any nurses out there - advice please

[vampire-teddy]

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.  

[polksaladallie]

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.

[vampire-teddy]

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.

[kengillard]

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.  

[twinkles**stars]

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.

[polksaladallie]

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.

[vampire-teddy]

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.

[freddie*rooster]

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.

[kyliecrv]

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

[azureline**]

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.