Expert: Cindy Keith, RN, BS, Certified Dementia Practitioner - 12/26/2011

Question
My wife's mother is in the final stage of Alzheimer's. Two weeks ago she fell and fractured her hip. She is in a new nursing home because of her current needs. She also has a severe heart disease. Currently she is bedridden or in a wheel chair. She refuses solid food and is sustained with liquid vitamins. She must be spoon fed, bathed, dressed and pottied with assistance. Her speech is confused and when she cannot find the words she makes noises. She has a DNR on file. The nurse said to enjoy her company while she is still with us. What can my wife expect in the weeks and months to come?

Answer
Hello Randall:  I'm sorry to hear about your mother-in-law's decline.  I'm sure it's very upsetting for the entire family.  
Since your mother-in-law has so many health issues, I would expect to see her continue to decline.  Any time an elder in the final stages of AD becomes injured like that, it's highly unlikely they will recover because the body has to fight on so many levels, and when the brain is so damaged, it just doesn't have the ability to heal the body as well. One big concern I would have for her is her pain level.  She is unable to tell you if she's in pain, or how bad it is, so she will suffer greatly if she doesn't have experienced nurses caring for her.  I would recommend you place her on a hospice service--they are usually very good at keeping an elder pain free and comfortable until the end.  
I would encourage you and your family to visit with her and talk to her about the great times you've had with her--a few of those memories may get through to her and she will enjoy your being there and sharing with her.  Playing her favorite music or singing her favorite songs will comfort her.  If she loved animals, either bring in a pet, or see about getting a video of animals or babies playing (no plot to follow).  One source I'm familiar with is www.alzstore.com.  
Decisions about her care will need to be made very soon, either by your wife, or the healthcare power of attorney. I believe everyone would be more comfortable if hospice is involved and advising you along the way.  What the nurse told you is correct--find comfort and enjoyment in your interactions with her now as she continues her journey to the end.  I wish you and your family happy memories with her.  Cindy