Are you over 70? If so, would you please answer this end of life question?

But then, none of us really know how that person feels.

My LO, who passed away a few weeks ago, was calm and composed and peaceful.

She could still respond when I kissed her and told her I loved her.

I hope that she didn’t feel as though her condition was horrible.

I was very happy to be able to tell her how I felt every time I saw her. She would sometimes say “I love you”, or “I love you too” when I would leave her.

‘’If we are assuming that a nonverbal, immobile person is “suffering” with no indications of distress or discomfort, is it unfair that we would think they might be feeling loved and cherished too?

Interesting perspective, Ann!

So, that leads me to ask, what if they WERE suffering?

Just trying to think this through. 🙂

IDK 🤔 When the downward trend is so incredibly slow and their quality of life remains poor but basically unchanged for months and even years it can be hard to recognize the time has come to let go, especially when the staff at the nursing home continue to pretend everything is "normal". My mom did receive antibiotics for her pneumonia, my choice was whether or not she should be sent to the hospital when she continued to worsen.... and even there I hesitated a second or two before saying no.

I know that you are asking for people over 70 to respond to your question.

I am not over 70. I am 67. I think that’s close enough to answer this question.

I agree with Ann’s answer. This person may not be miserable in their situation.

If they appear to be completely miserable, then that is a different situation. They may have preferred to die.

I wouldn’t recommend that a person of an advanced age agree to a serious surgery. This is a round of antibiotics so it isn’t invasive and anesthesia isn’t involved.

I suppose there may be legal requirements for notifying family members of care options when health issues arise. Otherwise, lawsuits are a possibility. The family has the right to deny receiving treatment.

Need,
Okay, they might not APPEAR to be suffering, but isn’t not being able to toilet oneself, walk, or communicate any needs its own awful suffering?

My mom passed in November. She was in the late stages of dementia but I tried my best to still resolve anything that I thought would add to her confusion or give her physical discomfort. I could not help the dementia decline but I could make sure she did not have discomfort from UTI’s, added confusion from thyroid problems, potassium levels and other health issues. I did not have the complications of pneumonia but would have certainly considered antibiotics if I thought it would make her breathing less labored.

I think it is a balance of trying to give them the best quality of life that you can while knowing that dementia is fatal. When her body began to shut down, then we let nature take it’s course, with a goal to keep her comfortable, with as little discomfort and as pain free as possible. Those last days were precious for both of us.

If I were as I am now - physically fit, cognitively sound, and able to do everything I want and need to do - I'd want everything done for me that could be done. That includes antibiotics. If I were as he is and unable to live a decent life, I'd want antibiotics withheld so I could die. It's up to each of us to inform our responsible loved ones what we'd want.

Have you heard of the program, "Death with Dignity." That is my choice.

To "if you are over 70" I think you should add "and if you know how it feels to have severe pneumonia" would you want to be given antibiotics.

The gentleman you have in mind had the same opportunities as everyone since about 1970-ish has had to state his wishes in advance. Nobody else has the right to withhold treatment, especially not treatment as straightforward as this.

CM,
I don’t know how pneumonia feels. Can you describe it?
Thanks!

Not enough information on that case to make a decision. You did say he "recovered". Life in a wheelchair with a diaper is not the worst thing that can happen to a person.

Right before Christmas, my 100-yr old Aunt with mod/advanced dementia fell in her home and broke her hip right under the ball. The surgeon called (from FL and I'm in MN) to explain that there is no way for this break to heal properly without a partial hip replacement. I said no to the surgery because I was pretty certain that even if she survived the surgery, she would not cooperate with PT and therefore never regain her mobility anyway. As it is, she doesn't keep her IV in.

She was transferred to a rehab facility where unbelievably she is only needing Tylenol for her pain. Every day she has attempted to get out of bed (part of her ongoing "going home" Sundowning). She is amazingly healthy otherwise. Dementia screws up how our bodies process and interprets pain. My goal, as her DPoA and niece, is to keep her calm and pain-free. So I am just taking it one day at a time.

Should an elder with dementia be given antibiotics? It all depends on their individual circumstances at the moment and the hoped-for outcomes of treatment. In my Aunt's case treatment (surgery) would not improve her future situation or return her to her pre-fall condition/abilities... so why put her through it?

I am 73 and yes I would want antibiotics for pneumonia. Otherwise, I would drown. Unless this man has a DNR or a Medical directive in place, he will be kept alive. Hospice would need to be brought in to stop the use of antibiotics if that is the only thing keeping him alive. There comes a time when the antibiotics will not work and he will pass.

Even hospice gives antibiotics, CX because they are about comfort care and comfort is what, to my mind, this gentleman should have. He shouldn't have treatment toward cure of incurable diseases such as advanced cancer, and etc, but when he has a painful bladder infection he should receive treatment as long as he cannot make his own decision to say "No"; pneumonia, once knows as "the old person's friend" falls somewhere between; many pneumonias are not bacterial and antibiotics will do little for them. They are viral or mechanical due to swallow problems, due to immobility.
I am 80. I have already written in my advanced directive what I will NOT take, and what I will. What I won't take is a lot including dialysis even temporarily, feedings through tube, PEG or IV (TPN or total parenteral nutrition), CPR or vents, IV fluids. I would take all comfort medications including any to decrease secretions from pneumonia, antibiotics for bladder infections, any and all pain and anti anxiety medications.
As people with diabilities cannot make decisions for themselves,, the system has to. I doubt any would recommend CPR for this gentleman. But I think all doctors would treat a bladder infections. Just my guess.
None of these decisions are easy ones to be certain. Sepsis is in some ways a quick way to go, for my brother it was two weeks total, but sepsis can be painful and is to be avoided when possible. When it isn't possible, and something has become systemic it is time, imho, to bring in the "good" meds.

A friend of my mother tripped & broke her hip in September. She is 91&had a partial hip replacement, did rehab and has been back home doing well. She is very lucky that anesthesia didn't cause her any problems mentally.
Anyone who has pneumonia or a treatable infection have a right not to die a painful slow death.

Pneumonia is easily treatable and doesn't need to be life-threatening.

Now, having major surgery, treating cancer, or dealing with life-threatening issues when other life-threatening issues are also in play is something else entirely.

I absolutely would have wanted antibiotics for such a treatable condition. I certainly don't want to die by suffocation, which is what death by pneumonia would be.

I'm not over 70, but I fail to see how that's relevant to the discussion.

first I am not over 70..yet...
If not having antibiotics would make my condition more painful then I would want antibiotics.
If the antibiotics would not work (drug resistance for example) then I would not want them as it would make the condition worse or more painful.
When my Husband was on Hospice they gave antibiotics when necessary so I guess that would be my Standard for Care. If Hospice would approve the treatment Grandma1954 is on board
I would NOT agree to chemo or radiation.
I have a POLST. I do not want to be intubated. I do not want artificial nutrition. I suppose the exception to intubation and artificial nutrition is IF there is a chance for recovery these can be used for a trial period. I do not want CPR. It breaks ribs, sternum in most cases, may puncture a lung or both and it does not always work. (If it is possible to use an AED without CPR that would be OK)
All this is great BUT if POST forms or DNR are NOT in sight nor available when you call 911 they will do what they have to do as if these documents do not exist. So keep a copy posted in your house where it is plainly visible and keep a copy with you. Keep one in your car make sure loved ones have copies AND they are willing to follow your wishes.

YOU can make your wishes known. It may be possible that this man is a "full code" and the facility and paramedics have to do all they can to keep this person alive no matter the cost (and by cost I mean physically, not monetary cost) You never know what the full story is.....

cxmoody - if I were 85 with advance dementia, spending my days in diapers and wheelchair, I'd take the first opportunity to leave that "life" of torture. The only thing I'd ask is that I would not be in pain on my way out.

I'm 66, in a wheelchair, on dialysis, insulin dependent diabetic and wear depends. On dialysis you rarely pee and because I have nerve damage in my lower back I never know when. But it's not a big deal. Lots of people think my life is bad. But I don't. At some point that may change, and I'll stop dialysis and die. In the meantime, I take antibiotics if I need to.

I had pneumonia when I was 30 and pregnant with my son. The feeling of not being able to breathe was painful, terrifying and exhausting all at the same time. The very act of just trying to sit up in my hospital bed made me gasp for breath - forget about anything "exerting" like eating.

I was absolutely terrified while I was in the hospital; my husband spent literally all day with me, but as soon as visiting hours ended and they made him leave, I remember crying like a baby afraid that I wouldn't make it through the night.

I know it has been referred to here in certain threads as a "blessing" to elderly, chronically ill people, but I absolutely would NOT want to have it again without being treated.

I wear a DNR bracelet so that no one else is burdened with my medical issues.

In my family, my dad had cancer that had metastasized to his brain, so was on hospice. He was given steroids to shrink the tumors, but they were discontinued because he started going after my mom with his cane due to “roid rage.” He came down with pneumonia and the doctor was about to prescribe more steroids and antibiotics when my mom asked him, “Why?” He stopped and had to agree that it was not a good idea. It may have prolonged my dad’s life for a few weeks, but life at a poor quality. There is a reason pneumonia was known as the old man’s friend. For myself, it would depend on my situation. Generally, I would want antibiotics if my life situation was tolerable and it would make me more comfortable. It is hard to judge what dementia would do to the equation. Judging from today, if I had reached the point where I didn’t know myself anymore I wouldn’t want to continue. I hate to speak today for my feelings at some future point, but then I wouldn’t be able to decide at that point.

Thinking about this ..and this may not be a popular opinion...
I am all for Physician Assisted Suicide.
(I suppose depending on the regulations...) If a regulation/law REQUIRES a person to administer or take a cocktail themselves but they are physically unable to do so but cognitively they are aware, want to have the drug(s) but they can not do it them selves I think that is a flaw in the system.
I would like to hear other opinions about this.
This is far from the antibiotics discussion that "cxmoody" started but I think it goes hand in hand.