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

I'm sorry to hear this. Although a different situation, my MIL was admitted to hospital for one condition (stroke), but after 6 weeks, it was discovered she had another one, which sadly was too advanced for treatment (uterine cancer).

A lot of assumptions were made about her low appetite, namely that it was just because of constipation/behavioural. She'd lost a lot of weight in the 6 months before she passed.

I guess a long-winded way of asking if other possibilities have been considered re appetite

A small dry sherry before meals?
Sorry.....I keep thinking of things which worked with my parents

Definitely ask for her to have mirtazapine as PP said. Wonderful for creating an appetite

How's her heart? Breathlessness could indicate congestive heart failure (which doesn't mean she's dying btw)

It sounds like she's declining cognitively (dementia?). Have they done a brain scan?

Unfortunately no one can force feed her. I'd try to prepare your Dad for her possible decline

I'd take her home, once the docs can't find anything obviously wrong, get carers in and allow her to live as she chooses

79 isn't old nowadays. But some 79 year olds ARE old, IYSWIM

It might help to try and work out whether it’s:

Knows that eating and drinking are important to getting better / staying healthy, and wants to but struggling to actually do it for some reason, or

Knows that theory, but totally not interested in that any more.

Or dental / oral issues that make it painful.

The former would point towards finding ways to get what she needs into her. Drips. Fortified drinks. Very calorie dense food. Favourites.

The middle is a mental health and / or end of life care discussion.

The latter is relatively straight forward.

It’s unlikely to be feasible for you to work out which if you’re not there. So it’s a conversation to have with a family member who is.

Being in a place she wants to be is likely to help regardless. So if that’s home, can look for ways to use that as a lever and motivator. You want to go home, dad wants you home, you cant go home with a drip. Can you find a way to drink three cups of tea a day so you can go home. Or wine. Or sherry. Or orange juice. Or whatever you like.

(late additional thought - continence or mobility issues that mean is avoiding intake to prevent issues there).

Would she talk to a hospital chaplain? They care for all faiths and none. Just as a way to open a conversation with her about what she's thinking.

My gran avoided food and drink for many months before she passed away. For ages we encouraged her to have little pots of jelly , and fluid rich foods like soup and fruits. In hindsight we pushed too hard for too long. I think it was her way of letting go and moving on. She didn’t eat for weeks before she died. And her last fluids were around 6 days before she passed away.

as PP said, urine infection can cause lots of unusual behaviours in older people, including refusing food/drinks. As can dementia.

re the nurses in the hospital. If I were you I would have a stern word with them. When my gran was in hospital for a while we had to really advocate for her and make sure the nurses knew we were present and engaged in her care. I challenged some really snippet comments from overworked and tired hospital staff who thought my gran was being ‘difficult’ on purpose. I do have massive respect for medical staff and know how hard they work, just to be clear.

Im sorry to hear your mom is so unwell and am sending love.

Sometimes not eating and drinking at the end of life is the only agency the elderly have left. I’m sorry you’re going this OP.

Can you try some sweets like jelly babies which might stimulate appetite? It does sound to me as though she’s making her wishes very clear. Are you seeing her soon? Sometimes it’s easier when you can actually see for yourself the situation. Sorry as I know it’s hard

My dad just died. He actually wanted to live but knew it was unlikely. In hospital he refused all food but when we got him home, he had bits of trifle, cake, beans (!). He said hospital food tasted funny but really he wanted deep down to die at home.
I got pallative care involved who got him released against doctors advice. As I said, he did enjoy mouthfuls of food at home but then lost his swallow reflex. He died at home a couple of weeks later, in his own bed. I just wish id never taken him to hospital and knew about pallitive care beforehand - its not just for immediate end of life. I could have got them involved months ago, so his treatment was what suited him, instead of medical procedures. Maybe you could call the palliative team in hospital today for advice?

It sounds like she has declined and withdrawn from the world in the previous 6 months? That is very common at the end of life. I don’t say this to worry but I wish I knew that was what was happening with my Mum.

Are the hospital keeping a diet and fluid chart and weighing weekly? Has she been seen by dieticians? Any oral health issue ie- thrush, lost dentures? Any swallowing difficulties?

79 isn’t that old - if she is very frail, did she look after her health in preceding years. Exercise etc?

I can’t offer any advice but I send my love to you. My grandmother went through this with late Alzheimer’s in 2023. She just refused to eat or drink after being hospitalised from a fall. In hindsight I would’ve pushed to get her home but she was 91 and I think she knew herself she was just done.

My mum was the same, refusing to eat or drink. The doctor said technically, she wasn't ill and kept saying she wanted to go home. We arranged a hospital bed, she went home on Friday afternoon, and died during Sat night/Sunday morning. She had had enough and wanted to die in her own home, it gave us comfort to know she got what she wanted.

When that happened to MIL, aged 96, the consultant called me in for a talk. I had taken DC to see her, so I was the oldest relative there at the time. He said, she was refusing food, drink and antibiotics, although she might eat and drink for us. She couldn’t stay there on a drip forever. Her kidney function was down to 5% and she needed dialysis; but she was too frail for that. Either she went home to die, or he’d withdraw the IV fluids at the weekend and she’d die there. He asked me where did she want to die? I knew perfectly well, she wanted to go home - he promised the family would get EOL drugs for her, if they took her home.

I told him, I was not a blood relative; it was up to her children DH and SIL. He asked me to convey the message to them to make their minds up.

As it was, she died 36 hours later naturally (probably a combination of kidney failure and weeks of not eating and drinking).

I would also say she’s a good age. I think it’s sometimes difficult for us to accept our aged parents quality of life might not be great and they may be nearing the end.

You and your family are going to have some very difficult conversations ahead of you. In an ideal world your mum would be able to speak to you all about what she wants the rest of her life to look and feel like.

We don’t live in an ideal world and this conversation is a mine field. The relatives don’t want to pre-empt and raise the subject of EOL care. The patient feels they can’t really speak about giving up as they feel it would hurt the relatives.

If you can’t have a frank discussion,the alternative is to speak to the Ward Manager about getting a third person involved. This might be the mental health team, palliative care team or one of her doctors. I think your mum will find it easier to speak in private to one of these.

I have some experience of this from both sides. In your heart you know she is not being stubborn. She does not get the hunger signals and it is impossible to persuade her to eat. This is a natural process that all people in your mum’s circumstance go through.

The average life expectancy age of a women in the UK is 82 so I would say she is old. Different people seem to age a different rates but I’ve found late 70s tends to see a decline.

Regardless of her age, she's maybe just had enough and wants to go. There is very little you or the hospital can do, I'm afraid. My mum was older and in hospital for two years. At various times she stopped eating and drinking. They tried everything and the best thing was when I made her cake. She would eat that