Alzheimer's. The very end.

[OrangeBlossomsinthesun]

MIL is 91 and has late-stage Alzheimer's and has been in a care home for about three years. She had a UTI last month which took a lot out of her but yesterday went suddenly downhill and is now unconscious. I think she is possibly able to swallow very tiny drops of water but is obviously not eating. She's on oxygen because her breathing is shallow and rapid. She's very very thin indeed. We saw her yesterday as the home think the end is near.
But they can't say how long.
I am guessing a few days at best. Does that sound likely? I am hoping she slips away gently soon as she's quite peaceful, it's like she's very deeply asleep. They said if she seems agitated or in discomfort the nurse at the home can give her morphine.

So sorry to hear this, I hope it’s gentle and swift for all your sakes. No direct experience, my MIL died very suddenly with Alzheimer’s which was a shock but a real blessing I think. 💐

Sorry you're going through this; sometimes the waiting can be exhausting.

As somebody who used to work in adult social care in a different life, it could potentially be days, maybe a week, or maybe much sooner. Morphine can be controversial but I honestly believe its's a God-send to aid pain relief and distress if there is any.

I have spent time with many end-stage elderly people who didn't have family and there is generally a pattern. Labored shallow/rattly breathing is usually a precursor to final stages of life, I have found at least. Also it's not too uncommon for some people to have a burst of 'rallying' for a brief period before the end, but not always of course.

Sadly people seem to have this ability to 'hang on' for days when you'd think they are on the brink.

Hopefully it will be calm and peaceful for your family x

Thanks for the kind words. Her breathing wasn't rattly at all yesterday, just shallow and rapid. The home said that morphine for pain further depresses breathing and in that sense can be a kindness iyswim. Like to help them along but free of pain. There seems to be no discomfort at the moment, but she's totally unconscious. Doesn't stir if touched, for instance. We were hoping she might slip away peacefully in the night. Today apparently there has been no change.

When my mum died of dementia, she had a massive downturn one day and just stopped eating and drinking, and was just about rousable but not a lot. It took 10 days before she died, the GP issued just in case drugs, but all the home needed were the anti agitation drugs the day before, and it was very peaceful.
Im so sorry you are going through this

My dad who also had Alzheimer’s had about 2 weeks where he mostly slept and didn't eat or drink much at all and then, recovered and lived another 6 months! His breathing was fine until just before he died though - it is v hard to tell with dementia though

I was thinking it could be a week or longer, or of course much sooner. She's very very thin, but has been for some weeks now.
If there is no change tomorrow I will try to go and sit with her for a while as I don't have much work on (freelance). DH has to work and is finding it all very difficult but I would like her to have someone there when possible, although I don't think there is much awareness of the world around her and even if there was, she can't remember who I am anyway.

My DM at 97 was similar, OP. She lasted for about 36 hour after we were informed. She was sleeping all the time and didn’t seem to be in any discomfort. We took turns to sit with her until the end, but she was evidently unaware of us, and unresponsive.
I don’t mind admitting that it was a relief that after about 15 years of it, she was finally finished with Alzheimer’s at last.

Wow, 97. I think probably it's going to be soon, but she was always very physically healthy, really active until her late eighties so maybe she will hang on longer. The home said on Monday to be ready for it and they think it's imminent. But obviously you can never know.

I hope she can just slip away soon though. Assuming nothing happens tonight I will go and sit with her for a bit tomorrow, even if she doesn't know I am there. I think it will be comforting for DH to think she has someone there. He was glad to see her on Monday but found it hard.

Similar situation with my mum and hospital informed us a few days to couple of weeks. She rallied and it was 7 months (none of it quality or kind) sorry

Sorry you're going through this. My MIL was in exact same situation earlier this year. The nurse at her care home advised us that her swallow went on the Sunday and she passed away on the Friday. The staff advised us when she was close to the end and my DH was with her. She became much more settled in her last few days.

I am not clear whether she can still swallow or not. If she can then it's only tiny tiny quantities obviously as she's unconscious.

MIL was similar. The care home has been encouraging her to swallow up until the Sunday, at most she was taking 100ml a day for about a week prior to her swallow going. She seemed to shrink every time I saw her. I think if she's unconscious and unless she's alert enough to swallow something, I would assume she stopped being able to swallow and to think of only comfort measures for her. Staff left music on in her room constantly which seems to help settle her.

She wasn't unsettled at all on Monday. It's like she is sedated, she's unconscious and not responsive to sound or touch. But not agitated at all.
I will see what happens over night and go tomorrow to sit with her if she makes it through the night.

By Monday I mean yesterday. It's a bank holiday here (abroad) and I am getting confused about what day it is.

I have just phoned and her breathing is more laboured apparently so I am going to go and sit with her for a bit.

I'm sorry for you, @OrangeBlossomsinthesun, not an easy situation at all. My dad (95) has had severe dementia for the last six years and it's only a matter of time.

Mil has progressed quite fast. She was diagnosed stage 5/6 in 2021.

I have come to visit.
She's ever so slightly more responsive but still cant open her eyes and basically pretty unconscious . Breathing is more laboured even on oxygen (the little thing that sits under the nose). Still not rattly though.
She seems to be able to swallow as I think they have been able to give her some liquid food this morning.
I don't think she's in discomfort or pain though. Will talk to the nurses /social worker before I leave.

I hope that who is feeding her is trained to feed in these circumstances. The chance of aspiration is very high and food isn't necessary now as it appears that your MIL is actively dying.
I'm sorry you are going through this, we had the same with my DF. We used damp mouth swabs to keep him comfortable.

I think it was a misunderstanding. I don't think she has been fed, just position adjusted and mouth care.
Spoke to the nurse and the doctor is going to come in this morning and discuss morphine and something to ease secretions in the chest and set up what I think might be a cath port or something (direct access butterfly thing ). It's all in Spanish so I am not sure of terms.
Her knees are mottled too.
Even in the time I have been here the breathing has changed. I don't think it will be long.

That's a relief re feeding.

I hope all is pain free and peaceful for your DMIL.

They just phoned now to say she´s just passed away. So I am glad I went today. I stroked her hair and told her she could go if she wanted and that her mother and father were waiting for her. She didn´t remember us at the end but still talked about her mother and father so I thought that would be comforting if she had any residual awareness.

My mum was very similar but as she was already very underweight, she actually died within a day, no end of life drugs were needed as she was not in any pain and died very peacefully. Her breathing just slowed down and very quickly she stopped breathing altogether, we did not notice at first it was so quiet.

You star, Orangeblossom. That's a lovely thing you've done for both your MIL and your husband.

I am sorry . It is trite ,but she is at peace now. May her memory be a blessing.