Expert: Mary Gordon - 3/23/2010

Question
Hi Mary,

You were so helpful the last time that I e-mailed you, that I felt compelled to write to you again.  My 94 year old aunt now requires 24 hour skilled care and is living in a nursing home.  Her now deceased daughter has made arrangements for an attorney to make my aunt's health care decisions.  Periodically, we get updates that she is "in good spirits" "is doing well health wise",but doesn't know who she is.
My last visit with her was in January this past year.  She says a few words, needed to be reminded to eat and I noticed that they now use a hoyer lift to get her out of bed and prop her up with alot of pillows to sit her upright in the wheelchair.
My question is, how long can someone live like this?  I know she has high blood pressure, history of a broken hip and a couple of recent respiratory infections.  Can this be the beginning of the end?  It breaks my heart to see her like this; she was so vibrant at one time.  Thank you for all your good work and sympathetic ear.

Answer
Hi Ellen, sorry for the delay in responding. I'm out of town. I know how very tough this is to watch, but one of the truly merciful things about this stage is that your dear aunt is no longer really aware of what has happened to her. She can no longer fret about the past or torture herself with regrets. She also can no longer be consumed with fears for her future, or worries about being a burden. She's like a little baby. She just lives entirely in the moment, so the job now is just to love her, and make her as comfortable, content and free of pain and distress as possible. Nothing else matters at all any more. Not what was past - or what is coming. All she has is right now, this moment.

Signs that her days are winding to a close usually include persistent weight loss (i.e. when she starts to lose weight no matter what anyone tries). They often start to lose interest in food and drink. It is as though they just don't feel hunger or thirst, of if they feel it, they don't know what it means, or the act of eating and drinking seems like too much bother. They often start to get frequent infections, as their immune systems start to wobble and fail. Often they get so weak and floppy, they can't sit up at all unless they are propped, and can't even hold their heads up. They will sleep all the time, and seem almost completely unaware of their surroundings. They stop talking entirely - sometimes they will retain one or two words, or some nonsense syllable. Eventually they stop eating and drinking, lapse into a coma and pass away. Although it sounds horrible to us, truly, having watched it happen more than once, it does not seem to be a painful death at all. They just slip away.  

It really is brutal on the family, though, having to watch and wait, and not really knowing how to help or how long the marathon may go on. So much depends on their overall health. A person is already very frail and has many complicated health problems will not survive as long as someone who is comparatively healthy. It is very hard to predict. Sometimes they will surprise you and live on much longer than expected - they are both incredibly delicate and incredibly tough. On the other hand, sometimes even a minor illness can be the straw that tips the balance into the final spiral.

My mother in law was only in her late 70's when she entered the final stage and she survived a full two years in that state. However, she was extremely healthy, and much younger than your aunt. I would think you are likely to lose your aunt in the next 3-9 months, but that is a guess.

Hang in there. You've already done so much mourning for her. I don't think it will be too long before the little bird will fly free.

Mary G.