Is this the end?(1)

Evangeline70

My mother has had a steep trajectory with this disease. She went from a mild/moderate diagnosis to severe dementia in one year. She was living alone in her own home until about 6 months ago. We placed her into MC in March 2021. She has always been active and walked/paced for hours each day. We are now on our 3rd facility. The first was ridiculously understaffed, and we moved her shortly after placement. The second was okay until she began falling about a month ago. They basically kicked her out due to falling. Now we’re in a good spot with the new facility. She was just accepted into hospice about 3 weeks ago. Fell again after being here a few days. This time she broke her arm. She’s in a sling and we’re not doing surgery. She’s on morphine for pain. It’s been 5 days since the injury. She is so sedated and barely eating and drinking. Maybe 25 percent of her usual intake. I’m concerned about dehydration. Hospice team is stating that this may be her body’s way of shutting down. It all seems so abrupt. Do folks succumb after a broken arm? We don’t want her to be in pain but are also concerned about being too medicated to eat and drink. I’ve asked to decrease the morphine to see if that helps. Does anyone has experience with this?

harshedbuzz

Evangeline-

I am sorry your family is dealing with this wretched disease.

It does sounds as though things are progressing quite quickly for your mom. My own dad died about 15 months after getting his official diagnosis. In retrospect, I believe his diagnosis was missed for a myriad of reasons (mostly my in-denial mother who fought evaluations until it almost killed her); I can go back a decade before the diagnosis and recall personality changes and later memory glitches that were surely the earlier manifestations of his brain damage. 

You ask if PWD are launched into the final stages by a broken arm? Yes and no. It is more often a hip or femur that we see as the beginning of the end. But I believe this can be a kind of chicken vs egg situation. It's easy to see the broken bone as the catalyst, but I think it's the damage to the brain- which we can only see through symptoms like falling- that is driving the bus. In other words, the trauma of the break didn't cause the downturn, it was the downturn in her brain's health that caused the fall(s) that resulted in the fracture. 

We lived through this with one of my aunts. She was found on the floor with a fractured hip/wrist in her AL in the midstages. She did have surgery and went to a SNF to recover. It was a nightmare- she couldn't recall that she needed her soft cast and would tear it off, she couldn't recall that she needed to follow certain protocols to protect her hip as it healed. She was miserable and needed 24/7 sitters. She declined at a rapid pace in the 3 months before she died. 

You could ask them to dial back the morphine, but then she may have pain she doesn't understand and a pretty lousy quality to life.

At the end of life, food and hydration are not necessarily a good thing. If she is moving towards active dying, her organ systems will be shutting down and unable to do the work to process food and water taken in. What seems feels sustenance and care that could help to us, could actually make her uncomfortable at some point. This is a question for her hospice team. That said, I had another aunt with dementia who would sometimes go on a jag where she wouldn't eat or drink for days leading us all to think "this could be it" and then after about a week or 10 days she'd return to both for a few months until the last time. I saw my MIL (who did not have dementia) do much the same thing at the end of life. 

HB

ADH77

I appreciate this thread, as I find myself in a similar place with my mom. Last week, she was taken to the hospital for being very lethargic with a high fever. They stabilized her with antibiotics and fluids, but told me that she is not really eating or drinking--she needs significant encouragement for the former and was getting the latter automatically due to IV, but won't have that when she goes back to MC. The NP at the MC is recommending palliative care and hospice, so it does sound like "the beginning of the end" to me. But we shall see. My mother can be very resilient, but Alzheimers is relentless, as many of you all know.