it can be left for after as well. )

When I look back, the person I was helping in this situation kept telling me how tired she was. I now understand that her body had started the initial phase of shutting down. Don't talk about things in the room, hearing is said to be the last sense to go. Tell your Dad how much you love him and that it is all right to let go. Bless you and your family at this difficult time.
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I am so glad you have hospice involved. They have the training and experience to answer your questions regarding pain, and the process of the body shutting down.
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