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I am angry and upset.... 
Some background... Mom is 94. Even 2 years ago, she was a young 92. She is getting weaker, but she is not bedridden. She has declined over the past 8 months, probably due to small vessel ischemic disease and low blood pressure (that was not treated until 2 months ago when her HCTZ was stopped). So, the damage is done. She is receiving palliative care from an in-home hospice program. (She is not yet on her death bed.) Hospice has her terminal condition as "aphasia". As far as they are concerned, that comes under an umbrella of dementia, Alzheimer's, and other cognitive issues. I am not looking for a cure or treatment, but really wanted a more specific diagnosis. It appears to me that she might have vascular dementia (from the SVD) without major memory issues. That may give us a better picture of what we are dealing with and what we can expect, and if there was a genetic component to consider (i.e., dementia). Hospice coordinates with Mom's GP. So, I called him and explained that I was not looking for a treatment, and wanted to see what stage we were in the disease progression. Basically, what he said was he was a generalist and he could not help with specific diagnoses. He then said that at her age, he would not even treat a UTI. He would just let her go. That was really hard to hear and I am trying to deal with the emotions..

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Ma; my mom was diagnosed with Vascular Dementia; some of her doctors thought that she might have Alzheimers as well, but no way to tell until after death, and getting an autopsy.

I don't think there are any accurate timelines out there; I used to look, somewhat crazed. How long can this go on? I wasn't caring for mom at home, just visiting her at her NH almost 2 hours away and dealing with medical stuff on the phone. It was slow torture watching my mom decline.

After a pretty disastrous hospital stay, we moved to "palliative care"; to us, that meant "treat what you can here in theNH and don't send her to the ER unless we give permission. They treated at least one round of pneumonia and at least 2 UTI's "in house".

Finally, she fell, broke her wrist and ended up needing to be transported to the ER; that did her in, I think. She returned to the NH in pain, bedbound and unwilling to get out of bed. We called in hospice and she went out peacefully about a week after the fall.

We are with you on this journey.
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My mom had some kind of dementia that I never got formally diagnosed. There was nothing to do with her as far as treatment goes, she was always pleasant and had mainly memory issues and general cognitive decline. So I don't know that getting a diagnosis will give you the information you want. It sounds like you want to know how long your mom has. No one can tell you that, even with a specific diagnosis.

Even in the last week of my mom's life, she was up and down. One day she seemed fine and the next day she'd be semi-comatose. It was crazymaking for me, trying to figure out where she was in her progression. I brought in hospice when she seemed to be really failing. I also stopped her meds. The hospice people couldn't tell me where she was in her progression to passing until her last day, when the nurse predicted she'd pass. She passed on the day the nurse predicted. I would only have treated her for comfort care, nothing that would have prolonged her life since she was ready to go and her quality of life was pretty much gone. My cousin, who is a nurse, has long said that pneumonia is the friend of the elderly, as that will often hasten their demise if left untreated. It may seem harsh, but as long as your mom is kept comfortable, I think it's the kinder way to deal with a failing body.

It feels so difficult to be a bystander watching your loved one fail bit by bit. But we don't really have any choice and we can't predict how long it will take. {{{Hugs}}}
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Does it really matter what kind of Dementia she has. I don't think it is genetic because there are so many factors cause it. Smoking, brain damage, some medications, heart desease. Alzheimer's is different. That is genetic. At this point, there is no cure for either. As my daughter, RN, says the body gets old so does the brain. Grandma is 94. She has lived a long time, longer than most. She maybe just declining. I would have been upset by what the doctor said. It was cold. Just be there for her. Hospice will keep her comfortable.
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I don't have anything constructive or comforting to add to the discussion but I find I keep coming back to this thread because the questions your post brings up infuriates me. My mom was a lot like yours, she also declined suddenly in her early 90's and the only diagnosis I've got is what I've come up with myself by reading online, I'm pretty certain that the combination of TIAs, decades of heart problems and finally months of frighteningly low blood pressure due to incompetent health care providers failing to adjust her medication all point to Vascular Dementia. When the professionals who hold your mother's life in their hands show ignorance by listing aphasia as a terminal condition, and her doctor shows a lack of compassion for both you and her by making that ridiculous statement implying she is too old and worn out to even consider treating a simple UTI it just makes my blood boil. In my opinion you have every reason to feel as you do, the ones you are looking to for compassionate guidance have betrayed you by treating you like a statistic instead of a person.
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I agree with the other responses you received. I think at a certain age, the body just starts to decline and treating certain things would probably do more harm than good. So many treatments and medications have their own side effects etc. and a body that is old and probably shutting down can't metabolize medicine like it once could.

As far as not treating a U T I, I don't really get that. My Mom had continuous U T I's as she got older. Penicillin does take away the bodies good bacteria and so perhaps that is why they don't want to prescribe it. I hate it when Doctors don't explain their diagnoses etc.. I know it's frustrating. Hang in there.
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I give your mother's GP "nul points" for communication. Well - maybe a grudging 1 or 2 out of ten: he was, I assume, trying to send some kind of message of accepting the inevitable.

But the malaise of a u.t.i. is not inevitable. Should your mother develop one, it should be identified and treated with antibiotics. It's not like it's a nice way to go or anything.

What the GP may have had in mind is the much greyer area of low grade grumbling u.t.i.s that are present in huge numbers of very elderly people, especially women. There are many, many learned papers debating which it's worth treating and which it is futile to treat, and the debate has been trundling along undecided for years. There is quite a lot of evidence that most of the antibiotics ladled down women for this purpose were/are a waste of time, money and efficacy.

But you don't care about epidemiology, you care about your mother. And if she is manifestly ill, you insist she is treated: palliative care does not exclude antibiotics for an acute infection. You are entitled to argue.

Meanwhile... Know any friendly geriatricians? Or, come to that, PCPs/GPs with a special interest in older people's health? It's not too late to vote with your feet.
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BarbBrooklyn, I am upset because of what the doctor said about not treating a UTI (if she had one), and just to let her go -- just because she is chronologically 94. A UTI that leads to a kidney infection can be very painful, but it is something that can be treated. Isn't that part of keeping her comfortable?? She has not been diagnosed with anything but aphasia.
Joann29, if a family member has dementia, others in the family are at risk. I just read two very good books on the subject. I don't like diagnoses that make no logical sense (ie., aphasia from a "possible" stroke). But, that is what it is, and there is nothing I can do about it. I can't take Mom to a neurologist because they would require an MRI, which they would not order. That would come from the GP. I am not sure Mom would go for that anyway. But, I can live with that. It was the part about not treating something that is treatable just because of her age.
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jeannegibbs, I think I would be/will be more accepting if Mom was not still walking around, still eating (a lot), still at least trying to communicate, even laughing at times. I hope she doesn't have another UTI, but will have to deal with that when it happens. i know where the doctor stands if he decides to not even order a culture.
countrymouse, thank you. It would be good to find a doctor who will treat a patient for an infection, no matter what the chronological age.
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Whether or not to treat with antibiotics for a UTI, there's an awesome drug that I've taken that is a contact anesthetic - super great for treating a UTI with the exception it stains the urine red. This is a miracle drug in my book. I don't know its name, and it is not normally prescribed because the red makes people think they are bleeding out.
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Surprise, I take Azo OTC for UTIs and it makes urine orange. Interesting!
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