Expert: Paula Damgaard - 4/23/2008

Question
My husband is in the later stage of Alzheimer. He is fully both bowel and urine incontinent, cannot dress himself, cannot bath himself, cannot brush his teeth, cannot eat without assistance, can still use the spoon but has to be prompted and prompted, speech is gone except maybe a word here and there.
My question is this:  (1) I would place him in stage 7b of the stages, would I be correct?  is this considered severe dementia?
His Doctor has suggested comfort care only and has indicated that we could even elect not to treat infections at this stage, however our Hospice nurse is saying that they would treat pneumonia with antibotics.  We do not understand this, it seems that with the living will and not wanting my dear husband to go through the horrible end of this disease process this would not be in line with what his Doctor suggested.  Am I missing something here due to not understanding??

Thank you

Answer
Dear Sally, I would say your husband is definitely in stage 7b and that what your doctor is suggesting is absolutely the best for him.  I am not sure if you got what the Hospice person is telling you correct, but if you did I would wonder about them.  Comfort care is what he is needing at this point.  

Pneumonia used to be the "old people's friend" because there weren't these high powered antibiotics that could cure them.  They would get the pneumonia and die peacefully.  There is no pain.  Therefore going with what your doctor is saying would allow this to happen.  Treating him for any infection, pneumonia or other one, would only give him more "quantity" of life.  No quality.  If he has a living will that says he only wants comfort care then that is what should be in place now.  

I am sorry you are having to go through this now.  But it will be a relief once he doesn't have to suffer anymore.  My thoughts are with you.  Paula