• Alzheimer's Disease: Understanding Sundowning Syndrome
• Choosing Between Hospice Care & Palliative Care: An In-depth Look at Your Options
• Hospice Care & Palliative Care: Choosing the Right Level of Care
• Alzheimer's Disease: Understanding Wandering Behavior
• The Importance of Partnering with Physicians in End of Life Care
• Artificial Hydration & Nutrition in Advanced Alzheimer's
• Hospice & Palliative Care: Where's the Common Ground?
• Determining Hospice Eligibility for Dementia
• Hospice Care: Living with Terminal Illness
• Living with Dementia: How Hospice Care Can Help

COMMENTS
5 Responses to “Artificial Hydration & Nutrition in Advanced Alzheimer's”

1. Charlie Says:
   

   Hi my name is Charlie i am 21 and i have a mother who was diagnosed with alzheimers disease and I live with 2 brothers,one sister,and my father and we find it really difficult to deal with the dimentia when it comes down to anger issues because she refuses everything and anyone.In this case how would you deal with this situation and how would you give her the prescribed pills she needs that were given and prescribed by a doctor.She is at Level 7 I believe but on her good days she does not have a problem eating or anything and sometimes she remembers how to respond to a question or ask for something out of the blue which seems irregular cause usually she doesn't make sense when she speaks.Any advice given, i would be more than grateful for.Thank you:)

2. Audrey Wuerl, BSN, RN Says:
   

   Dear Charlie,

   As this article outlines, there can be various reasons a person with Alzheimer’s dementia refuses to eat. One thing is certain: forcing your mother to eat when it is not clear why she is refusing can be counterproductive. This is the same for trying to get her to swallow pills. She may need to be evaluated by a qualified professional to determine if she is having trouble swallowing. The cause of her refusal—while taken “personally” by the family—can simply be a progression of her disease process. I suggest you discuss this behavior with her doctor and determine what is “safe” regarding feeding her.

   Difficult behaviors with Advanced Dementias, such as refusing to eat, angry outbursts, etc., can be challenging to you, your father and your siblings. This is especially true when you describe her “good days”. Families need to remember that behaviors with Alzheimer’s are changeable and will become more difficult to deal with. Ultimately, you may need to think about professional care for your mother outside of the home setting.

   Celebrating Life!

   Audrey Wuerl

3. Pam Veelle Says:
   

   It is also important to remember that sometimes these behaviours may be related to a secondary medical problem, bladder infection, pain they are not able to communicate, and various other issues. It is always important to check with her doctor when you see a significant change in her bahaviors. It is hard not to take refusal personal but remember the best way to honor mom is to honor her choices after you have ruled out medical issues. The progression in refusing to eat is a normal process of this disease she is getting ready, are you? Hope this helps, I know it is hard I am at the same spot with my mom. Hugs

4. Dianne Says:
   

   My mother is 88 years old living in an assisted living facility. She is not oriented to time or place, but does recognize her adult children. She can get to the bathroom with a walker but needs a wheelchair for any greater distance. She is occasionally incontinent of both urine and feces. She recently stopped eating. The facility contacted her doctor who prescribed megace. I was stunned that he did this. Now she is constantly gagging and dry heaving. I don't see how this added to the quallity of her life at all. Why would a physician be trying to prolong her life at this stage?

5. Audrey Wuerl, RN, BSN, PHN Says:
   

   Dear Dianne,

   Your mother's physician has prescribed a medication that helps stimulate her appetite. Sometimes this is helpful if a patient has been on chemotherapy, for example, and has difficulty with nutrition. The assisted-living facility wants to see your mom "thrive" and, too, they are closely regulated by Medicare which means that patients should not be losing weight. With end-stage dementias this is the normal, expected progression when death is near. Your mom may have "quality of life" as she can still recognize you (be happy for that!), ambulate, and eat. From your description, she does not seem like she is near death.

   You might want to contact your local hospice, and have your mom evaluated for "appropriateness" for their services. Remember, patients must quality for this benefit. On the other hand, it is never too early to call your hospice. If nothing else, they can help advise you.

   Hospice is all about quality of life and making your mom comfortable, pain free, and symptom-managed. We encourage our patients to eat and drink whatever they want—however, we do not force patients to eat when they choose not to. In your mom's case, we need to understand why she chooses not to eat, is having trouble swallowing and if her food need to be of a different consistency. The hospice philosophy believes in "following the lead of the body" but that does not mean we would ever starve someone. You did say she was now "gagging" which indicates she is still eating (she may just need a minor adjustment in the food she can eat).

   My experience with physicians is that they try their best to follow the oath of their practice: to cure and prevent the suffering of their patients. You could talk to him about your concerns, and let him know about the gagging and dry heaving. There may be more going on with her that you do not know. Good luck!

   Celebrating Life!
   Audrey

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