topic Re: any nurses out there - advice please in Community Spirit

any nurses out there - advice please

vampire-teddy — Sat, 24 Aug 2013 18:05:16 GMT

my father is in a nursing home. he has dementia. he has not wanted to eat much for some time and now refuses to eat or drink anything. at present he is in hospital after a fall two nights ago during which his head went through a wall and he had a minor brain bleed. he weighs 53 kgs at 5 foot 8 and is 86 years old. he is completely emaciated. he is currently on a drip at the hospital but when he goes back to the nursing home on monday he won't be anymore. I am wondering how long he will survive if he doesn't eat and or drink anything. he already has bad kidneys and a very low heart rate. i am prepared for the evitable. he is on a non resus order and is not to be force fed or sustained in any way. i know he would hate it and the he wants to go as he has said so when he was still able. he is no longer coherant and has to be heavily sedated or he gets agitated and tries to get out of bed (he can no longer support himself). he also lashes out to anyone who tries to help him. he was a wonderful gentle man who has been a great dad and i hate seeing him like this.

I know i should be asking the doctors and i am trying but tracking them down in the public hospital system is nigh on impossible. if any nurses out there have any idea i would appreciate it. i know nothing is exact but wonder how much longer he could be suffering.

Re: any nurses out there - advice please

polksaladallie — Sat, 24 Aug 2013 18:53:35 GMT

Oftentimes the reason residents of nursing homes lose weight is because the staff bring a meal, leave it on the table, come back later and collect it, when the person is not able to feed themselves. (This was reported a few weeks ago in an article about poor care in nursing homes). Sometimes the food is not fresh, but pre-packaged stuff, I wouldn't like it either.

Does he have mouth ulcers or another reason why he doesn't like eating?

Does he refuse food when you feed him? Are there some favourite foods that you can take to him? Any food at all, doesn't have to be healthy. Soup in a cup, sweet drinks - Sustagen or similar to help him regain some weight.

I am sorry you are faced with this problem. It is hard to know what to do. If he is willing himself to die, all you can do is make sure he is as comfortable and content as possible. Best wishes to you and your Dad.

Re: any nurses out there - advice please

vampire-teddy — Sun, 25 Aug 2013 00:48:47 GMT

We have tried everything as have both the nursing home and hospital. We are lucky the nursing home where he lives cooks the food fresh and it is very good quality food (it is an excellent nursing home). My FIL is in the same nursing home and loves the food. My father didn't want to eat when still at home with my mother pre February this year and she would cook anything and everything he liked to try and persuade him. He doesn't have mouth ulcers or anything and there is no other reason other than he isn't hungry and he has completely given up and wants to go. Yesterday the hospital provided us with yoghurt, custard, mousse, fruit puree and pureed meat and vegies. I tried to spoon feed him and he flatly refused to take even a taste. He gets quite agitated if we try and convince him. He also cannot swallow water as it is too thin and he chokes so he can only have thick liquids which he refuses to drink. He would previously drink strawberry sustagen but now even refuses that. He always had a sweet tooth so we have even tried to bride him with all sorts of goodies but to no avail. I have accepted that he cannot survive much longer. I just want to keep him safe as he has had two falls this week and is black and blue on his arms and has a black eye from the fall. I don't him to be in pain so I will have to work with the nursing home on the best way of keeping him contained. He wants to walk around but cannot hold his own weight anymore (though he doesn't understand this). The other morning at 3am in the emergency department he was trying to get up because he believed he had to go to the market to get fish for tea.

Re: any nurses out there - advice please

kengillard — Sun, 25 Aug 2013 01:17:18 GMT

I'm not a nurse, but my OH has dementia and is currently in hospital....he doesn't eat much either..lack of appetite seems to go with the disease. Anything I give him at home is only half eaten, even tho it is a small serving.

Sounds like there is nothing you can do short of force feeding him, which would be upsetting for everyone.

Re: any nurses out there - advice please

twinkles**stars — Sun, 25 Aug 2013 01:21:22 GMT

I agree with Gill re lack of appetite. The less active they become the less appetite they seem to have, they lose weight due to loss of muscle also.

A very stressful and difficult time for everyone.

Re: any nurses out there - advice please

polksaladallie — Sun, 25 Aug 2013 01:24:32 GMT

It sounds like you are doing everything possible to help him. He is lucky to have you and ? your partner. Is your mother still alive? I have nursed dementia patients in a hospital setting, but as a junior nurse then so I didn't know anything about the drugs thery were given. It was a while ago and things would be a lot different now. There might be someone else here who knows more. It seems that he wants to go, and perhaps sedation is the only answer to minimise injuries and pain. Remember that old people bruise very easily, they have very thin skin, so those injuries might not hurt as badly as they look. He will be in pain soon if he is not eating.

You are doing a wonderful job, and I'm sure he appreciates it. Let us know how he is doing in the days ahead.

Re: any nurses out there - advice please

vampire-teddy — Sun, 25 Aug 2013 01:43:02 GMT

yes mum is still alive. she is nearly 78 and is learning to live alone for the first time in her life. my parents have been married for 53 years. we are trying to keep a close eye on her and my sister and her husband are considering either moving in with her or moving her in with them early next year. she wanted a chance to live alone but she is getting lonely and we worry about her safety as she is not in the best of health. sadly it has gone beyond a loss of appetite to refusing any form of food at all even a sip or taste. my partner is a wonderful support . we nurse her mum through the last month of cancer last year and then looked after father for six months until he had to be placed in care for milder dementia, though he has thrived in the nursing home and is healthy and happy.

Re: any nurses out there - advice please

freddie*rooster — Sun, 25 Aug 2013 01:44:25 GMT

Awww Teddy your post made me sook.

The only way would be by gastric feeding with ensure or one of the protein liquid fluids, they would need to secure his hands to stop him from removing the tubes though.

Re: any nurses out there - advice please

kyliecrv — Sun, 25 Aug 2013 02:31:03 GMT

Vampire, I offer no solutions just posting to send you and your family my very best wishes. X X X
You sound very brave and loving and your parents are very lucky. Huggggs

Re: any nurses out there - advice please

azureline** — Sun, 25 Aug 2013 03:00:49 GMT

So sorry to read this, it is very difficult when they won't eat. We have had similar issues but one day he just started eating again, no idea why but he is again putting on weight Hope it works like that for your dad 🙂

Might be time to consider mum looking at her future too, re where and when she might need to go into a facility that can cater for her needs, now and in the future.

I think it is important for them to be able to socialise with people of their own generation as much as family.

Re: any nurses out there - advice please

izabsmiling — Sun, 25 Aug 2013 03:17:44 GMT

((((Teddy))))

I have nursed the elderly in the past (not a proper nurse some may say as I didn't hand out pills) .It sounds to me as though your Father and his body may know where they are at xxxxxxxx

the medical staff need to be communicating with you .I'd suggest asking a nurse if there could be a family meeting arranged with the Dr so that you all informed and involved and supported ..as you should be in the care of your Father.

Re: any nurses out there - advice please

lost*over*time — Sun, 25 Aug 2013 04:34:56 GMT

I've worked in the hospitality area of a residential care facility until pretty recently, as well as in the management of 2 home delivered meals services for aged predominately.

The stimulation of a person's appetite starts with aroma....something as simple as having the aroma of a cooked meal will stimulate the production of saliva, and aid appetite.

Ofcourse, speak with the nursing staff, but the cook or hospitality manager may also have some great advice as far as appetite and sustanence.

A person can last a long time without food, but will not without fluids.

It's incredibly heartbreaking to watch someone that you love go through this....my thoughts and best wishes for love and strength are with you, your dad, your partner and your families xx

Re: any nurses out there - advice please

cherry*135 — Sun, 25 Aug 2013 04:44:09 GMT

Sorry to hear this vampire.

I am not a nurse either. When my Aunt (n her 90's) with dementia (living in a secure home) had a fall and broke her hip, the operation went well, no problems physically. After the operation, in hospital, she would not drink or eat... just spat out anything that was put in her mouth

With her having late stages of dementia there was no way to explain and for her to understand must eat/drink to get well.

My cousin who is a nurse said to me farily early on they don't expect her to recover because of the dementia. She wasn't well enough to return to the retirement home and spent the last month of her life in a rehab hospital.

Re: any nurses out there - advice please

kwozie1 — Sun, 25 Aug 2013 04:55:56 GMT

my OH lasted about a week without any food or water but he was also on heavy dosages of morphine....it is not nice to watch someone you love fade away like this.

Thinking of you at this sad time

Re: any nurses out there - advice please

kyliecrv — Sun, 25 Aug 2013 05:18:45 GMT

From memory my OH last 3 maybe 4 days with zero food or water (no drip etc). He was at home so no medical intervention besides a morphine pack, was pretty brutal.

Re: any nurses out there - advice please

freddie*rooster — Sun, 25 Aug 2013 05:42:50 GMT

I agree with Iza, you need to ask questions and get some positive advice as to what the nursing staff will do for you, it sounds to me like the food refusal is part of the disease, and not his intention to refuse food in order to die. Teddy, don't live with regret that you didn't persue this with the Doctor, you need to ask lots of questions and demand to know what they intend to do to help your Dad.♥

Re: any nurses out there - advice please

kengillard — Sun, 25 Aug 2013 05:52:35 GMT

can the staff at the hospital discharge a patient in his condition legally? I don't think so. I'd be talking to the social worker at the hospital.

Re: any nurses out there - advice please

vampire-teddy — Sun, 25 Aug 2013 06:07:53 GMT

unfortunately they cannot keep him in because there is nothing they can do for him and will need the bed. the nursing home may send him on to pallative care. the not eating thing has been going on for a long time well before any dementia show up but is now a complete refusal. we have tried everything for well over a year as far as the eating is concerned to no avail so i am sure that there is nothing that can be done on that level. today he was complaining of a bad headache probably because of the fall and brain bleed but we do not know what the situaton is regarding that now (despite asking). I am not leaving the hospital tomorrow until i see the doctor and know what is going to happen. i think they will put him on morphine because you can't touch him without him being in pain now. he no longer recognises my mother and won't let her touch him either. i tend to agree with iza that his body knows where it is at. luckily my mother is still quite active though not 100% but she has a large network of friends through her church and is very well looked after by us and lots of people keep an eye on her.

thank you for all the well wishes and thoughts, they are very much appreciated. we will see what tomorrow brings and just hope the outcome is the right one for him whatever that may be.

Re: any nurses out there - advice please

twinkles**stars — Sun, 25 Aug 2013 06:38:14 GMT

Never an easy time....healing thoughts sent

Re: any nurses out there - advice please

izabsmiling — Sun, 25 Aug 2013 06:51:07 GMT

Hi Vampire Teddy

I've tried to find the right words in a private message and other posts to you and not felt they sounded as I would If I could speak to you in person. I will try again and hope that it comes out right .

I suggest that you may be best to call the ward where your Father is and ask to speak to the Nurse in Charge .Tell her/him of your concerns about your Father ,the future plans for his care, the state he was in today and lack of information being shared with your family.Sometimes it is the person on the phone who gets the attention/ear of the right person and doesn't so often get put off .Perhaps also ask that if there is a possibility that your Dad may be put in Palliative Care in the very near future if it is possible that the Palliative Care Team be involved prior to the planned tranfer back to the Nursing Home on Monday .It may be more comfortable for him and all of you if Palliative care is required that the transfer on Monday be to Palliative care unit rather than to the Nursing home ?

Thinking of you all xx