Can an Alzheimer's patient decide they are ready to die?


My mom has had Alzheimer's for about 8 years. She's 81 and has been in a nursing home- a memory care facility- for a year and a half. Recently, Alz drugs were discontinued and then she developed a bad cold which lead to pneumonia. Beginning about 2 weeks ago, she began refusing care most of the time. She also pushes her food away, isn't drinking much, and she's refusing her meds, some of which she gets to reduce agitation. This is not all the time, but at least part or most of every day. Could she be trying to check out, or would she be able to make that decision? My MIL who had Parkinson's did make the decision to die, but she had her wits about her. Mom can't communicate much anymore. She gets some words out, and seems to understand words. She's even still able to read some words (former English teacher!). She rallied for a visit with my adult sons 4 days ago. But yesterday was awful. She wouldn't even open her eyes when I was there, which is very strange. They can't get her to cooperate for a urine test. I don't know if she's trying to tell us something through her actions. Do any of you have experience with this with an Alzheimer's loved one?

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It is so sad, and feels very hard, to be in this situation. My heart goes out to you. Do you have supportive people helping you cope? Those could be a real help.
It can be very heart-wrenching to be in that Med.Directive/Advocate position of making end-of-life choices for someone who no longer can.
It can Feel like it goes against everything we ever learned...and certainly, against inner survival instincts, to have to be the one to stop life support activities [food, water, meds, etc. treatments].
Often, people "rally" before they go. It sounds like maybe yours did that.
The pattern usually always is followed by relapsing into their illnesses and/or has nothing to prevent or improve that.
It has been my experience, during patient care of elders and in hospice, that even those with severe dementias, including Alzheimer's, can often show some evidence that they do have some thoughts left, which they might wish to act on...and will try to do so. Stopping eating and drinking, is often that.
Whether that is intentional, or related to them "forgetting" to sustain themselves, is a moot point...they are too sick and science has Nothing to help it with.
They might, or not, be able to express them clearly to others.
To those not paying attention, the evidence that they have any cogent thoughts, can also resemble behaviors of a dementia'd mind...unless one knows that person, or has watched their behaviors closely for some time.
Things people might be ask themselves, might include:
---- Would your elder want to exist long-term, in a facility with no way to communicate and _no quality of life_?
Many, with minds intact, express strong feelings about NEVER wanting to end up in vegetative circumstances, much less prolonged using advanced life-saving techniques.
Most just say they wish to "be kept comfortable"...which can differ, per person, but bottom line, they don't wish to have their lives artificially extended, at the very least, not beyond reason.
---Inside yourself, is it OK to allow loved ones to naturally dwindle and die due to their illnesses/conditions, faced with only worsening of that?
You are her Advocate...make sure the facility honors her wishes in the most humane ways possible.
Search yourself; see what your beliefs are, and how those might help support allowing someone in her circumstances to die more naturally, with as much Grace as possible.
----If there is an Advanced Directive on file there, to prevent anyone from using advanced lifesaving, artificially prolong life, are there some staff who might be struggling against that? Some do. Even some dealing with writing orders for hospice patients.
We cannot prevent death; nobody gets out of life, alive. We miss those who go before us, terribly. We want to keep each piece of our hearts with us.
But we cannot, no matter what, prevent anyone dying.
We only have a certain amount of control over some of it, for a certain amount of time.
Sooner or later, we must allow them to die, with as much _Grace_ as we can muster, holding tightly to the good memories.
Imho, they are still there in our hearts...we can still talk with them...only their bodies are gone.
Keep talking with her. It is said that the last sense to go, is hearing [unless it was already gone].
In those precious, brief moments during the dying process [minutes, hours, days or weeks..sometimes months], one might experience that sense of Grace, sort of like attending a birthing for them into another level of existence.
Kinda like witnessing and feelings at a birth into this life. Just at opposite ends of the lifespan.
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skanea, I don't think so. The NH staff may have some thoughts on the subject, based on frequent and repeated experience. Hospice probably has the most experience along these lines of any group, but they are often wrong in their predictions, too.

As Shakespeare put it, “Death, a necessary end, will come when it will come.”
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My husband has been in a nursing home for 2 years with alz disease. He has reached a point where he rarely speaks, recognizes no one, is unable to get himself in/out of bed (needing a machine to do this for him) but he is still eating very well. Is there any way to predict his death?
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See how he is doing over the next few weeks but don't make any rash decisions about taking him home.
You can try for a W/E if he is mobile enough and you can get him to go back, or before that try taking him out for meals or a drive.
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My husband has been in the NH for a year. Months ago he went through a stage that he did not wanted to eat, tired, unable to get out of bed, and uncommunicative. I also thought he was "giving up". During the past weeks, I have noticed a big change. I must say that today, he was another person. He seemed to me like a completely healthy man. I talked to the nurse about this change, and she said that is part of the process. She said that at the time of the Sundowner syndrome, he is also another person. I am still feeling the hurt of leaving him there looking so "normal" and pleading me to take him home.
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Yes- she has had a DNR in place for a number of years now. She did this when she WAS of sound mind. She isn't now- she has Alzheimer's. We discussed all of this when she was in her 50s. I have already talked to my kids about what I would want for myself, as well- we all should. So I have no qualms whatsoever about letting her go. As I've stated, I just wondered if she could decide to die as a patient with advanced dementia.
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She can if sound of mind, make a DNR order. She can refuse to take medicine and care. usually the humans around will then say she is NOT in her right mind and get her considered incompetent, so they can force it. I am NO expert, I am a person who is a rare few. this may or may not help but. A Human being is supposed to be free here. if they could charge you when you commit suicide the powers that be would. The poor woman is 81 and suffering, Only she knows whats going on in her mind. She has had a life. Help the Dr's determine if she is sound in mind. Then ask her-talk to her and be calm and do not treat her like an idiot or incompetent because she might want to let go, she's tired. All you should do is whats right, make sure it's HER deciding. Alot of people who keep life support on or push hard for severe elderly to hang on, why? is it in there best interest or yours? is your inability to part with them keeping them suffering?. I do Not know wether this helped. if it did not I apologize , but if it did in someway help her to have a choice still then it helped.
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Chimonger, That was a wonderful post. Thank you
Iwentanon You will know when the time comes. Your 86 year old will accept less and less. If she can't refuse will clamp her lips shut. As she slips she will simply let food sit in the mouth, let it fall out or actively spit it out. Continue to offer tiny amounts of easily swallowed food but do not force give small amounts of liquid with a straw, or sippy cup if she is able. Water is no always palatable but some other drink you know she likes. Ginger Ale is good. If it soothes your conscience try a little Boost. Personally I hate Ensure but the chocolate Boost is just like chocolate milk but contains no dairy and is very easy to digest. If she is unable to swallow you can use a 1 ml syringe without a needle or kids medicine dropper to drip liquids into her mouth to keep it moist. Never squirt it into the back of the throat as she is likely to choke and get aspiration pneumonia.
Medication are also of little use and can often be stopped with the exception of those for pain or anxiety.
Your job as a caregiver is to take care of the whole person. Eating is only a small part unless your job is simply to go in and feed her
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These are very difficult decisions, I know my turn with this will come soon enough
these sites are very informative and people do tell their stories,
so we are not alone.

Our 86 year old has dementia and yes, I do worry about keeping her alive,
against her will, but in her case, like some forget the days of the week, she does that too, but her issue and has always been forgetting to eat.

My job as her caregiver is to make sure she eats.

When would I know that it is different and this time has come?
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Deardau: As waddie said, she made her choice when she was of sound mind in her Trust and DNR orders. You are her caretaker to make sure her wishes are carried out.

God Bless You!
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