Expert: Mary Gordon - 10/18/2010

Question
My mother was diagnosed with dementia about 10 years ago after a serious head injury(car accident)my sister is a RN and has been caring for her since her husband past away.she says she believes mom has entered the final stage.no longer able to walk too painful to get to toilet.we are going to her regular DR. appointment this week.my is says its time for hospice and i agree she needs help,also stopping all meds except those needed trazadone,and anti-depression.she is running a low grade fever and has had numerous UTI"s,we all agree on DNR.how long can this last and shoul she still take anti-biotics.i don't want to make her live but let her die with dignity and peace

Answer
Hi Monica,

Its very hard to know how long a person will survive in the end stages. They are both very fragile and very tough. Sometimes a minor thing like a little cold can send a person into a final spiral, and yet another person will soldier on, and live much longer than anyone could have predicted, despite being in poor condition.

My rule of thumb for my own loved one (my mother in law) was that we would only allow treatments that were for her comfort. If I thought any problem was going to cause her discomfort but not be life threatening, I would have allowed it to be treated with medication. So, if she had a skin infection or UTI,  or her allergies were making her miserable, I might allow medications or pain killers.

I would not have permitted aggressive measures, tests, procedures, therapies, being taken to hospital, IVs, catheters etc. We had a DNR order on her as well.

Had she had any chronic health conditions that didn't seem to be bothering her, I would have left it alone and let nature take its course (i.e. had she had a heart or lung problem, I would have not let there be further investigations or treatments). I also would not have treated life threatening infections or events beyond keeping her out of pain.

The big thing for us was palliative care - with the goal to keep her serene, content, as happy as possible and as peaceful and unbothered as possible. We didn't want anything to disturb her in any way, and we wanted her to have the best quality of life possible - and for us, that meant no poking or prodding, no running around, no transporting.

Generally, the signs a person is in their final months include gradually losing weight no matter what feeding strategy is tried, a pattern of getting repeated infections, weakness to the point they can no longer hold their heads up (i.e. they have to be propped in a chair or in bed, or they will slump over), and sleeping more and more.   

You know her and her wishes better than anyone. You are making a very loving choice. Most families find hospice workers, whether home or facility based, very kind and supportive - not just for the person who is ill, but for all of you.

Hope this helps. Wishing you peace and strength.

Mary