Should my mom's doctor stop treating her UTIs?

Two elderly women in my family, MIL 82, BIL's mother 84, passed away in hospice care after more than a year of suffering recurrent, hospital acquired (from catheterization), UTI's. Both also suffered from severe dementia and were bedridden as neither were able to walk anymore. It was the choice of the family to allow them to pass away as they no longer enjoyed any quality of life. Neither were treated for the UTI's while in hospice. Sepsis and starvation took their lives. Neither suffered pain as strong medications were administered by hospice doctors and each appeared comfortable. Dying is rarely easy. Extraordinarily difficult decisions must be made according to one's beliefs. These decisions should not be judged by outsiders.

Has anyone told why she's having recurring UTIs? From my experience not changing undergarments frequently and chronic constipation can lead to UTIs.

Four years ago when my mother was put on hospice due to a UTI, the doctor told me that UTIs in full-blown pathogenic mode eventually hit the kidneys and this is the least painful way to go; the patient just falls asleep from the buildup of toxins/bad bacteria not being filtered from the liver and kidneys. My mother recovered due to Old World genetics - she's a fighter! :-) I'm actually waiting for another UTI to come so I can put on hospice and let nature take its course. There's only so much suffering that one person should take. We can't reverse the disease process. And more painful health issues will surface. Its possible for the body to build resistance to multiple drugs that treat UTIs because of a compromised immune system.

You should consider her quality of life now as it is. At her age in a nursing home is she functional, lucid, socializing with others? Some residents are still striving strong but others not so much, unfortunately. If she were to develop sepsis from the UTI, does she want all aggressive measures - very painful/not very pleasant measures - to maybe recover - and then return back to the nursing home until the next medical issue surfaces? We all want as much time as possible with our loved ones but there is a time that the suffering is just too much and its time to let go - because you love them so much that you don't want them suffering anymore. I'm not saying your mother is there yet. But I'm there now with my mother.

I hope you both will get some responses on this, by those who have dealt with it. I have read a lot about these types of issues, in preparation for my LO's likely future. (Severe dementia, wheelchair bound.) I researched online about end of life decisions and read articles by doctors, nurses, and other health care professionals. I wanted to continue with Palliative Care, until Hospice is appropriate, in light of my LO's wishes for her end of life.

I recall reading that once infections set in, even if treated, they will reoccur repeatedly in those who are already ill and immobile. It sounds like you have a perceptive doctor, who has experience treating those like your mother.

Thanks, Sunnygirl. I wish my mom would talk about her wishes or even acknowledge that she might die someday. She doesn't have severe dementia, but definitely some cognitive/confusion issues. I know she is DNR/DNI, but that's a lot different than DTUTI (Don't Treat UTI - just made it up!)

Not that this needs to be said again, but it is so d*mn heartbreaking and stressful.

My mother is 91, after several admittances to hospital for pneumonia, we contacted hospice, at hospital doctor's advice. Their evaluation determined she be accepted as COPD is her direct line to eventual death. We determined her pneumonia was being caused by aphasia, which she had speech therapy for, diet changes (cut up food, thickeners). It has now been 3 months and she is doing better. Although she walks, is reasonable rational, she developed a UTI a month ago. Her palliative nurse was able to get prescription for UTI without examination. Along with antibiotic I always request a med for yeast infectioni (pill form). I was dragged resisting into this hospice situation because of prior experience, but have been surprised at the helpfulness of the hospice personnel. Also I learned a lot of things I did not know about end-of-life aid. Talk with hospice, they will help with decisions you need to make. It is your choice whether to go with hospice or not.

I think that a hospice evaluation will tell you much on this subject. It did for us.

We had a meeting with hospice about two years ago after my mom suffered a second bout of pneumonia in two months. We were able to see clearly that while they were able to clear up the pneumonia, each week long hospitalization set my mother back further and further, both physically and mentally.

Mom was determined to be hospice eligible by her doctor at the nh. We met with the hospice provider and discussed what would and wouldn't be able to be treated. We elected to go with palliative care, not hospice. For mom, this means that they will treat what they can "in house" and not send her to the hospital. She has had pneumonia once and it was successfully treated with IV antibiotics.

Xina, do you have a doctor or NP who comes to the house? Can they simply script antibiotics when she becomes symptomatic? 

My mother has been in hospice care at home for close to 1 year. She has a feeding tube (for meds or when needed for nutrition or hydration) she has a colostomy (which I am now proficient in caring for) and she has a foley (catheter). She was having persistent UTI's, which is not uncommon with having a foley, and is now on an antibiotic 3x's a week. I administer cranberry tablets crushed and dissolved into feeding tube on days she is not taking antibiotic. Hospice is very accommodating in keeping her comfortable. Thankfully my mother remains pain free. It is interesting that hospice will treat a UTI but they don't supply insulin. We get Mom's insulin through her private insurance plan. Mom is 92. I pray she goes peacefully but I would never not treat something easily treatable to allow her to pass on. My Mother is bed bound and I would not call this a great quality of life. She still knows my name and holds my hand when she needs to and cries at times with me joining in. She still waves and blows kisses to everyone. When she moves on is God's call. Till then I do the best I can for her. Bless you all and hope you all find good solutions for whatever you encounter on this caregiver journey. After all, we are all walking each other home.❤️

My mom is on Hospice. She is stage 7 Alzheimer's. She is bedridden, incontinent, has to be hand fed, verbally rambles most of the time, but does say a sentence here and there. She has had a number of UTIs. She lives with us and is extremely well cared for. She is changed every 2 hours and her Peri area washed, we use a barrier cream and expensive disposable briefs. She is kept hydrated and given probiotics. The UTIs are coming more frequently...it is not just because they are not changed often enough. Hospice does allow us to treat her UTIs in home. My mom is extremely allergic to penicillin so this adds to the issue as she cannot have anything derived from penicillin either. At this point, we have made the decision to no longer give my mom antibiotics. It is not that we are wanting to hurry along her death...we have done everything possible for the past 9 years to extend her life with the best quality we can. My mom is a fighter. She over came cancer, twice! I believe that at this point, the quality of her life is so compromised that she is ready for the next chapter...she is ready to go be at peace with her parents. We will do nothing to hasten her leaving this world, but we will also do nothing to force her spirit to stay. This was a long, tough decision for us to make. I think each family must consider all aspects of their loved ones life then make the best decision they can. No one else has a right to judge these decisions...it is so very difficult. I have to say I am so glad someone started this thread and for all of the comments...it has helped me to strengthen my resolve.

Wow, PamZ, I was just about to ask the same question. My mom (84, lives at home alone with 24/7 care after a stroke a year ago put her in a wheelchair and incontinent) has had 2 UTIs in the last few months - both of which landed her in the ER and one of which led to sepsis, but she recovered.

She has a large kidney stone, which is a big contributor to these. Unfortunately, it is large enough that it would require minor surgery and general anesthesia; her urologist thinks she might not be able to tolerate all that, given that she frail and has multiple health problems.

Today her dr asked me if I've considered hospice, which I haven't. I need more info about this. I understand if she had terminal cancer that it would be time to stop treatment, but it's tricky with the UTIs. It is very traumatic for her to keep going to the ER for these; on the other hand, they tend to make her acutely ill - diarrhea, chills, and vomiting. I can't imagine just saying "we're not going to treat this or take you to the hospital," just let you become septic and die. That seems cruel, yet, again, I understand that routine hospital stays for these are crazy too. I'm stuck. What would the scenario be if we didn't do anything? So scary.

Nobody is going to live forever. Hospice care can be helpful and some actually live longer than expected with Hospice. While conditions that are painful should be treated, the older you are the closer you are to death. Treatments should improve the quality of life, not prolong it at all costs! Better a shorter quality life than useless treatments that offer a longer life of pain and sickness.