Expert: Paula Damgaard - 1/11/2006

Question
My grandma is 86 and has been suffering from Alzheimer's for over 10 years.  She has been in assisted living for the last 6.  In the last couple of months she has lost a lot of weight.  This last month she lost 10 pounds.  Her oxygen level is extremely low.  It fluctuates, but has been as low as 60.  She isn't bed ridden or in a wheelchair yet, but she has been falling.  She looks terrible with cuts and bruises from all of her falls. Hospice has been taking care of her for the last couple of months.  She hardly ever speaks.  When she does speak, she doesn't make any sense.  In the last week she has been refusing to eat and she sleeps more. My mother has been her primary caregiver through it all.  My mother is struggling with making decisions regarding her refusal to eat or drink.  (example: Giving her medicine that makes her hungry.)  She had an unfortunate experience a couple of weeks ago with one of the employees at the assisted living facility.  My mother told them there is no reason to force her to eat and the employee said "What do you want to do, starve her to death?"  Ever since then my mother has been in tears and felt so guilty.  In your opinion, is my grandma nearing the end?  If so, how can we let her go peacefully?  She does have a DNR, thankfully.  Any advice you have will be appreciated.  Thank you from the bottom of my heart.  

Answer
Dear Britney, you tell your mother that I said to tell the employee to take her hat and shove it where Mary never wore a hat!  That person deserves to be drawn and quartered!!  The nerve!

Your mother has NOTHING to feel guilty about.  Nothing at all.  All she has to do is think about how her mother was before and ask herself would her mother ever have wanted to be in the shape she is in now.  I bet the answer is absolutely not.  What I want to know is where was Hospice when the knucklehead asked that question?  

The disease is wrecking havoc with her brain and as it does it destroys the appetite area of the brain so she has no stimulation to eat.  This is not a bad thing.  It doesn't hurt to (for lack of a better word) starve.  She wouldn't feel anything.  We have no idea what these patients know and are cognizant of and maybe somewhere in her head she knows that she doesn't like the way she is and wants to go.  I have to believe that she will be going somewhere better than here!  SO let her go.   Your mom is doing everything right.  She does not want intervention she wants comfort care.  So please tell you mom the next time someone asks her that to tell them to write me I will answer the question for her!

I am sorry you are all going through this, I know it is hard, but I also know that it is probably what your grandma would want.  I know from personal experience that my mom wanted us to let her go when the time was right and we did nothing to interfere, she had some kind of pneumonia and we chose not to treat it.  She also had Alzheimer's and all of us knew that if she found out that we had the chance to end her suffering and we didn't do it she would take it out on us.  She died peacefully, almost 6 years ago.

Good luck and keep in touch let me know how it goes.  Paula