My mother, who has moderate dementia has, since the beginning of Lent, decided that she needs to Fast/Abstain EVERY day. She grew up Catholic, and has expanded these "rules" to mean that she eats:

-a small breakfast
-ONLY fish and vegetables for lunch and dinner
-no snacks
-no liquids between meals

Again, this is every day.

She is in a Memory Care facility that offers beautiful snacks, a varied menu, and the ability to reject all offerings and have the chef make something completely different.

My mother has lost 10 pounds since the beginning of Lent.

I have printed out the "rules" for Lent. They are not this strict, according to her church. Plus, she is too old to be required to participate.

She, of course, will not listen to any attempts to get her consume more than this. Not from the care staff, the doctor, family, or the chaplain. She also says that she will not change this once Easter is over.

Mom is now dizzy and unsteady on her feet. She is now down to 106 pounds at 5'7.

I see possible falls in the future. She has ZERO padding on her body, and I am concerned about broken bones, or a broken hip.

Dementia has been one surprise after another. I don't want to go into the unknown world of hospitals/rehab/nursing home without SOME kind of plan.

My mother has been wanting to die for some time now. I'm thinking that her refusal to eat a regular diet is from wanting to end her life. She is on anti-depressants and is under the treatment of a geriatric psychiatrist. I do not want to prolong her life unnecessarily.

If she were to end up in the hospital after a fall, how do I make sure that the hospital does not do anything that would be life-extending, but provides her with comfort, only? She is under palliative care from Hospice, but they are not going to be with her 24/7.

I have Medical and Financial POA.

Any advice?

Thank you.

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Your mother's diet doesnt seem so extreme to me. If she were skipping a meal every day, or actually fasting (as in not eating for an entire day) I might have a different opinion.

Have you had the staff dietician look at how much she is eating each day?

I would not argue with her about this. Arguing with people (age 2 and up) only engenders digging in of heals.

Have you considered a hospice evaluation?
Helpful Answer (5)

I understand your worry and it all sounds like a lot of stress. You've done all you can, and the staff there seem to be doing all they can also.
Once you've assured yourself that her end of life desires are protected, if she goes to the hospital, take some deep breaths. Take care of your stress levels!
She is doing something that feels important to her. It isn't rational, no. I wonder if it connects her to her God. Perhaps she feels she's preparing herself for passing. End of life is so mysterious. Blessings to you through this as you give so much loving care.
Here's an idea: Since she doesn't remember or track things well....Can you tell her she's right, it's meal time again, and feed her a meal of fish and veggies every time she asks? Even if you have to pay more to the facility, or bring the meals in, perhaps ask to keep them in the freezer, and then to microwave?
Good wishes to you and your your mom.
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First of all, she may have dementia but is aware that the end is near and wants the end to come soon. I would respect her wishes in every way - leave her in peace. As far as forcing her to eat, etc., get a medical power of attorney so you can put into place the "rules" to be followed when she gets to the final stages to prevent being forced to take on medical treatments that will prolong her life (and suffering) vs. letting her go. You need to talk with an eldercare attorney who can help you with the legal documents you need to protect her wishes, and yours as well.
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For me, as a Catholic, Lent is a journey, a solemn time of self-denial, prayer and waiting. Easter Sunday is a joyful release and celebration. Your mom is trying to keep Lent with her "rules", even though they are not what the Catholic Church now teaches. Since she has gotten this into her head, you will not be able to argue her into eating. Probably, she is becoming more stubborn the more you try.
However, can you walk with her through into Easter? Make a big deal of Easter Sunday. Watch an Easter Mass on computer. (Her home church is probably live-streaming Masses with music that would be familiar to her.) Bring her Easter lilies, dyed eggs and foods that you have traditionally eaten at Easter. Bring her a tempting Easter basket of candies that she can get into when no one is looking?
My sister once mentioned casually to my mom that she was trying to lose weight by eating half-portions. It took me a month to convince my mom that she didn't need to eat less too. I remember something my mom said when I got too pushy. She said that when we scolded her, she couldn't swallow even though she was hungry, so I tried not to scold or argue.
Helpful Answer (5)

It's her choice to eat or not eat, so here's the NEXT hurdle for you to worry and fret over. If possible, don't lose any sleep over it, either. These women make choices we disagree with but there's nothing we can do about it. Her new diet is extreme enough that it led to a 10 lb weight loss on an already thin body!

So if she falls and breaks a bone, you'll deal with that crisis when it happens. I assume she has a DNR in place, but if she's taken to the hospital for a broken bone, hospice takes a back seat to necessary medical care. In fact, even hospice sends their patients to the hospital for broken bones to be set or repaired, normally. What can be refused is rehab and PT. She can choose to go back to MC afterward and forego further medical intervention. If she becomes bedridden as a result of a fall, then it's time for permanent placement in a SNF.

Unfortunately, you need backup plans for everything with stubborn mothers like we have. We had to take away my mother's "slippery" pants after 69 falls, the last one on Friday out of her wheelchair bc she found ANOTHER pair of slippery pants in the back of her closet. Today at the window visit, I found her wearing ANOTHER pair of slippery pants with a large hole in the leg she fished out of the donation bag! She spilled coffee on herself at lunch, went back to her room, found them, and changed herself! She knows these pants lead her to fall out of her wc, but she insists on wearing them. The CG went in there and cleaned out her closet today, making sure there were no more pairs hiding out! 🤐

Wishing you the best of luck coming up with Plan B C and D for your mothers next levels of care.
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I write this from the perspective of an Early Onset ALZ patient and lifelong Roman Catholic. I am in my early 60's. The requirements of Fast and Abstinence changed at the time of the Second Vatican Council in the late 60's. We are now only required to Fast and Abstain on Fridays during Lent and Senior Citizen's are exempt from those regulations. We used to have to abstain every Friday of the year. Yes, some Roman Catholic's choose to continue to abstain and fast during the entire year. that is a choice, it is no longer required year round. Now, if Mother has one of the Dementia's it may be a losing battle, however, Lent will be over in two more days as this is Holy Thursday, and the Easter Vigil's will begin at 830p on Holy Saturday.

I'll be sure to remember you cxmoody, and your mother and family throughout the final Solemn Days of the Easter Triduum.
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SandyDory Apr 2021
I'm a 79-year-old "cradle Catholic" and my understanding of the rules for Lent is that anyone 59 over older is exempt from the FASTING requirements, but not from the requirement to abstain from eating meat on Fridays during Lent. Wanting to make sure that my understanding is correct, I just checked a Catholic website (The Catholic Telegraph, February 16, 2021) and this is what I read:
Ash Wednesday is one of two yearly days of obligatory fasting and abstinence for Roman Catholics, along with Good Friday. According to the United States Conference of Catholic Bishops, the norms of fasting are obligatory from age 18 until age 59. Fasting means a person is permitted to eat one full meal. Two smaller meals may also be taken, but they are not to equal that of a full meal.
However, the rule of ABSTINENCE FROM MEAT is binding upon Catholics AGED 14 AND ONWARD.

Additionally, the United States Conference of Catholic Bishops' Questions and Answers about Lent page states these non-age related exemptions.

I mention this not to nit-pick your excellent answer to cxmoody, but to try to clarify the confusion over these rules. I have several friends over 59 who erroneously think it's OK for them to eat meat on Lenten Fridays. All this being said, at 5'7" and 106 pounds, and suffering from dementia, jfbctc's poor mother would certainly be excused from all regulations. I hope somehow, someone can convince her of that.
Hello. Im sorry to say this but it sounds to me that your mom is ready to die and feels, consciously or unconsciously, that she can let herself go with religious conviction.
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cxmoody Apr 2021
I think this is exactly right. But, she also says that she is soooo hungry, and asks when the next meal is, EVERY FIVE MINUTES. It’s maddeningly difficult to watch.
There are clear protein drinks that look and taste like herbal teas/regular tea. Instead of her normal drink during lunch you could swap this out to help supplement her calorie count. I drank these before a colon procedure they taste okay and do help you feel "less hungry".
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Does your mother currently take any medication? Perhaps they could slip in an appetite stimulant, either by mouth or in the food she does eat? That may not work, since you say she already indicates she is hungry, but refuses to eat more.

Since she is eating "a small breakfast" and " and vegetables for lunch and dinner...", it is perplexing that she is losing weight. Our caloric intake/need is often less as we become older and less active. Is it possible something else is going on, which is leading to weight loss?

I would agree that reduced fluid intake could lead to be dizzy and unsteady on her feet. If possible, when she does drink, perhaps try something like Gatorade, which has more electrolytes than plain water or other beverages. Would she allow any blood draw, so they can determine if anything is out of whack, such as potassium? My mother was actually drinking too many fluids when she was still living at home (before any signs of dementia.) I called on my way to work one day and she seemed so out of it and befuddled, I detoured to her place. Several hours later in the ER, they determined that her levels were out of whack, esp potassium. She was admitted with an IV and by that evening she was back to her normal nasty self, demanding to be taken home! My plan had been to leave her overnight and bring her home in the morning, esp after she told the nurse she was okay staying the night. I was at work late, due to arriving so late, and during a call to check on her she was SO nasty and demanding, that I called my SIL and asked her to take mom home.

Since she is eating some vegetables, she may be getting potassium, but low fluid intake can impact that. I would, if possible, have that level checked before resorting to getting more potassium into her.

Otherwise, strict rules during early years combined with dementia are going to override anything we can say or do. Odd that she plans to continue this abstinence after Lent is over, but with dementia, all bets are off.

She can, and perhaps should, refuse transport if she falls or becomes weaker. My mother had a stroke around Labor Day and the nurse called for an ambulance. Mom refused to go. They tried to get me to authorize transport. My initial take was this is mom's decision, but let me talk with one brother to get his input. We agreed so I called back and left it with the EMT - if YOU can convince her to go and if THEY can get her to cooperate with testing, fine, but NO hospitalization. She's 97, has dementia, almost no hearing, is already in a wheelchair (she had been for a while, refusing to stand and walk, mostly out of fear of falling.) What exactly are they going to do for her? If I say take her, you are still going to have to take her kicking and screaming, so what's the point? She didn't go. After the EMT left, mom started asking who called them. The nurse admitted (silly woman!) to it and mom got angry and tried to kick her! It did impact her dominant side, so they brought in PT to try to improve ability to feed herself, pivot, etc, but she began picking at food, lost weight and several months later, another stroke finished her.

Sometimes we just have to let them "decide" what it is they want. Dementia does lie to them, but nothing we say or do can change that. If your mother does fall or become bed-bound, perhaps they can get some fluids in via IV? If not, perhaps it is her time to move on. We can't force our LOs to do what they are refusing to do and can only do so much to prevent the inevitable. If it's her time, may she pass in peace and may you not harbor guilt for not trying extraordinary measures to prevent further decline.
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Cx, the thing is, if your mom is esting 3 meals a day (with fish and vegetables for lunch and dinner), WHY is she so hungry?

My mom would "fast" for 3 hours on Good Friday every year, meaning that she would abstain from all food and drink. She would have to lie down while doing this, she was so "weak".

In my community, we have a complete fast of 27 hours on Yom Kippur and very few people "rest". They pray vigorously and take walks in the afternnon. Once in a while, someone faints. Not often.

So WHY does your mom feel so hungry? Has her blood sugar been tested? Is this hunger "in her head" or is her stomach growling?
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