Mom has dementia, uses walker, incontinent and has stage 4 kidney disease. Dr. says we need to decide on dialysis.

If you elect to decline Dialysis ask the doctor if she would be considered Hospice eligible. If so call and "interview" Hospices in your area and have your mom evaluated.
2 things to know.
1. She would probably be considered Hospice eligible due to the dementia.
2. She wold be considered Hospice eligible due to declining dialysis treatment.
If she goes on Hospice because of the dementia you can later decide to try dialysis and she could remain on Hospice. On the other hand if she enters Hospice because she is declining dialysis if you later decide to try it she would not be eligible for Hospice (they could change the diagnosis to dementia though)
Personally if her quality of life is not good if it were me I would elect to NOT do dialysis and go on Hospice and let them help me manage any pain or discomfort I may have.
There are many advantages to having Hospice.
She/you will have a Nurse that will come at least 1 time a week to check on her. A CNA at least 2 times a week to help bathe and dress her as well as order supplies.
You will have medications delivered to you as well as other supplies.
If equipment is needed that will be delivered to you as well.
Honestly I can not see a downside to going on Hospice.
There are 2 types. One is a For Profit the other is Not for Profit. The Hospice I used for my Husband was a Not for Profit and I could not have been more pleased. The goal was patient focused not saving or making money.

This is what you need to ask the doctor. Will her body be able to take it. Isn't it like 3x a week and 6 hrs of sitting? Can she do this? Home dialysis involves a lot and training.

The option is to do nothing and putting Mom on Hospice. Eventually the Toxins will make her septic and she will pass. So sorry that u need to make this decision.

Did your mom ever make any advanced directives? Or did she ever indicate to the family what type of interventions she would or would not want in her declining health? That is where I would start. Next I would consider a family meeting or conference call. These are difficult decisions but they’re even more difficult if there’s dissenting opinions amongst family members.

About a year ago, I was faced with a similar situation. My father required surgical intervention for a heart condition. We decided against it and contacted our local hospices as Grandma1954 suggested. It’s been a good decision for us. It’s given him quality of life and I don’t believe the surgery would have given him quality or quantity. As you said, I don’t think he could’ve handled it.

No matter what you decide, I wish you peace and comfort. I understand how tough this is.

I'd consider what she would want and look at any Advance Medical directive if she has one. I did a lot of reading when my LO got sick with dementia. I was surprised at all of the professional literature about not proceeding with life extending measures, when someone is terminally ill, which dementia is considered. So, we went with palliative care, then hospice when she qualified. The goal is comfort care and not to extend life, due to her failing health and extremely low quality of life. You can discuss it with her doctor and/or hospice to see what each path would look like.

Absolutely not! Google Atul Gawande and " being mortal" for a doctor's take on end of life care. You would not be extending her life for any kind of positive comprehension. That would be cruel to put her through a process she cannot understand. Sign her on to hospice and allow her to pass in peace.

You are in a very difficult situation, when you are left to make decisions for someone who isn't able to do so on their own. I would discuss with the doctor how well it is felt her body can handle this intense process for dialysis. I would also ask what her prognosis would be. I however, would then ask myself what her life would be like going through this process and decide if it is something which is for my want to keep my parent alive, or is it really going to make her life better. If you answer that she is suffering enough now, make arrangements for hospice. Hospice keeps them pit of pain, and really it maybe the best way to show your live, by letting go. Very hard, but have had to do it, so I feel for your decision and heartaches. May you decide what works best for your situation and don't feel guilty no matter what choice you make.

Is she able to discuss wishes with you. Who is the POA for health care? Have you spoken to doctor about a palliative care consult and hospice. I have made it clear in my advanced care directives that I will not accept dialysis. I hope all who feel this way will be certain to write this directive out for their families. Dialysis is truly a GRUELING thing to go through, and to what end?

This is so sad. If you feel she is too week then I think you should tell her doctor how you feel.

It seems cruel to make her go through all of that.

It sounds as though the doctor has to offer dialysis as an option, for professional reasons. One thing you could do is to ask the doctor what choice they would make for their own mother if she was in this situation. It might help you with your decision, and with any family members who question it.

Dear
in brief: just go for treating her through nutritions. i know that you will do alot of reseach on google but believe me its really useful. find the nutritional deficiencies which cause dementia and the first thing you have to think about it is Anemia (iron. ferretin. vitaminb12 ... and all the items related to that including basic minerals like zinc. potassium and so on)

find the nutritional deficiences that cause kidney diseases

im reading in english. german. swedish. swiss only for my mom and each one has different point of view. you can use google translate. even you can read in japanese. try to read universities reseaches.

try your best to go for alternative medicine which you can find lots of solutions but you have to have patience to read and to make sure that this is completely right.

wish you all the best

I would see if she qualifies for hospice. Doesn't seem like dialysis really makes sense for the condition she is in. Keep her comfortable and let nature take it's course. I know that sounds harsh, but I think it is the more humane option. If you drag her to dialysis time after time, what kind of quality of life will she be having? If the answer is it will continue to be very low, then I think that helps make your decision easier. Best of luck.

If she has dementia how will you explain the need to sit still for the hours it takes to do, and how many times a week would this be?
I wouldn't accept dialysis unless it is going to markedly increase her quality of life.
Its a hard choice for you to have to make, but you know her views when she didn't have dementia, balance treatment against current need and what you think she would want you to do.

Agree with TaylorUK *what you think she would want you to do*.

You asked how it may benefit her? I'm really not sure. All I know is I recently met a lady who declined the dialysis option & passed quicker than everyone expected. She was at very end stage kidney disease though. She got weaker & a little more confused each day until just sleeping. It was very peaceful & what she chose.

You don’t mentioned if she has an advanced directive. I would not think dialysis at this point in her health is a viable option. For what end? To prolong her life so she can continue to sit in her bodily fluids and to exist. Has anyone explained how hard it is to go through dialysis? If it were my parent in the mental and physical condition you state, I would say No. let the body die a natural death and get hospice on board. End stage rental failure is one of the criteria for acceptance. The dementia diagnosis is much more strict under their guidelines. They must have ceased communicating.

I would contact hospice. I think sometimes the body naturally takes the best course for our loved ones with dementia. It's a progressive downward trajectory. Wishing you peace.

My mom’s kidneys were failing her, she was in and out of the hospital and had stated before she wasn’t going to do dialysis. When we took her into the appointment with the doctor after he had explained what would be done and how often, I only had one question for him. “ Would he put his mom on dialysis if she had all the health issues that my mother had?” His answer was No.
What you and your family have to decide is it going to improve her other health issues? Dialysis is very hard on a person and you are looking at several times a week, each time takes hours. The chances of her pulling the needles out are high if she has dementia. I know we all want our loved ones to live forever, but a some point we need to protect them from medicinal treatments that will do more harm than good.

My dad, no dementia, is 95 and faced the same issue. He had already done a lot of reading on the subject and did not want dialysis. Nonetheless, he and I went to the dialysis class and visited the center. It did not change his mind.
He has signed a DNR for paramedics and has an advanced directive for doctors and hospital...you must do both.
If you read up on dialysis, you will see how difficult it is. I agree hospice is the way to go. Death from kidney failure is not always peaceful, however, so you need to be prepared, hence hospice support is vital.
Hugs to you.

She will spend hours, 3-4 days per week in dialysis. There will be transportation to and from. Shunt will need to be placed, which is a surgical procedure. Dialysis will allow her to continue life temporarily. She will probably pass without dialysis. That is a personal decision. I am sorry you have to make that choice.

I lost a friend about a year ago because he chose not to continue dialysis. Kidney failure was caused by diabetes. He had lost a leg to the desease.
He had undergone 600 dialysis treatments. He did not want to do it anymore. He was 69 when he passed.

My daughter is an RN and has worked in rehab/LTC for 20 years. And she would probably say, don't do it.

This is one of the questions on the MOLST form in my state. Delaware has its version. Does the individual want temporary dialysis? Does the individual want permanent dialysis? If your mom hasn't completed one of these forms that addresses the level of intervention she wants concerning ventilation and CPR, she should. The form is filled out during a doctor's visit or in the er and signed by your mom and a physician. You keep it on your person as it doesn't go into a central database. The good thing about that is that it can be changed or updated at any time. Learning about the realities of dialysis and learning about hospice care is the way to go in order to make the best choice in her difficult situation.

I can't imagine, though you know your mom best, someone with dementia being able to tolerate the time and procedures of dialysis. Not to mention what others would experience around someone incontinent who are trapped at a center in close quarters. I doubt the dialysis staff have the capacity and facilities to do changes nor would it be easy when someone is hooked up...and what will mom be saying or doing? Is she even able to be transported? In my mom's case she is still quite functional...and day programs might be good for her...but she would never get her act together in time and be combative with us urging her on...hard enough just for a hair appt. Though...there are always exceptions...and in her case she did cooperate with going to the DDS for 13 cavities to be filled over 6 weeks. It's hard to face the trip life is coming to its final destination so to speak...but it may be the kindest path to follow others here who suggest hospice. Sending you a hug....

Don’t put her through dialysis. It sucks the life iut of patients. She is already weak.

You really have a tough decision to decide. However the question is with any treatment, does the benefit out way the risk? If multiple weekly procedures will make her already low quality of life even lower, then I wouldn’t in my opinion.

I was my father's health care proxy, my father passed away over 13 years ago. He had stage 4 lung cancer, colon cancer, while in the hospital he suffered a stroke that affected his whole right side of the body and was on a respirator. I had a conversation with his PCP and it was best to put an end to his suffering. It still was a difficult decision to make however if I didn’t do that he would have just been laying in a hospital bed, unresponsive and linked to machines just to breathe for God knows how long. I knew he would not have wanted to go on like that.

God bless you for being there for her, good luck in your situation.

One of my college roommates is a nephrologist. Her motto is "I don't dialyze bodies". Dialysis is intense. Most people do not realize how intense. It's fatiguing. Some patients go into cardiac arrest during dialysis. Dialysis is a commitment to three times per week for hours at a time. In my opinion, it's time to get consults for both hospice and palliative care on board for your mom.

It's a terrible choice but dialysis is surely too much to put her through only to keep her in her current frail and dependent self. The benefits to her would not be worth the process.

Let the specialist know her true state of affairs, e.g. sits in urine and stool.

My dad started dialysis at 92. Gave him three years. Felt great in the beginning. Not so much later on.

I personally have had end stage kidney disease and was on dialysis before I received a kidney transplant this past October. I am also a Gerontologist who works with folks diagnosed with dementia. Dialysis is very rough on the body and causes fatigue and other issues. Depending on the stage of mom’s dementia she may not even be able to understand or remember what is happening or why. She may fight it especially if she experienced discomfort like I did. A suggestion as you consider the best move for mom is to talk with a Hospice/Palliative care company about comfort care. The Medicare benefit pays for it and the support they give your mom in her final months/years it takes for her kidneys to ultimately fail is priceless to quality of life. The thing to think about here is that she is no longer able to care for herself at all and is unlikely to bounce back from where she is. What would be her goals for this time of her life? Would she want to try dialysis to try and extend her life or would she want to pursue her own path for end of life? It’s a hard choice. Even if you choose not to go the route of Hospice support, they may be able to help you identify what path mom would want. Good luck!

I’m surprised they would even offer dialysis at all. It’s a difficult procedure to endure three times a week. My diabetic husband was on dialysis for years, and the center was a very grim place to be. He was younger than most of the other patients there. They literally had patients wheeled in on gurneys. Quite often a patient would pass away while there, and there were always patients who just disappeared.

I have to agree with most comments here. By choosing hospice, they can keep your mom comfortable in her final days. Just remember that kidney failure is part of the dying process. Good luck.