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My mom has bi polar disorder and experienced a relapse summer 2014 after 5 years of stability. She is 81. This happened six mos. after my dad died where she began having panic attacks and depression came back. In the past her depression caused memory loss. The last episode of depression lasted 2 years. She made a full recovery in 2009. Over the last 8 mos. she has been in rehab and now long term care at a nursing home. She has off and on confusion but still knows who we are. Last December she was diagnosed with dementia. I struggled with accepting it because she had similar symptoms in the past that were caused by psychosis. In the past month she has experienced problems swallowing food. She reaches for it but holds it in her mouth. It is pureed. She also has had to be placed in a wheelchair. She is practically skin and bone now. She has an advanced directive to prolong life. I have POA. The doctor has advised me not to take extraordinary measures to prolong her life because of end stage dementia. I am struggling with making a decision regarding a feeding tube.

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My FIL was in very similar dx, and had the medical advanced directive also saying to keep him alive, however the doctor and a 2nd option both explained the complications not just possible, but likely, from feeding tube. One that we had never heard about was heart attack, from the increased fluid levels in body. It can be a tough decision but it is possible to not do the feeding tube, because to do so would be more likely to cause discomfort & death, than to increase comfort & life. At a certain point in everyone's life, any feeding tube is inadvisable, it will not prolong life. Hope that helps. So sorry you have this situation to decide. You are most definitely not actively killing your loved one, to omit a feeding tube!
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Thanks everyone. You have been very helpful.
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gardeners -I think you have answered your own question in saying she is very unlikely to get better. Surely she would want to have every procedure to prolong life if she had a chance of getting better. Is that your sense of what she wanted or do you really think she would want her dying process to be prolonged? The doctor has essentially said she is near the end. What I have read is that the use of a feeding tube at this stage does not, in fact, prolong life and can bring some difficulties of its own. "High complication rates, increased use of restraints, and other adverse effects further increase the burden of feeding tubes in severely demented patients." INA LI, M.D., Thomas Jefferson University Hospital, Philadelphia.
You can find many articles online about the inadvisability of using a feeding tube for an end stage dementia patient. The complications can cause a lot of distress and their is little or no evidence of benefit. Several articles do write about the benefit if continuing hand feeding if small amounts of appropriate food like apple sauce as tolerated, as a form of communication between family and the patient which is meaningful to both.

I personally would not want one nor would I want one for my mother.

This is a very hard time for you. ((((((((((hugs))))))))
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gardners I'm in the same position you are. My mother is almost 89, in a NH and just skin and bone. I doubt she weighs as much as my lab. She's had Parkinsons for 16 years, many strokes and increasing dementia for years as well. She's now bed ridden, barely able to speak and starting to hallucinate.

No doubt the subject of a feeding tube will come up and I am dead set against it.I doubt she has little time left so why put her through more suffering when there' no hope of improvement? You wouldn't do that to a beloved pet. ,
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I think it would only make sense if there is a chance she would get better like she did before. The inability to swallow makes me think that its unlikely to happen except through divine intervention.
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Was the advance directive completed before or after dementia diagnosis? Not that it matters, because you job is to follow Mom's instructions. But since you also have POA, does it state that you can decide on end of life care? Advanced directives may have been appropriate when they were completed, but sounds as if this is no longer appropriate. The end stages of dementia, with a feeding tube? What a difficult decision for you. Do you really think that Mom would want to continue life with the tube? For me, no, not the quality of life I would want.
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