She and I are afraid that is she stops her meds before surgery (aspirin, Celebrex among others) she may have a recurrent mini-stroke or more seizures or that the anesthesia would progress the dementia, if she even survives surgery.. She has chosen to be fitted for a brace instead. She tells the nursing staff (she is in a nursing home) she is in pain (8 out of 10) but sometimes refuses pain meds (Ibuprofen and Tramadol, and a knee patch for pain). She is immobile and was in a wheelchair and only transferred to bed or commode even before the fracture. She sometimes refuses to eat (1 or 2 meals daily) and also has dementia (relatively mild). Some days she cries and sobs almost hysterically (she is already on anti-depression/anxiety meds). Hospice has turned her down twice now because she is on PT (only to try to get her to stand enough for transfer to the commode with full assist). What next? Do I back off and let her be as she is, do I try more "forcefully" to get her to eat? So frustrating. She was declining and on a pureed diet, had problems chewing and swallowing but "recovered" from that episode and is now on a regular diet as far as food, but still on nectar instead of liquids. Occasionally she will not respond to open her eyes and cannot use the call button but then this passes in less than an hour. Seems like her end-of-life issues come and go, worsen then improve dramatically. Has this happened to anyone else and what do you do on this roller coaster (she has no other children and my Dad died 13 years ago).