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I don't have any advice, I am just reading all the comments and wondering what choice we will make. My mother, 99, with moderate dementia is anorexic and dehydrated. But this is nothing new, she has been this way for years and years, lousy eater, won't listen to anyone, doesn't want help, refuses to go to assisted living. We have given up trying to help her, advise her or get her to move. This is the way she wants to live. She lives on ensure, sweets and soup although we buy her healthy food and the facility provides meals. We know eventually her body will give out, considering her age. We're amazed she is still able to get up, dressed, put on makeup and get around. She even insists on walking up and downstairs (to our horror). They can't even draw blood on her because she is so dehydrated. We know the end has to come eventually, probably she will fall and end up bedridden. Then we will have to make a choice of a feeding tube to prolong things. I don't know what we will do, considering she wants to live (I guess) but she is self destructive and will carry on and have to be sedated if she is bedridden. I wish there was a perfect answer!
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I hate to seem unfeeling, but a feeding tube is NOT EATING! Would you want this done to yourself? I can't imagine just existing, which is what this would be. If I am totally incapacitated I hope people have the common sense to let me go. My Mom and Dad long ago established Living Wills that prevent anyone from using artificial means to keep them alive, including respirators, feeding tubes or anything that would prolong their lives simply to keep them alive. Think about it, please! Just existing is not living. Theres one thing about fighting for your life, but when the situation is basically hopeless it is time to pull the plug.
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I would NOT opt for the feeding tube. My mother-in-law also suffered from severe dementia. She was in a nursing home and had been dropping weight steadily over a few months. She went from about 1120 lbs. to 78 lbs.; she was 5; 6". Like your mother, she was simply uninterested or unable to eat or drink much. She could no longer speak. My father-in-law and husband, like many previous commenters here, wanted to do what they thought she would want and what they wanted: do everything possible to sustain life. They got PEG (gastric tube) that delivered a high-calorie formula directly into her stomach. She was pretty immobile at that point anyway, but she became completely bedridden. She then ballooned up to 147 lbs. (more than she had ever weighed in her life) and lingered in that immobile, semiconscious state for another 10 years. I made my husband swear that if he was ever in a position to make that choice on my behalf, that he never, ever choose the feeding tube. When one's brain is failing--disintegrating, really--as it is in Alzheimer's, your body naturally begins to respond in ways that will ultimately result in a natural, relatively painless death from malnutrition. My mother-in-law's ultimate death was terrible. She developed congestive heart failure; her lungs filled with fluid and she choked and gasped for days before finally expiring. Sorry if this is a brutal message, but you must try to foresee the ultimate consequences of such a momentous decision. For my part, I would choose not to intubate your mother. It may be time to let nature take its course.
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Absolutely NO feeding tubes for demented patients. Unless you can hire caregiver to watch that tube 24/7! You will do more harm for your mother when she will pull it out every day. Yes, catheters and tubes do not go together with Alzheimer's. Even though I understand your concern for mom's health, you need to find a way to entice her eating: fresh fruit cup, scoop of frozen yogurt with fruit, apple dipped in caramel, fresh made smoothy and fresh juice (carrot+apple+orange+etc...). OK, instead of hiring somebody to watch tube I would hire somebody to squeeze juices all day long and offer them to your mother every 30 minutes" "here dear, make a sip or two!"
I nurture patients back to life simply feeding them the best -- fresh organic food!
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My mom was mobile until her last 3 days. She refused to eat and drink but could occasionally be coaxed into a few bites of food and a little to drink. We read all the negatives about feeding tubes and actually talk to people who had done it and regretted it so we decided against it. I am sure that we made the right decision about that.

Have you called in Hospice yet? We latched onto any small bite of food as an encouraging sign and it put us back into denial. My one regret is that we waited so long to call in hospice. Their purpose is to make your mother as comfortable as possible and to give you emotional support. They will send in nurses and CNAs to give your mother extra attention to supplement the limited attention the NH staff can provide. Sometimes the extra attention causes an improvement and people do graduate out of hospice. If not, at least they are as comfortable as possible to the end.

My heart goes out to you. It is a terrible disease and it is so hard to see a loved one go through it.
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My mom is still pacing and walking. Most everything Ive read on end stage is that they are immobile. She is refusing to eat and drink, but still actively pacing around. Anyone have any thoughts on this!
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Hugs Sujean, I know it is so hard to come to this conclusion. Glad your brother is on board and understanding. It was a very difficult time for us to watch Mom go through, but she is free now and I am sure in a better place. Just framed a lovely picture of her today from a few years ago as this is how I want to remember her, not with all the tubes !
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We have decided to not place a feeding tube. If she needs an iv to rebound then if it is possible we may try that once. Since she is a pacer and I mean moving all the time, I don't think that an iv would work for her. I do realize that this is the end for my sweet mom. I have talked to my brother and he is beginning to except the end. It is comforting to hear others in this same situation and how they dealt with it. Though this whole process in the last two years as I was a caregiver, I have found great comfort and information on this helpful site. There are many caring people on this board who have brought me comfort and for that I thank you!
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I am an only child and only have POA in writing. My mother and I have discussed many times what she wants as far as cpr, a ventilator, feeding tube,she doesn't want any of that if it is to prolong her life not the quality of it. Right now she is very alert, no dementia, just mobility problems for OA and the pain meds.The morphine she is on means she no longer drives, she lives with me but still is awake, can dress and feed herself,not cook, needs assist with a shower .Do I need the actual papers of a living will and medical power of attorney even if I am the only child,also she is an only child and I have no children. I would be comfortable at this point that if something catastrophic like a sever stroke happened of not putting her on a vent ,feeding tube etc because I have talked with her so many times even before she ever started on morphine about what she wants and doesn't want. Our plan is that she will stay in our house till she dies. When the time comes we will get hospice. She wants her privacy and her 2 little dogs with her.This is such a hard decision.
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Does your mother have an Advance Directive that tells you exactly what she wants or does not want in the way of health care? If she were in complete possession of her faculties, would she want to prolong her life as it is today? To stop eating and drinking is the body's natural way to die, and is not painful or traumatizing to the person as one might expect. Many times we don't want to let our loved ones go, but in fact it is the most humane thing we can do for them. I believe this is especially true in the case of Alzheimer's and other progressive dementias. She will not recover - there unfortunately is no cure. I would not, however, consent to a feeding tube in her case. God bless.
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Sujean, I agree with everyone that this is a very difficult choice to make, so please comfort yourself that you can only do your best with it - there is no certainty.

I wondered if one other way of looking at it might help to clarify the choice for you: if your mother were given this feeding tube, is there any prospect of its helping her get better to the point where she wouldn't need it any more? If there is, it's worth trying. If she'd need it for all her remaining days, maybe it would be a burden for her.

Please let us know how she's getting on, best wishes.
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My heart goes out to you...I just had to make this decision in February. Mom had lost weight..104 to 89 lbs in a couple of weeks, had three infections..I almost lost her 4 tiimes. Mom and I had talked about this long before she got ill.....and teh doctors wanted to do this...even though she is now 88 and cognitively very aware, I opted not to do the tube. It was the right decision....Mom is still alive and enjoying things again, although she has some things she is recovering in rehab for...I researched the topic of tube feeding and unless it is in a case of someone having ti to get them through chemo....personally I would not do it. I had a couple of staff members at the hospital tell me what happens....and my research confirmed it...hope this helps you somewhat.
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I'm sorry you are dealing with this disease...it's frustrating and you feel helpless. But understand that Dementia is a disease and it affects areas in the brain that will eventually disconnect. Her eating and drinking is the last stage of this disease. My sweet mom at 91 stopped eating a year ago last January. She had a DNR so my job was to make her as comfortable as I could for her last month. It's a grueling thing to endure...but as much as I would have done anything to change it. I couldn't. My mom lost her battle after 9 days of no food or water. My heart goes out to you. God Bless.
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Hello im 31 and a have park 2 gene is this posibile
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Thanks everyone for your input. My moms vital signs are still good and her kidney function is good. Her sodium and potassium levels normal. What I meant by healthy was she doesn't have any real medical problems beside the alzhemiers. I knew that the not eating would be the end of her. She wasn't eating much at my home and had started forgetting some foods. She had forgot how to eat corn on the cob. She had forgot that she really liked it. She looked at it like she didn't know what it was. I didn't know that they would stop drinking fluids. She can not reason that she needs to eat to live. I don't really want to put in a feeding tube, but my brother is still in the denial phase. So we will have to discuss this issue after he has some time to think it through. He has not seen our mom for 2 years, so he doesn't really know the true shape she is in. I have lost 2 brothers and only have my little brother now. A long sad road to walk alone.
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Ladee's comments on forgetting basic functions reminded me of a video clip we saw in the Creating Confident Caregivers class.

It showed a medical professional working with women in varying stages of dementia. The tasks were always the same: remove a slice of luncheon meat from a package, remove 2 slices of bread from the packaged loaf, add mayonnaise and close the sandwich.

As the video showed women in the later stages of dementia, they did not know how to remove the bread, or the luncheon meat. They could look at the objects but really didn't know what to do with them.

Obviously it was very emotional to watch that section of the video but it was enlightening because it emphasized how much memory and cognition had been lost.

Perhaps that's what's happening to Sujean's mom - she doesn't remember how to eat?
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One thing not mentioned here,is sometimes as the disease progresses, they actually forget HOW to eat.... they may say they are hungry or thirsty, but when the actions are required to accomplish this.... they have forgotten... I personally am against tube feeding unless it is a short term measure until they improve and are able to eat on their own again... a very tough choice for you.... and we all understand... I support what ever choice you make.... like you said, you have to say you tried.... prayers for you and mom
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If her kidneys are failing, I don't think a feeding tube will make her any better. Have a long chat with her MD.
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Sujean it's so hard when our moms aren't eating. Mine is eating very little these days. She doesn't have Alzheimers per se, but has no short-term memory. She's gone from 190 lbs to 106 pounds. With my mom, it seems like she has a certain calorie level each day she'll eat no matter what I do. I've been going over and making her a good breakfast and leaving lunch in the fridge. If she eats both, then she won't eat any dinner, even though she's got a ton of different things readily available (Boost, nuts, rice pudding, cookies, mac and cheese, etc.).

We spent 3 hours in the ER on Tuesday and she was dehydrated, so now I'm trying to get her to drink more water. I told a friend I feel like I'm trying to bail out the Titanic with a teaspoon. I agree with Gladimhere, think through your decisions carefully. We can only do what we can do. Our mom's bodies have their own timetable and I'm not sure we can affect that no matter what we try to do. It's just incredibly hard for us to go through. No doubt about that. No doubt at all.
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SuJean-
"She has severe alzheimers but still pretty healthy". Alzheimer's is not healthy, nor is it normal aging. The body systems will begin to shut down one by one which will be hard for you to be a part of. Sometimes the most loving thing we can do is to let go. Do you really think your mother would want to live like this? I don't think many people would want to live when they are completely dependent on others for their care and survival. A couple of years ago in one of my mom's more lucid moments, understood what is happening to her, she asked me to help her end her life. Think your decisions through carefully and thoughtfully. Some caregivers have a very difficult time letting go, and have a very difficult time after the passing of their loved one. Your decisions will be yours, but they need to be what your Mom would want.
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Mom went one very long period with just fluid and no food. As the disease advanced she had more and more trouble swallowing. At first we were taking her healthy snacks every day, but this last 6 mos, we didn't care if she wanted pancakes with chocolate sauce, if she would eat or drink it she would get it. The last month even her favorite things were turned down after a bite or sip until she would take nothing at all the last 5 days. Our elderly aunt who passed at 93 got to the not wanting to eat anything but ice cream and frankly at that point who cares! It has calories she likes it, go for it!
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Before placing mom in the nursing home she wasn't eating much. Only a few things she really liked, and I had to work with her to eat. I have tried visiting her during lunch and she would get mad if I tried to help her. I have visited her every day this week and packed a picnic with all the things I know she liked. Still she will only take a few bites. They have tried to get her to drink. I brought her gatorade upon their request and she ended up drinking about 4 ounces in a 3 hour period., with sips. Before placing her in the nursing home she was pacing here at home, so pacing there is nothing new. She still walks and talks and is not laying in bed looking at the walls. She responds to music, moving arms and such. She can still interact somewhat. If she pulled the feeding tube out, then I would stop and say we tried. She was very tired last week, which is very unusual for her. Her leukemia white count was up from 65.000 to 98,000 in a week. So something was going on there. She has had cll for 32 years and always stayed in stage 1 and never needed treatment. Oncologist was not to concerned yet, but maybe that had something to do with not wanting to drink. She still does not want to eat, so her body will just get weaker and weaker by starving. Right now they are concerned about the fluids.
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Sujean, from your post I'm assuming that your mother's eating habits changed after she was placed in the nursing home? Was she eating acceptably at home? She may still be adjusting to the different surroundings, but I keep wondering about her pacing and what seems to be some unsettled if not agitated behavior...is she still trying to acclimate to her new home?

There are some good articles in the magazine CURE, which is primarily directed toward the cancer experience, of which lack of taste during chemo can be a real problem. It's a print as well as online magazine; you may be able to find some helpful information there, notwithstanding the fact that it's directed toward "chemo taste."

What were your mother's favorite foods at home, and before she developed Alzheimer's? Could you try those? We also found that thicker fruit juices such as apricot and pear juice helped when taste was an issue.

Has she had anything like Boost or Ensure?

Perhaps something as simple as your presence during mealtime might encourage her to eat. She's probably in a world of isolation, unable to communicate and feeling a lot of emotion and perhaps fear. Maybe just being there when she has food will comfort her.

If I were in your place, I think I'd do as much research as I could about loss of appetite, try different foods and then make the decision on the feeding tube if nothing works.

I would also get some music and pet therapy for her. Bring in a CD player, radio or something that you can easily set up for her so she doesn't have to fiddle with electronic selections.
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I haven't been fond of such phrases as "quality of life". I'm finishing up chemo and believe me my "quality of life" is so very compromised yet my future is looking up. My best buddy had Alzheimer's. Oh yes, it is possible to really love someone no matter what. "Betty" was placed in a nursing home for four months to rehab. During this time, she too stopped eating. Betty was not thieving in this environment. She was returned to her home with 24/7 care with a caregiver she enjoyed. Eating returned. Years later, as she progressed and was bedridden, eating issues returned and every bite was spoon fed. Still, she thieved probably because of TLC. She by-passed any discussion of a feeding tube decision by dying suddenly or a stroke or heart attach at age 91. Tip: Her sippy cup always had a power pack of nutrition. Every sip was nutrition based such as raw green juicing, ensure, yogurt fruit smoothies, etc. No doubt the nursing home is giving your mom water during the day, which has no calories nor nutrition. Tip: Does she go to the dining area to much ? For Alzheimer's patients public dining could be too much stimulation. Tip: Betty enjoyed a nice chocolate bar which worked to stimulate an interest in eating. Nursing home staff has extreme limited time to devote to their residents. Losing 20 pounds in 6 weeks is absolutely extreme and should be ringing the bells and whistles. Sounds like your mom needs a lot of extra time spent on feeding and hydrating which she isn't getting in her nursing home. Speak to the nursing home doctor to see if an order for "eating" PT time can be established not once but several times during a day.
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My Mom's most recent hospitalization was for a bowel obstruction. Due to dementia she is not a candidate for surgery. To get the intestine to open up the needed to insert a GI tube through her nose and down to her stomach to relieve pressure lower. It worked, but not before Mom pulled that tube out three times it had to be reinserted. She just did not understand where she was or that she needed the to be. She also pulled out her IV twice. In order to keep mom from removing tubes and needles, she would either need to be sedated, restrained or 24\7 watch in the hospital, which is what we tried. In order for the 24\7 to work, even if you step out for a bathroom break someone needs to be watching her.
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What a slippery slope the tube is! Mom had one two different times. The first time immediately after stroke/surgery until she was able to eat again on her own. The second time a more permanent one was put in and she kept pulling it out despite belly bands and creative clothing covers. She finally began to eat again, but for what? The quality of life was terrible and we wondered if the decision to do it just prolonged the inevitable. 4 years in a NH , unable to walk, potty, feed herself and even know her family left a shell. WHY? If your Mom has a quality of life yet that is one thing, but just using it to wring out the last moments of life no so sure. My living will has addressed this issue for myself and I know that I would not want to be kept captive in a body when my time comes .
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I do agree with Jeanne. When my father was in final stages, he was completely bedridden. It is possible that your mother is still adjusting to being there since she is mobile. Is there anything that they make that your mother will eat? Maybe pureed food, protein shakes with ice cream.

I will add that we were told with our father, that putting in a feeding tube at this stage with him, will not prolong his life, but it will cause much discomfort due to bloating with the digestive tract shutting down.

I think having hospice come in will be a good idea. Hospice does not mean the end...they can in some cases turn things around.

My heart goes out to you are you make these difficult decisions.
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Sujean, you were apparently posting again while I was typing. If you know in your heart that in the current situation your mom "would want everything to live" and you think that a feeding tube gives her the best chance to live, then I think your answer is clear. Do what you think your mother would decide if she were in her right mind.
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What stage of Alzheimer's is she in? What is the quality of her life? Does she recognize you? Is she content most of the time? Are there things that make her laugh? Smile?

With that kind of weight loss, I expect that your mother is eligible for Hospice. Have you considered that?

The feeding tube came up for my husband, twice. I did a little Googling on feeding tubes in the elderly with dementia. This researcher's remark represents a view I came across repeatedly: “We found that there is no research evidence that tube feeding prolongs survival or improves the quality of life for people with advanced dementia,” said lead author Elizabeth Sampson, M.D. “In fact, some studies suggest that tube feeding may have an effect opposite to the desired and actually increase mortality, morbidity and reduce quality of life.”

My husband was opposed to a feeding tube in his situation, and we decided against it, both times. The first time a very young speech therapist was presenting the option to us. She told us all the presumed benefits. (She did not mention that dementia patients often rip the tube out and to prevent this are sometimes restrained.) When we told her the decision was not to have a tube, she left the room to update the chart. When she came back she had tears in her eyes. She said, "I wish my Grandfather had not had a tube!"

My brother recently had a feeding tube, while he was recovering from treatment for throat cancer. He is now eating normally. I think that is exactly the appropriate use of the device -- as a temporary measure while someone improves to the point they can eat again. Or perhaps even as a permanent solution if they have a high quality of life. But when someone is approaching the end of their life anyway, I personally just do not see the value.

But that is a very personal decision. And I do know at least one person who had a tube for her loved one because of her religious beliefs.

I certainly would not criticize you for either decision. You asked for input and I'm just frankly giving you mine.

I do suggest that you do a little research with Google and have the doctor explain exactly how this will work, the benefits and risks as he or she sees them.

This is an extremely tough decision to have to make. My warm regards to you and to your mother, and I wish you peace, whatever you decide.
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I have POA . I do have the DNR in place. I know my mom would want everything to live. Her vital signs are still good, blood pressure and pulse.
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