Mum refusing food & drink in hospital, what happens next?

OP I think there are two things going on here. My mum is the same age and had a hospital admission earlier in the year, eating/drinking was a massive issue.

No cognitive impairment but she could just not make the connection between getting out, and eating. The doctor had to put her on a drip as her salt levels were low. It had been suggested that it would be better if she ate salted peanuts or plain crisps but no. "I don't like crisps". Meals routinely refused as "don't fancy it" or "I've been lying in bed all day doing nothing how could I possibly be hungry". I ended up losing my rag a bit and telling her just to bloody eat it, whether she fancied it or not.

I also think if your mum is showing signs of depression then she may just have given up. Even if she can't vocalise that to you, her actions say this is possible. Could you ask for a psychiatrist or mental health nurse to speak to her and get their opinion? Medication can also really affect appetite. Mum was on codeine which made her hugely constipated and unwilling to eat.

Unfortunately sometimes it's a sign they want to go, and forcing fluids and food is just delaying the process if she has decided it's her time I think you should allow her to make that choice complete a dnr and accept it's her decision no matter how hard it is it's her right to make that choice

I do really hope that your mum gets through the Covid on ICU, it must be really stressful for you.

I just wonder if your mum has either quite bad depression underlying which needs to be treated as it would in a younger person (if she hopefully pulls through the Covid) and / or the start of a dementia.
The hospital should have a Dementia & Delirium Team (who also look at depression in older patients) so I would find out and get her referred. Ask to speak to her consultants secretary about an appointment with her Consultant maybe.
Personally I don’t find 79 to be particularly old unless you’re at the end stage of a serious illness.
I have older friends in their 70s who still work part time & care for grandchildren etc.
If my Mum (sadly RIP) was giving up before she was even 80 I would be asking why.

I am so sorry to read your latest update. Sending love and wishing you and your family strength as you go through this.

just seen update, Covid won’t help appetite obviously, especially if she already has respiratory issues.

can you talk with mum privately , in person ideally, or on video call? Can you ask her bluntly if she acknowledges if she doesn’t drink she will die and is that what she wants? It’s hard to ask, obviously phrase it gently. Not as a “ you do realise” but a “ is this deliberate, is this what you want?”

if it is VSED, in that she just wants to die, then you are going to struggle unless she agrees to some intervention regarding her mental state, and some reassurance her quality of life can improve, how that’ll be achieved. If she’s set on VSED then that’s getting her support, palliative care to manage any discomfort…but without an underlying condition, I’m not sure how nhs supports as she’s essentially going a suicide route.

if it’s not VSED, and she’s genuinely just can’t face food or drink, then the question is why, and it’s all the family pushing to get investigated…something must be going on…she’s not old, old at 79. Not if, other than breathing, she’s seems in reasonable health.

.what I will say is the elderly, especially when not mobile can exist for long time on very few calories. My dad stopped eating ( he was on EOL though ) for 9 months before he died. He’d have Something for a day or 2 here or there when he’d fancy something, but most of time was barely having a mouthful, and 3 days or so of nothing at all. He also didn’t drink much at all…sometimes a quarter of a cup of fluid all day. I was shocked at how long he lived on so little food and drink. So many other posters saying same thing. But, he was on eol, and his body was shutting down anyway. If there’s no terminal condition underlying, it wouldn’t seem normal.

not impressed by nurses getting frustrated…no matter the reason, she needs support not impatience! I’m surprised by that.

Oh no. She would only be given a place in ICU if they thought she has a chance of pulling through.

Sorry to hear this OP. Sending a handhold

Confused by this
why would mum be seen by palliative care if not on end of life pathway, or diagnosed with anything serious, life limiting etc?

op says only thing is she suspects mum has depression maybe, but has just stopped eating ordrinking

it may be mum is going down route of VSED, but that would surely be in domain of mental health team, if she has no underlying terminal condition

can you explain?

I don't have any very useful advice OP but I just wanted to say I'm having similar issues with my DM except she's not in hospital (though she has had two admissions in the last month ). In fact we just got back from a short trip away together. She won't eat more than the occasional mouthful, whatever is offered, and she doesn't drink much either. She has a lot of diagnoses now but no one has mentioned palliative care and it's hard to know whether this is something she wants. I don't feel I can instigate it on her behalf as she's got very cross at me interfering in much less intrusive ways.

It's easy to imagine it'd be obvious whether someone is refusing because they've given up but with my DM it isn't really.

She talks positively about eating well and getting stronger, doing more things independently and having more fluids and carbs, but then refuses anything in front of her, even if she's asked for it and we have gone to shops especially for it. She complains about most food being not right. She's starting to say water is difficult too and gets very grumpy about being nagged. She's not particularly confused though occasionally she is. Part of me feels it would be easier if she was. She's not just lying there being wan either - she's quite forceful in many ways.

It is frustrating and confusing but I feel I can't really do any more than I have and so I don't nag and just follow her lead. But then I don't really think she wants to die, and certainly not in this way - from malnutrition - which is frankly pretty grim, so it's quite hard to stand by as her actions don't match her words.

Sorry - probably not much help but I empathised with your post. I don't think the nurses in your case sound very experienced? I found the ones we dealt with generally very good, and pragmatic, but I felt they left a lot unsaid.

My grandmother we think gave up or atleast made her own choice. She went into hospital after a fall. She hated having to have help at home . We as a family would take turns every day also to cook/clean and help her.
But she stopped eating/drinking. They moved her into her own room after several days . And she quickly deteriorated.
But they also didnt put her on any drips or interventions. We didnt insist as a bit clueless .
Turned out she was on the Liverpool care pathway. Which has since been banned . But I suspect variations of it still exist .
I think the hospital considered it the best plan but did not communicate to us as a family at all .
I hope thinks improve for you.

That’s so weird we posted at the same time!!! Hive mind! 😂❤️

I also wonder if you pause the requests to eat and drink - or just do it less often? She might be getting fed up of it and think everyone’s nagging!

would she agree to have the drinks if she was allowed to ho home with a nurse visit every couple of days?

https://www.jellydrops.com/#gad_source_1
These are great for people who won't drink. Being dehydrated often causes confusion which then makes it difficult to reason with them.

Sorry if this has already been tried but these were recommended a while ago: https://www.jellydrops.com/?utm_source=google&utm_medium=cpc&utm_campaign=11707355703&utm_content=109008883090&utm_term=dementia%20sweets&gad_source=1&gad_campaignid=11707355703&gclid=EAIaIQobChMIn7eV7YXOkAMVJZqDBx1EsA6FEAAYASAAEgJq9_D_BwE

Sorry you are in this position OP. Having been in your shoes, I think if I was there again I’d question what being in hospital was achieving - my relative had many many hospital stays that with hindsight were pretty pointless, in fact they came home weaker than they went in every time.
Id try and speak to whoever’s in charge (assuming she’d rather be at home) and get some extra care arranged at hime. My relative hated hospital with a passion…

Could be that she has just had enough. My grandmother in law was fine, but in he early 80s she decided she was bored of living, and the next flu she got killed her, and she was obviously ready to go.

Oh no @Mini712 that's a real blow 🙁

Have they assessed her capacity ie: does she fully understand the risks of not eating and drinking?

What a wonderful way to treat people at this defining time. I’m really impressed with this service

Yes was just coming back to say that palliative care is about the last 12 months of life, not just last hours. In fact for dementia, gold standard is good palliative care from the point of diagnosis. It’s about a mindset not a timescale.

No one mentioned EOL to us either. I dont think doctors do and it was only the consultant who said to move from curative care who even triggered palliative team. And then they said he had 5 months even though he was unable to eat.
When people get to the EOL they dont have desire to eat and it went against all my instincts and I had to try really hard to not pressure my dad to eat.
You dont need doctors or other family to call or find the palliative team in the hospital. It can just be for you to get advice, seriously they were amazing for me and dad. They sorted out SALT, got him continuing health care funding, overrode the ward doctors about his discharge, even got the transport to come sooner. But before that, they popped in every morning and spoke to my dad like he was an autonomous human. Sadly, I hadnt been doing that as he was unwell for a few months and I was nagging him to eat, exercise, take meds etc. I was focused on keeping him alive.
At home they still visited him and took only his wished into consideration. I would call them see what they say x