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He is over 90 now, has not recognized the family for over 4 years. He is still given treatments for his diabetic condition and injections to encourage eating. Am I wrong to believe all meds should stop except to relieve any pain? I know he would not want to live like this. He is in an ALZ unit.

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I don't have an answer, but share your feelings and concerns. If doctors have hope of recovery and some quality of life, that's different. Praying that God will give you wisdom and guidance. (((( Hugs ))))
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My belief is like yours, that it is OK to stop treatments other than for pain. However my own experience is that it is easier to make this happen in a hospice/ palliative care environment than in many nursing homes. My MIL lived like this until she was three months short of 100. The nursing home and its doctor believed that it was their legal responsibility. I would love to hear any ideas about how to deal with this.
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i would have him on hospice care. They have their own dr and their nurses will guide you. If he is not eating or has swallowing issues, it may be time. With not eating, his organs will eventually start to shut down. Hospice will come to the nursing home.
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I'd try to find a Hospice that provides Hospice care and Palliative Care. Some do both and they can explain the difference, so you can see what route is best for your LO and if he qualifies for Hospice. My LO is on Hospice now, but, before that Palliative Care. Only meds that provide for her comfort are not administered. She still takes pills for her Type II diabetes.
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I agree that you should look into hospice for him. Does he have a DNR? You'll need this if he is hospitalized. Hospice can be a wonderful resource for you. Personally, I agree with only having palliative care at this late stage. I'd rather go with some quality of life versus quantity. Blessings to both of you at this difficult time.
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I'd like to point out that you are not withholding food, just allowing him to eat if he wants to. You don't want to keep giving him shots to increase his appetite when he really does not have one. I see that as the body shutting down and think it is wrong to prolong it more than it already has been. You probably cannot avoid giving him insulin, as that is for comfort (kidney failure is very very painful! and a consequnce of high sugars).
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Hi - I don’t have any knowledge about the shot to increase appetite, but with what I see with diabetes you want to keep controlling that. surprise names just one longer-term reason; watching my mother, there’s also undesirable loss of control in the moment with poorly controlled blood sugar. It seems sodium and magnesium imbalances also create a lot of bad things in the moment. msPat, talk talk talk to the doctor and nurses. Best wishes, and I’m sorry for how hard this must be.
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Do you know when they last checked his HbA1C?

As weight drops, insulin needs to be adjusted. Mom's daily readings were normal with an occasional low dip in the mornings. Even so, she started having morning episodes where her mind would completely go. This went on for months. Sometimes they lasted into the afternoon. We were told it was likely lack of oxygen by the nurse even though her oxygen readings remained normal. I finally remembered a doctor once telling me insulin needs to be adjusted with weight so I demanded a HbA1C. Her insulin was not just lowered...they discovered she didn't need to be on it at all! A day later, our Mom was back. No more mindless morning episodes. This may not be the same in your case, but don't assume they are tracking his insulin as his weight drops. Ask to see his last HbA1C test results.

Mom was in Palliative Care at home for 11 months, then transitioned into hospice the last two weeks of her life. She was prescribed a pill to increase her appetite, but it didn't work. We took her off all her meds in increments. It was difficult because we had to acknowledge she was dying. First the vitamins went, then her allergy and acid reflux meds. We consulted the Palliative Care doctor when it came to her thyroid and heart meds, and she was taken off them when she transitioned into hospice. The only meds we continued to administer and increase were for pain.

Recommend a heart-to-heart talk with his doctor.
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Just as a knee jerk reaction to your question I would say:

- you can't not treat diabetes, as far as controlling blood sugars from day to day goes at least.

- you can not give an appetite stimulant.

Why? Because... [thinking aloud]

Insulin and routine blood monitoring are basic systems maintenance, not onerous for the patient, not heroic, but preventing extremely unpleasant symptoms. To withdraw these would be at the same end of the spectrum as withdrawing food and water.

An appetite stimulant, on the other hand, goes beyond routine care and by implication anticipates a future where the patient, having "got back to normal," will resume his previous habits. Since that is not going to happen, there is no benefit to the patient in having his appetite stimulated in this way. Mind you: stimulating his appetite in other ways, such as offering well-presented treats, snacks and drinks, is still worth doing because any potential enjoyment is of value to him in itself.

But in principle, no I don't think you are wrong to want all medication to be withdrawn unless it is of demonstrable, realistic benefit to the person *as he is now.* Where you might want to stretch a little bit is in relating the person's present condition to what he would theoretically have thought tolerable when he was fit and of sound mind. He isn't the same person now, and his personal red lines will almost certainly have been re-drawn.
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When my father was in a very similar state I stopped all medication (he was on very little anyway), except for pain meds if he seemed to need them. He could no longer hear, see, recognize family, speak, move his body himself. Why fight with the dear man? (And he resisted meds, so it caused him distress to adminster these.) After speaking with a medical ethicist I directd his AL doctor to end any medication except for pain. After about a year he developed an infection and was placed on hospice. The first thing the hospice nurse wantd to do was prescribe an antibiotic, and I said no. The point was no longer to prolong a life that already seemed like a living death for my father. He died a day after being place on hospice.


At some point it's not a matter of extending a person's life. It's about letting them go in peace, I believe.
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I would contact Hospice.
They can help you make the decisions what to stop and what will be the result of stopping the medications.
Hospice will also provide medications that will relieve him of pain.
You will also have the support of a Nurse that will see him weekly, a CNA that will come in at least 2 times a week, maybe more and a Chaplain if you would like and a Social Worker.
You can talk to the director at the facility he is in and ask about the different Hospice organizations that are in your area. Then call each and "interview" them and ask for an assessment.
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I agree about contacting hospice, but if you father has a living will, I'd use this as your guide.
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well he might be already to go on his journey ..i stopped my mom from taking medicine about a week into her hospice care .. it does not hurt to treat or not to treat eat or not to eat ..it prolongs there life at the point he does not get out of bed
he will automatically will do it by if he chocks b/c they forget to eat & drink ...we gave my mom yogert = bad spelling sorry . so my stance was to help her as long as i could i do not think he really needs the diabetic stuff what difference is it going to make ..but to finish the meds off so be that but to keep giving him more so money is made no!! also his breathing is going more shallow ...but to treat the rattling a asthma inhaler can help i do say use that will help him to be more confortable they say it does not matter i think it does . my mom had dementia ..so you will know when to stop - when he chocks ok ..be more cautious then go very slow ..i did everything right for my mom ..use your feelings pay attention that will let you know to do the right thing or not ..god made us that we would know what to do or not ...unless you are deaf to your own feelings .dont seem that you are deaf good luck ..also if you have morphine to use they should give that to you or him ..that do not stop use when needed .do you have him on hospice care he needs to be on that ..my mom was for 3 weeks so ok by good luck
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To continue treatments is inhumane. Doesn't he have a living will?
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No. Before my Mom passed away with ALZ, I had her put under Hospice. Only meds given were pain and only treatment given was to make her comfortable. She passed away peacefully.
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Have hospice make an evaluation.
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That’s a tough one but I am with you. Not sure what I would do because of diabetes. I asked them to stop th BP meds. It wasn’t that high in the first place and she would get dizzy. I don’t see the need for vitamins either. The only thing my Mom is on is boost as a supplement. I may ask them to stop the aricept. She has been on it for 3 years. I don’t see any change anyway.
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My mother had ALZ and had fallen & broke a pelvic bone. We had a hard time getting the medication from her doctor that she needed to make her comfortable. When I asked for something stronger like morphine I was told she might become addicted. I said "My God, she has ALZ why are we worrying about addiction". A couple of weeks later it was obvious that she was dying, and seemed to be in pain. I called the doctor and asked for morphine for her. He refused questioning how we knew she was dying, and said we would have to take her to the hospital & have her assessed. So we called for an ambulance to take this 92 yr. old woman who was dying to the hospital. When we arrived I told the doctor in charge in the emergency room what was happening. He said "Some doctors have a hard time dealing with death". He said he didn't know when she might die, it could be two weeks, but he gave us a prescription for morphine and told us to have the ambulance take her back and give orders to the nursing home for DNR - Do Not Resuscitate. We drove to an all night pharmacy 35 miles away and returned to the nursing home with the morphine. She died the next day in peace. Please, if he has a living will, let your father die in peace also.
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I believe that diabetics and people on kidney dialysis are fortunate because they can choose when they die by refusing treatment--if they are mentally cognizant to do so. I have known someone in each of those situations, and that is what they did. However, as suggested, calling for a hospice evaluation is a good idea. They will give palliative care only if they believe your LO qualifies--and being 90 with Alz seems like a qualification to me. People stop eating for a reason, and it is because it is time for them to go. Hard to watch, but they really don't seem to suffer. Hospice will give mouth care so that their mouths don't dry out, and whatever food or drink they want--which is usually very little. Best of all they give morphine for pain and when the last days arrive--which they can tell by observing the mottled condition of their hands.
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jacobsonbob Oct 2018
I recall reading that it actually makes a dying person very uncomfortable to eat if at the point at which s/he doesn't want food because it will stay undigested in the stomach for a long time.
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Contact hospice and transfer him to home hospice or to a hospice center. You may be able to start the conversation with the doctors by asking about "Allow Natural Death".

There is no hope for recovery from Alzheimer's disease and he is 90 years old. Death with dignity is what I think you want for him. Unfortunately, his doctors do have a monetary incentive to keep him alive and keep Medicare paying. It's perverse but, sadly, it is how our system has come to work.

Doctors do not have the final say especially when you and your family feel that their ongoing treatment of him goes against your family's cultural and/or religious beliefs and what you know his wishes would have been.
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No, you're not wrong. Hasn't hospice been called in? If not, it is overdue.

If you're his daughter or spouse, have a straight with his doctor. Doctors often err on the side of treatment and they need to clearly hear the immediate family's wishes with regard to over treatment.
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My mom is in her last days & they advice keeping the insulin as without it your LO will feel nauseous & generally bad - I'd stop the others though - we have mom in pain & some small amount of insulin but just the long acting as all the rest have been discontinued - both are 'comfort' meds only
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my dear father died earlier this year from ALZ. In the last couple of weeks, he didn't want to eat and my mom and I were encouraging the staff to feed him as we figured if he didn't eat he would die. Well, he was dying anyway.

One day we asked them to feed him and he threw it up and died later that day. Probably not the main reason, but hard to shake the guilt that our forcing him to eat killed him. But it may have been had we not encouraged eating he would have been more peaceful on his last day, whenever that would be.
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Is he in hospice? If no that you are wrong. If yes you are right.
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Thank you all for your very helpful suggestions and moral support. I will set up an appointment with his doctor.
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I DON'T KNOW THE STATUS OF HIS HEALTH IS, BUT I WOULD CERTAINLY TALK WITH HIS DOCOR[S] ABOUT THIS SITUATION TO HELP YOU FEEL COMFORTABLE WITH ANY DECISION YOU MAKE. QUESTIONS TO CONSIDER: DOES HE STILL EAT A FULL MEAL? 3 MEALS A DAY? DOESHE WANTY TO EAT OR IS HE BASICALLY JUST MADE TO EAT? IS THERE ANY QUALITY TO HIS LIFE? ENJOY MUSIC, TV, ETC.?
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Your heart and head are in the right place . We forget that dying is a process, and what your LO has already communicated to you and your family should guide you.

Doctors and staff sometimes have rules that prolong life needlessly. Ask for a gerontologist and hospice advice to guide you.

May you and your family be at peace.
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I would advise you to get Hospice for your LO.
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My husband is on Hospice, and they tell you that when someone starts sleeping more and eating less, that this is a sign they are getting ready to leave. When this time becomes evident I will stop all my husband's medication except those for his dementia. My husband and I have talked about this and feel comfortable with that decision. Right now he is sleeping more but still has a very good appetite.

This morning I am going to pack a picnic lunch, and we will take our aluminum chairs and go sit by the river at one of the most photographed spots in the country here in Sedona.
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