Are we nearing the end?

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My mother, 87, with Parkinsons and moderate dementia, has been in a NH just over a year and increasingly refuses to eat. She'll go for breakfast as she likes oatmeal, refuses lunch and I suspect is now refusing dinner as well. Yesterday I picked up things she had asked for which included two types of cookies and assorted chocolate bars. I used to take her a little fruit but, in the last couple of months (since having a stroke) she won't eat it and only wants cookies and chocolate. I didn't go to her room but left the shopping at the desk as I have a cold.

I called her just before dinner time (when I knew she'd be awake as the staff try to get her to go eat) and she told me she wasn't going to dinner. She also said the last time she was weighed she was 80lb. As you can imagine, she's skin and bone and due to taking blood thinners (has for many years) is covered in bruises. After her stroke she was returned from hospital to the NH deemed palliative and sleeps most of the time.

Is her body starting to shut down? Are we nearing the end? Deep down I think I know the answer to my question.

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Wise words skinonna very wise words
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First of all, I would like to say I respect the sanctity of human life. Secondly, dying is the price we pay for having the opportunity to live. Thirdly, we need to be careful that we are not prolonging death instead of prolonging life. It is for the individual and family to decide. Forcing food on someone whose body is shutting down may not be the best thing to do. To keep them free from pain and assuring them they are loved may be more advantageous. Hospice may be able to help you.
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I just re-read your post, you did state that she has Parkinson's, ask the doctor for a swallow test, my dad has Parkinson's and stop eating, or drinking much at at all, we had the swallow test done and they saw that different textures of food were impossible to swallow, even his water had to have a mixture added to it, so he could swallow. He also tried to stop going down to the dinning room, now we all, that includes the facility has adjusted his diet and food textures and he is starting to eat and drink a little more, still skin and bones. Hope this helps.
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Why is everyone focusing on Ensure, it does not have enough protein to substance anyone and it taste bad. Try real protein drinks, I personally use EAS Multiplex I buy at Walmart. that has only 3 grams of sugar and 20 grams of protein. Costco has an excellent protein drink that has 0 sugar and 30 grams of protein. If she is not eating, she is missing much needed vitamins like D, B, Calcium. Add you can blend some fruit or ice cream into the protein shakes. NH will not be so hands on, I was getting foggy and having some memory loss, and after a blood test found out I needed to add Magnesium and vitamin B to day, and wow, it helped a lot. Again, were is her doctor? The ER doctor does not know her health history. . Have a blood test done, there may be some kind of chemical imbalance, she may be lacking vitamins or minerals. Her wanting sugar may be a medical issue, again, were is the doctor, you should not be trying to figure this all, and the NH can only do so much, also, people with OCD, ADD, other Neurological issue should probley be seeing a Neurologist. There are medical test that will let you know what is going on. Once, my family and I got involved in my dad's medical issues, we got his Parkinson's diagnosed, found out he had Basal Cell cancer, had it removed, found out he has Arial Fib, got medicines adjusted. We found out that he had an old brain bleed were he had a fall he did not remember. The blood work or labs uncovered a great amount of issues we did not know he had. Once we got his medications adjusted, we got the nutrition from the daily protein shake in his system, got a daily multi-vitiam with iron into his system, his memory seemed stronger, he has more energy, I think I made a point, she is having more than just cravings. You said she has increasing dementia, what stage did the doctor say she was at? Maybe, the lack of B-6 and B-12, can make you have memory lost. They have facilities that are set up to work with dementia, if the doctor has stated that she has dementia, he can write medical orders stating the stage of dementia and that will help you find the facility that can manage the stage of dementia. Some facilities do complete lock-down, to other things that a regular NH will not be qualified to offer.
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I agree with Twenaton. Ensure is really nasty. I did manage to get one down when I mixed it with coco powder. Now Boost is a different story that is really pleasant. I like the chocolate best, it tastes the same as chocolate milk but strawberry is OK too. Don't like the vanilla. I have had exactly the same experience as Frenchmadeline after major illness and surgery. Eating was like trying to swallow rocks so I existed on Yogurt and turkey sandwiches for a long time. I had zero interest in food or the desire to cook it. Once in hospital they sent an aide to encourage me. Well if they had sent the cute ex marine they might have had better luck. But this guy just hovered and as soon as I reached for anything he was right there to take the top off. In the end I just told him I hadn't lost the use of my hands. You really crave the strangest things when you are in that zone
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Have you guys drank ensure? The stuff is nasty, I wouldn't drink it on any basis as any form of food??? What is it with nursing homes?? People are suppose to die on their own, not be made/forced to die?? When did all of this all take place??

Candy and cookies are not ideal choices for people with dementia, they bring on the problem of the mind scattering to much at least that is what we notice here, we use that stuff only if she eats and has regular food, so far it has worked, she has been home now for 1 and a half years, she has an afternoon treat and one after dinner, they are usually home made to be in charge of the ingredients.


A person starving themselves to eat chocolate and goodies does not do anything for their muscles, and would be prone to falling, but it us a proven fact, that people often crave what they shouldn't eat, we do limit her intake...so far...is she any worse in the year and a half??? OCD's are really kicking in and of course they do not make sense to us or her...
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Thank you for all the thoughts and suggestions. Cooking for her won't work. During the years I cared for her I'd spend hours cooking and creating things to tempt her but she'd only pick at it, if I was lucky, though she would take a protein shake each day. In the NH she dines with 3 other residents who have shared the table for months and she's comfortable with them but she just has no desire to eat. If the staff didn't insist she go to the dining room she'd just stay in bed 24/7 and meals are only delivered to a room if a person is quarantined due to illness. Due to increasing dementia, having a talk with her will get me nowhere and I often have to check with staff to see if something she says is real or imaginary - yesterday's disaster was a light bulb had gone out and the NH didn't have any light bulbs. I deal with her as one would deal with a petulant stubborn child in the hopes that some of what I say might sink in, such as you must not try to get out of bed by yourself or you will hurt yourself badly - did that Christmas night, taken to hospital for stitches but thankfully nothing broken. According to the doctor there is nothing more that anyone can do and we go day by day.
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Are you nearing the end? I can't answer that because I have not seen your mother.
As we age our taste buds do alter and we crave sweet things. can you add peanut butter to the cookies? or even eggs. Food needs to be of a soft texture and moist without things like nuts in them. Is she a real vegan? I assume not so make your own mayo for the salads with real eggs and her favorite seasonings.
if she appears to be able to swallow soft foods and salads I would not put her through a barium swallow. I have just done that and managed to inhale some. I am not going back for the food challenges. I know what I can swallow! The staff should be checking on her bowel habits if she can't stand she must be getting help. She needs a stool softener regularily start with half a tab. I doubt she could manage Metamucil because of the volume. Plenty of apple juice helps too. Everyone says make drinks cold but sometimes room temperature is easier to swallow. By all means have a hospice consult and consider a higher level of care and talk to mom to see how she feels about things herself and follow her wishes
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@Ashlynne: I don't know why you would think your Mother is "shutting down." It sounds to me like she wants to eat what she wants to eat (cookies and chocolate) and she will also drink what she wants (apple juice) and where she wants. Because she doesn't want the food the NH has to offer she doesn't feel she needs to go sit in the dining room, she may find the room and the other diners annoying or depressing to her. She'd like to eat alone but what happens of course, is she has her space invaded (she has never been a joiner!) by a staff person whose job it is is to make her eat the food she wants to avoid. You have said that 1) she is a vegetarian and that 2) you used to take her fruit. She also might find the smells of the dining room peculiar and/or off putting so all things being equal, she has decided to just skip the effort/experience entirely. So then as her daughter I would STOP the staff from making your Mother appear in the dining room and insisting that she sit at a table (alone?) just to drink her juice. This could be very humiliating for your Mother. This alone could create stress-related eating problems. I think perhaps it would be a good thing for you to begin once again taking her fruit, interesting colorful tasty fruit...maybe even something like chocolate dipped strawberries which you know would appeal to her. After surgery for a broken hip all I wanted for many months was cool and tasty liquid yogurt (Frusion) and in only one flavor, peach. (And I was relatively young, 59, at the time). My husband was a bit alarmed but he let this run its course and it did; it took two years but I eventually moved on to other things though my taste and desire for food (and wine) never returned to as it was before the surgery. You also might bring some creamy Greek yogurt to eat with the fresh fruit.
More important however is that you start a conversation with your Mother, as best you can, about her diet and the fact that she wants to limit her food intake to cookies and chocolate. Ask if she's even aware of this. Her response might surprise you. I wish and will pray that you and she will work this out together because talking about shutting down seems to be jumping the gun as far as your Mother is concerned.
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Does the NH staff think she is nearing her end, and shutting down? Would an evaluation for hospice care be helpful at this point?

While he was on hospice, I gave my husband what he wanted to eat. Some days that was only popsicles. Some days he wanted breakfast. Some days he ate almost normally. He ate small portions of a traditional thanksgiving meal, including wine and pumpkin pie. The day he died (two weeks after thanksgiving) he enjoyed breakfast.

If professionals think that your mom is actively in her final stage, it may be best to relax about the food and let her set her pace and preferences. That is why I ask about the NH staff opinion, and an evaluation by hospice. Always make food available to her, but don't try to figure out how to get her to eat it. Don't let the poor dear think she has to hide her protein shakes! On the other hand, if it is not close to her time yet, it makes more sense to try to coax some nutrition into her.

Hugs to you. This is a very difficult time in the caregiving journey. I felt privileged to be there for my husband on the last leg of his life journey, but it was also a painful time.
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