My mom (93) with advanced Vascular Dementia. How do I know when the end is near?

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The past few months she has become much more sedentary; she usually would walk, now not so much. She is on Seroquel and Buspirone for mood/behavior issues because she gets so agitated and excited. Very irritable. Now she is calm, smiles, but sleeps off and on in the recliner most days and through the night. She is incontinent now, rarely can go to the bathroom anymore. She struggles to feed herself, and doesn't say much. When she does talk, it's a few words but no real conversation. She is confused often, and when she tries to make a conversation these days she struggles with words and non words come out instead. Like her brain knows but she can't get it out right. She hasn't even gotten dressed out of nightgown and robe in about a week. Again, she is 93, with advanced (stage 6 I'm guessing?) vascular dementia. She was not this bad a month ago, and 2 months ago she was even a little better than last month. Seems like a pretty rapid decline to me. Also she was on those 2 pills now for 2 months so I don't think it's that. She has a cough, and she feels clammy at times but when I ask her if anything hurts she says she feels "fine". She drinks 2-3 cups of coffee a day, has a good breakfast, light dinner. and pie or a muffin. but it's tough to get her to drink water. Just wondering about hospice. It's depressing but I have to be prepared and really trying to keep her home. Thinking about pneumonia too... just don't know what to do, if anything, or let nature continue taking its course. She has a DNR in place and I am POA. Thoughts?

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if you are very observant youll notice that hospice keeps a close eye on body weight . when the pounds are dropping , so is digestion and life itself .
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JessieB, everything you are writing today strikes me as funny..."still breathing", so true LOL
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cwillie, funny how our definition of "fine" changes so much. In late life it simply means "still breathing." When someone asks me how my mother is now, I tell them that she is the same, because saying fine seems silly.

I do like how the nurse called your mother pretty healthy. Sounds a lot like "fine."
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Well I went to sit with mom and keep her company today, and something funny happened. I was late giving her her mood pills, and she opened her eyes and - while still not talking much - was making light conversation. Made her coffee and cookies, she asked where the bathroom was (we were in her house) and if it was "busy". Then I escorted her there, she did her business, and slowly stumbled back to her chair. She remained awake watching HGTV and petting her dog the rest of the time until finally I said shoot her pills and gave her the one buspirone. within a half hour she was napping in the recliner again. Problem is, if we don't give it to her, there is hell to pay for both us and her... And it is the lowest dose. Funny because she has been on it for 6 weeks now, yet the sleeping has only begun last week.... ??
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Energizer bunnies with weak batteries, that's brilliant!
My mom will often recover from declines, but never fully back to where she once was. The process has been excruciatingly slow and unpredictable, but the one saving grace is that I usually have time to adjust to each little decline before another one crops up. When our nurse was in this month she commented that mom was really pretty healthy, good BP, healthy lungs, good bowel sounds, peeing OK, pain under control. Of course she is also fully incontinent, sleeps 18 hours a day, can't turn herself in bed and recently is having problems standing, no appetite, as well as mostly deaf and blind... but other than that she's mostly healthy ;)
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Nikki, vascular dementia is hard to predict. It doesn't have the stages of Alzheimer's, but progresses in a step-wise fashion depending on strokes and mini-strokes that happen. Many times the only way we know that an ischemic event occurred is they get suddenly worse. If your mother became suddenly worse, I suspect she had a small stroke or age is taking its natural toll. From what you wrote, it sounds like a good time to call in hospice.

The end point to VaD is often a heart attack or stroke. We don't have a good way to predict it. It seems to me that people with VaD can be like energizer bunnies with weak batteries. They keep going even when it looks like they're ready to stop.

Huge hugs coming your way. I know what you're going through.
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Nikki, all I can base on is what I witnessed with my Mom [98]. She was living in long-term-care, not eating much, couldn't walk [due to a fall at home with complications 3 months prior] and her mind was now befuddled most of the time.

She would be ok one week, then the following week you would think this is it, it's the end of her journey.... then she would bounced back eating more, chatting more.... then it was noticeable that her journey was finally starting to end as she refused to eat or drink, wanted to sleep, and was under the watch of Hospice. Hospice was able to pin point the final hours within 24-48 hours.

Elders will slow down on their eating because they aren't getting the exercise that requires more fuel. Staying hydrated is important only if you can get water into them. My Mom wouldn't drink Ensure or Boost unless it was in a cup of ice.
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