Well it seems that as of today my mum is entering the palliative stage of her life after living with Alzheimer’s for the last few years.
She went into full-time nursing home care just last week, but the staff transferred her back into hospital last night due to her condition. A phone call from my dad this morning informed me that all medical treatments are being withdrawn, with just morphine now to ease her into death I guess. (From my understanding, med issues are just a leg- thrombosis, comprised respiratory function and maybe her kidneys are playing up?..not sure about that)
So, I guess the question is, how long can this palliative stage last?
(No condolences needed by the way…I have been wishing this for mum for a long time: Alzheimer’s is a cunt of a disease).
My mom has Alzheimer’s too. No condolences; I understand. Have been wishing for her death for the past few years. Feel in many ways my grieving will be over when she dies.
If her kidneys are shutting down, and she’s developing pnemonia, then you are probably looking at no more than a few weeks, tops. May be much, much sooner than that, if kidney failure and respiratory distress are related – toxins are probably already releasing and building up in her system, which will cause other organs to shut down. This could take 1-2 days.
Not a doctor, no professional opinion. This is how the process went for some of my loved ones. They were also kept comfortable with medication and didn’t seem in any pain or distress.
Palliative care is usually reserved for when then anticipate no more than six months. But it can be a matter of hours, or it can be years, depending on her condition and the progression. My sisters mother in law has been in palliative care for Alzheimer’s for more than two years, they thought they were going to lose her to pneumonia last winter, but she pulled through without any treatment. My brother in law lasted 24 hours, cancer had reached his lungs,
I prefer Tracijo’s prognosis over yours, thanks all the same Dangerosa.
It’s hard to get any straight answers from my dad…he’s the sort of bloke who has to give you a half-hour preamble (including the names, ages, dietary, political, and spending habits of people who might be in some obscure way connected to his ‘story’ de jour) and this morning was no exception. :rolleyes: It started off, “Got some bad news…” but didn’t actually get to the gist of what had happened until much later in the conversation. I tried interrupting earlier just to ask what her oxygen sats were, but he he was pissed-off that I’d broken into his spiel…
Anyways, I figure that if morphine is now involved (and again from my understanding, she’s not actually been in any great pain) that the unspoken protocol is that it will be gradually increased until she dies. Hopefully sooner rather than months down the track.
I was thinking that the morphine is probably going to hasten things for your mother. I’m convinced that it did for my father (it is especially potent when organ failure is already evident) and was nothing but extremely grateful for it.
The idea behind morphine is not sneaky euthanasia. If she’s in pain they’ll give it, but if she isn’t they won’t. My mother had a morphine Rx in her last days but seldom needed it. (She actually used more anti-anxiety meds) She never needed an increase in the morphine dose.
It’s impossible to say how long exactly it will be before the end. As noted, it could be days, or it could be weeks or months. Is she eating? Is she drinking? Is she being provided food and/or fluids?
My mom stopped eating, which meant her life was measured in weeks. Then she stopped drinking, which shortened it to days. We elected NOT to go to tube feeding or IV fluids, which would have prolonged her dying. Tubes are also much harder to get removed than installed.
I’m glad your mom’s suffering will end soon, but I’m still sorry you’re losing your mom, although it sounds like you lost her a long time ago
You’re right about having already grieved; I did the same thing when my granny was dying. When she finally went on home I cried some, of course, but only for myself. I knew she was much happier now that she was finally out of that old, broken down body. Death can be a friend sometimes.
I’m sorry for your loss; Mother in mid-stage ALZ, my Dad died of same 11 years ago. Palliative care will last as long as the physician in charge says it does, to my understanding there are no longer limits on the time.
No condolences, OP – my mother had ALZ. I signed the DNR form when she came down with aspiration pneumonia. I don’t remember the interval between that and when she stopped eating/drinking (aka the UTI That Never Went Away) but I reckon to say it was maybe a month or two? When she started shutting down, it was maybe a week between starting and when she passed…?
I apologize for being vague. I honestly don’t remember, considering I was in panic/survival mode at the time.
The purpose of the morphine is probably to make sure that your mother doesn’t feel any discomfort from her trouble breathing. That’s a very common way to use it in people who are close to the end of life since it helps with the feeling of air hunger that people who can’t breathe well have.
Once someone is in hospice/palliative care, the goal is to treat their pain even if there is a risk it might hasten their death, but they will not give morphine to a patient who is not in pain just to kill them faster. I wouldn’t want anyone to get the idea that hospice people are sneakily euthanizing patients and consequently be afraid of having help from them.
Technically, palliative care is for patients who are expected to die within six months…but I would agree with the poster who said that, usually, by the time palliative care becomes involved in a patient’s care, the actual time left is much shorter - days or weeks.
I wanted to add my agreement that in hospice, administering morphine with the PURPOSE of hastening death is not the goal. I know how loving, reasonable people can struggle with what they earnestly believe to be the moral implications of intentionally assisting in the dying process.
Rather, I was speaking from the practical aspect that administering morphine to a patient with renal failure and respiratory distress will probably hasten the death as the morphine is (as intended) alleviating pain and making the patient more comfortable. My Dad’s hospice nurse had to be very clear with some of my siblings, who were not ready to let him go, and feared that higher doses of morphine would kill him. More importantly, although he was clearly dying, my father wasn’t ready to go. There was no intent to hasten death. And the nurse did explain that hospice patients on a whole can tolerate dosage levels that would likely immediately kill someone not accustomed to it. The side effect of morphine, widely known, is that in high doses it can suppress breathing. For someone in renal failure, unable to rid body of toxins…
… I don’t think a doctor would prescribe morphine to a patient in this circumstance who might otherwise live.
Regarding your dad and information, hospice doctors are usually far more informative with information to family than hospitals, and where the doctor at the hospital might only talk to your dad, with hospice we discovered doctors who would explain to pretty much anyone who cared. If you are visiting hospice, have this conversation with the doctor on duty or the RN. (I’m assuming a move from a hospital or home into hospice). Or call her doctor. They can let you know if the kidney, lung, thrombosis are going to take a while, or if its failing quickly.
Mum is not going into a hospice, but is going to be returned to the nursing home I believe. I guess hospital beds are at a premium around there.
She WAS diagnosed with aspiration pneumonia a week or so ago and had been on antibiotics which (from my understanding) are now being withdrawn. She had also been on Warfarin to hopefully prevent clotting issues, but that is gone now too. My dad just alluded to kidney problems without going into any detail, but that could be expected I imagine.
So, (again, this is if my comprehension of the somewhat incomprehensible conversation yesterday is at all valid) it appears that her medical issues are now going to be let go to run their course. My dad had informed the Doctors that this is with the full acknowledgement and acceptance of all the family. She’s just tired and all worn out.
I’ll get the name and number of the doctors today and give them a call (if they’re around). Can’t visit because it’s a four-five hour drive and I HAVE to work this week unfortunately. Hopefully a call will give me more info than the Old Fella could or would provide!
A hospice isn’t necessarily a discreet location. My mom, for instance, was in a hospice program but spent that time at home and died in her own bed. My sister, who is a hospice director in New York State, has both at-home patients, patients in a defined hospice unit, and also patients in a conventional hospital in a hospice program. So, she may be at the old nursing home but she also might be in hospice at the same time.
Since the idea is to provide comfort care and not curative care a lot of people actually could go home and be kept comfortable there… but sometimes the family can’t handle it (it’s quite emotionally intense) or the spouse simply isn’t physically able to provide the necessary care for comfort.
My mother (92, not Alzheimer) was in a nursing home. About once every three months she would be sent to the hospital (COPD complicated by arrhythmia) where they would stabilize her and send her back to the home. At some point it started to get frequent and the doctors said we should not do this anymore. We changed her status to DNH (Do Not Hospitalize) and put her in Hospice care (still in the nursing home). She died within the month, because she had another crisis and was treated with painkiller (a morphine gel that was applied to her shoulders). I assume that anyone in Hospice is in DNH status.
I imagine your mother will stay alive until she has a crisis (perhaps brought on by her compromised respiration). If she appears to be in constant pain, they may administer morphine and this may hasten her death, but this is not their goal. It is also my understanding (perhaps flawed) that if someone in hospice will not take nutrition, they will just try to keep them hydrated. This will also hasten their death, but again, this is not their goal. Their goal is to keep the person as comfortable as possible.
Not necessarily. They may even undergo medical procedures. When my father-in-law was in hospice he underwent at least two operations to decompress nerves that were being pressured by tumors which relieved pain and restored some function although it did nothing to cure the cancer killing him. It’s all about making the patient comfortable. If a hospital setting is most appropriate for that then a hospital it is.
Of course, this is also dependent on the wishes of the patient (if able to express them). If the person doesn’t want to go to a hospital they won’t have to. If a person is being driven batty by hysterical relatives at home that might be a reasonable option. Also, short-term “respite” admission to inpatient care gives home caretakers a break, which can be very necessary in some circumstances.
It’s not quite as clear-cut as that on the nutrition/hydration option. The patient, for example, might express his or her wishes in that regard, which would be respected. It’s also not unusual for the dying to have no desire to eat or drink, even as they get dangerously underweight/dehydrated. In my mom’s case we gave her water when she asked for it, but gradually she stopped asking for it and when asked said she wasn’t thirsty even as she was showing signs of serious dehydration.
It’s a bit of a mixed bag. My father in law knew he was dying and that nothing would change that, but he still “fought” until the end (witness at least two operations while in hospice) because he wanted the maximum life he could still get. Mom, however, just said she was tired and wanted to go home, and simply didn’t struggle the way my father-in-law did. She was more a matter of slipping away, of sleeping more and more until finally she fell into a brief coma and died.
Theoretically, palliative care can go on indefinitely. It’s really just semantics in terms of medical care, and I wouldn’t get too hung up on it.
Generally with typical medical care (actue/chronic) there is a therapeutic goal - cure/fix or prevent progression/worsening. Palliative/hospice care doesn’t aim to cure or fix anything.
With hospice care, one generally has a terminal illness with a specific life expectancy, usually 6 months or less.
With palliative care, one doesn’t have a specific terminal illness.
The nuts and bolts of each are pretty much the same, making sure the patient is comfortable and experiencing a little pain as reasonably possible. Either or both can be done in the home and/or in a facility (hospital, nursing home, etc.).
My mom died in her home a couple months ago. After surviving breast cancer, then cervical cancer, then recurrence of the cervical cancer that was not responsive to chemo. My sister stayed with her the final two weeks. A hospice nurse stopped daily, supplying morphine and ativan.
Watching the process reaffirmed my thoughts on euthanasia.
Just to clarify, in our area, to get hospice care a doctor must sign papers stating that a patient is expected to live six months or less. When six months passes, the doctor would have to sign again for another six months. This can theoretically go on indefinitely. As long as you’re still terminal according to your doctor, you qualify for hospice care. The six months is not a deadline.
Being designated on hospice care shifts what your insurance will and won’t pay for. It can also put you on a number of volunteer lists and local Social Services will drop by. They can point out resources that you didn’t know existed. Sometimes going on hospice is a huge relief financially and/or logistically. Sometimes it’s a smaller change.
Some doctors are reluctant to bring the subject up, though, and wait until a patient specifically asks to go on hospice. This can turn into a sad dance when a patient tries to be chipper and waits until the doctor brings it up, because he’s the one who would know. Talking about the possibility early helps.
