Should my mom's doctor stop treating her UTIs?

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.

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.

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? 

PamZ, from what I have read, even if one is on Hospice, the patient will be treated for an UTI. It is one infection that is extremely uncomfortable.

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 think an evaluation for hospice would give you more input to consider, and not obligate your mother in any way.

My Mom has passed on, but for me if it was my Mom I'd skip the doctors all together and give her natural remedies. For instance Olive Leaf supplements are wonderful or an ounce or two of colloidal silver given orally is a great cure. But to let someone die for something so simple to cure? I couldn't do it. UTI's bring on so many horrible side effects like dementia and hallucinations, I'd think by curing it would be a much more desirable option. Why is everyone in a hurry to let their loved ones go and painfully I might add? I realize that NH will not administer these things nor will docs prescribe them or believe in them, but if there is a will there is a way.
IMHO I truly believe most of our seniors are suffering at the hands of today's doctors and way too many prescriptions and the lack of decent care.
You might want to think twice about Hospice unless you want to get rid of your loved one fast.

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.

My mother has had UTI's from having severe diverticulitis and not clean enough.
However. .... My dad is looking after her and forcing her out of bed and dressing her. Neither of them can face up to their end of life care. They are 95. She has no life now never goes out , doesn't eat and I know she would prefer to slip away now . I wouldn't watch my dog suffer like this and she can't take antibiotics because she is allergic to them. So if my dad wants to treat her at home and basically not face up to her dying he is in denial that she is slowly deteriorating and suffering . It's not we want rid of them early it's just between them and there relationship and we can't intervene .

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.

To each his own, I'm not here to judge anyone. Everyone's situation is different and what I wrote was nothing more than my own personal opinion. I'm truly sorry if I offended anyone. I just believe our seniors deserve to be treated with the upmost dignity and respect. And unfortunately have very little faith in today's doctors and pharmaceuticals.

.... not gonna offer you many suggestions but this; I refuse catheters when my mom enters any hospital, and I am very serious about that. Catheterization are what most gain the uti from. Second cause, dehydration will cause utis almost as often. Third cause "yeast (unclean)... I will say this, dying from a uti is not dying painlessly as I'm reading, unless the patient has become so septic their brain no longer recognizes pain (highly unlikely) but before that the individual has indeed had "pain and if individual dies from not being treated when treatman was available, well folks, that's called death by willful neglect, etc . Dying from an infection, is never a natural death, never. 

Correction my post, my mother has asphagia, not aphasia.

Yes that is how many patients will pass since many will become septic. Only you can decide on her quality of life.

My Mother is 98, broke her hip at 96 and had a successful hip replacement. BUT...she could not do/keep up with the PT and became bed ridden and landed up in a nursing home. Currently she's been in a nursing 2 years and during the last year I placed her in Hospice Care. She is actually doing a bit better the last few months. IMO Hospice is another set of helping hands and reports weekly to me, whereas the nursing home would never even return my calls. Hospice has a chaplain stop by a few times a month, and Mom gets weekly visits from her Hospice nurses. I should have mentioned I live 2000 miles away so Im grateful for an extra set of eyes/hands on my Mom. At my mom's age things don't get better, but as long as she is comfortable/ pain free and not mistreated in the nursing home I am very grateful!

My Mom is 92 still lives on her own. She gets UTIs from time to time. I buy her cranberry juice and also give her probiotics for urinary. I can't believe some of the responses I am reading here. You'd rather not treat, call in Hospice, which I would never use. That org to me is evil. My personal opinion. There is no way I would leave it to a so called Dr or NP to not treat just because. I always thought Drs took an oath to treat and cure not cause death. Sorry if I seem harsh but my sister in-law's mother will be 101 this Sept and also suffered from UTIs. The doctor took her off of some meds and then prescribed a natural supplement along with a tsp of coconut oil every day. That was 3 years ago and she has improved greatly. My sister in-law refused to just let her mom deteriorate just because. Her mom lives with her and has a daycare person come to the house every morning and afternoon. She keeps her mom company and helps with her daily routines. Its amazing what this does for her mom. Please find a Dr that is willing to treat with other common sense methods or change her meds as that can be the cause of the problem. Be happy your Mom is still around.

I think Amitebird offers some valuable information. If it can be treated without hospitalization I would have her treated for the sake of her mental and physical comfort and to avoid the hospital. A UTI is what took my mother. She only had one, but between the time it took to realize she had an infection, wait for a culture, run 10 days of antibiotic, run a culture again, run another 10 days of a different antibiotic...it took 31 days to cure. She had already started a rapid decline and we left rehab for home and hospice care. She was gone in three weeks.

Think about your mother's quality of life from HER perspective. Did you have discussions regarding what conditions would be acceptable and what conditions would make her prefer not to live any longer? Decisions must be made based on what she would want.

People say my being my mother's caregiver extended her life. The psych Doc in rehab was amazed she was so engaged and focused and responding as well as she did given that there was absolutely no memory there. She would not have wanted to live like that - did I do the right thing? I did my best, but recognize that maybe she would have preferred I did it differently. When I saw signs that she wanted to go, I brought her home and moved to ensure her comfort and let her go as quickly as possible. But there are no black and white answers. You may always wonder if you made the right decision. All you can do is your best, make her desires you guide.

did you mean "this would be the time to DIScontinue to treat the UTI's"?

My philosophy would be first to avoid as much pain as possible, even if it leads to death. If the UTI is painful, then treat it or if possible just treat the pain it is causing. Most people in their 90s are tired of living, and kidney failure is indeed a good way to go from my observation of my mother. Unfortunately my cousin, a year my junior at 78, was treated for UTI and colon cancer (via surgery) and died anyway after a lot of pain caused her to beg for an end to it all...but her family pushed her to "fight."

Oh my. I just posted a question the other day about my mom having surgery for a prolapsed bladder. She has been getting uti's more frequently, depend, infrequent baths. Also she has been put on risperdone for getting nasty and mean. Another uti symptom. I have decided to get another opinion from a well known urologist whether to do surgery or not. I will never know unless I try. Someone mentioned that her tissue might not be strong enough. Another has mentioned that this might be the beginning of the end, instead of the dementia running its course. It all sucks.

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.

My Mother-in-law has late stage Parkinson's. She has been in the hospital at least 3 times now and rehab 2 times since January with urinary tract infections and an intestinal infection due to the constipation that comes with parkinson's. Urologist determined that her UTI's come from incomplete emptying of bladder and the inability to completely clean herself due to the Parkinson's mobility issues. The only solution left was a supra pubic catheter (through the abdominal wall into the bladder with a drain into a bag that must be emptied promptly and often). She was living at home with father-in-law until the 2nd hospital admission in June, and has been admitted to Long Term Care as of July. Father-in-law will not manage the catheter and clean up for her, Mother-in-law cannot self care for the catheter, and home health kept getting sent away by both of them for "interfering and being lazy". Even with a probiotic and antibiotics, MIL kept getting the UTI's. There are many strains now that are resistant to antibiotics and the cleanliness issues are only solved by constant availability of health care assistance which even at AL is not 24/7. MIL is miserable even though the catheter seems to be working on the UTI's since she is no longer living at home with FIL. She has now told her sons that she is in God's waiting room at the assisted living/nursing home and that she was put away by FIL. Was treating the UTI's aggressively here the right decision? Both sons are questioning it now, but the deed is done. FIL is fine with it....

While we can't post links here, for the most part, I think it's important to talk frankly with the doctors and to carefully research and read about the process of aging, decline, infections, end of life care, etc. I was surprised at what I learned.

Treating some conditions does not always help or prolong life. There are professional articles about these matters that can be found through your doctor, health care provider or online.

Have the talk with your loved ones about their wishes. I did, but still it was so very hard. She was first in and out of hospital with a UTI ( she had home caregiving to assist with bathing, but still a UTI), declined a great deal, became psychotic (I am sure from her medications) then assisted living, to then nursing home. Good facilities with such loving care and employees. However, she was medicated improperly by the Medical Director, and even though I could see she was ready to die and was 'doing so', they (the Medical Director and the Marketing Director) refused to speak of this and made her dress, go to 'activities'. Even stating that 'she loves it and is doing so well'! Ridiculous, anyone could see this was not so, such gaslighting. We called in hospice to add to her caregiving, and additionally had our own paid caregiver there 6 to 7 hours daily for her comfort and companionship. She was wonderful, and that is an understatement. I live 500 miles away, but came to visit over 30 times, 200+ days. Mom continued her decline, and we wanted it to be as natural as possible. Her wishes. Remember, hospice is paid a $200 per diem by Medicare and wants your loved one to 'live' as long as possible, no matter how horrible it is for them. The visiting hospice agency was not doing this well at all and improperly administering her morphine dosage (too much and too long between dosage). In desperation, as hospice would not adjust her palliative care meds correctly, I had her case reviewed by a residential hospice facility, two nurses, a psychiatrist, another physician and my own research. I then decided, on their advice, to remove her from the NH and take her to a residential hospice facility. I did not of course want her to die, but she WAS and had been dying. The rez hospice were horrified at her condition, and gave her the proper palliative care. Mom had been falling repeatedly, hallucinating, and just miserable (no UTI). She also had Terminal Agitation that was not noticed or addressed in the NH, by the MD. We believe her falls caused a concussion, and she died at almost age 98 within 4 peaceful days at the residential hospice. It was actually a beautiful experience, but she went thru such unnecessary agony that she didnt want nor did I, to get there. The guilt is non stop and my husband says we have PTSD from the experience. Honestly, I dont think these people meant ill, they were frankly all quite sweet and honestly I miss many them, but our system for handling the infirm and dying is set up to pay very well for long term care, and this clouds actions. Without their even knowing it sometimes.

My new standard answer:
What would you want done for you? Because Karma is real and the care we give is going to be the care we get.

So go look in your mirror and ask yourself, what would you want done for you.

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.❤️

This is a horrible thing to ask of a daughter. To stop treating UTI'S? Fire that doctor immediately. You are allowed to have any doctor you want take care of your mother in a nursing home. it doesnt have to be the 'staff' doctor.

My mother, now 86, has suffered from chronic UTI's for years. It was not until we had her hospitalized from seizures resulting from these infections that she was able to find relief. Her kind hospital doctor said that he didn't think it was going against her living will to put in a catheter, get a clean catch (which they weren't able to do in the ALF), and take it out.
Getting a clean catch and having it cultured is the only way to know which antibiotic is the correct one. She had been taking the wrong ones for years, as the bacteria she had was a very rare one, according to the doctor. Many months have gone by without a new infection developing, and when one did, I had them use this method again. After all, how "comfortable" is a UTI, as painful as it is, especially when it leads to seizures.

Hospice is there to ease pain and suffering and mental anguish for the patient and help and comfort for the caregivers.
To be admitted there must be a terminal diagnosis with the expectation that the patient will die within six months.

They will continue medications for the admission diagnosis as long as it is beneficial for the patient. Other conditions remain the responsibility of the patient and family. If the diagnosis is heart failure but the patient also is diabetic they do not supply those medications but will offer helpful advice and visit if there is a crisis.

Things like infections may or may not be treated depending on the patient's general condition and  the wishes of patient and POA. If family does not agree with hospice decisions they are free to have the patient discharged and seek more aggressive treatment. There is not a problem with readmission after treatment. Hospitalization and visits to the ER are strongly discouraged and can lead to the patient's discharge from hospice. Sometimes these are deemed necessary by the RN for many reasons in which case it has no impact on the patient's status with hospice.

Every few months there is a five day respite when the patient can go to a hospital or NH to give the caregiver a break. Hospice nurse continues to follow patient and has to approve changes in treatment.

These are always difficult decisions to make and there is no right or wrong choice and there should be no guilt. After all there is no way of knowing the outcome of a different decision. The wishes and welfare of the loved one are the primary goal.

They are preparing to die and that situation must be respected however much the caregiver wishes otherwise. You can only do your best.