Potentially upsetting question about death.

[Chocchops72]

I’m not sure how to word this so I’m just going to come out with it.

how do frail, elderly people in nursing homes eventually die? When every ‘natural’ cause of death is denied to them?

My MIL is 85, aged advanced Parkinson’s, dementia and osteoporosis. She is immobile, very frail, doubly incontinent. Any time she is ill, a dr is called - most recently for a chest infection where she was prescribed antibiotics. Is this what happens now? She is just kept alive (existing) at all costs?

i don’t have much experience of the end of life, I don’t know how it happens.

A general observation about DNRs (Do Not Resucitate) is that I think as a someone's child the first time you have any interaction with or thoughts of DNR (which often happens for the first time following an emergency admission) your whole body and mind is screaming against the very idea because you want your parent to be with you forever and stay alive.

For many people, it takes a bit of time, distance, calm thinking and outside of an emergency to realise that in a lot of cases resucitating someone elderly near end of life or with a terminal illness would be cruel. It can take a lot to mentally make that jump to acceptance.

Thank you for this thread it is very worthwhile.

I was talked into a DNR in 2014 for Mum who was in Epsom General Hospital after nursing home neglect. Her BP had gone down to 40/20. The idea was if she had cardiac arrest it might be cruel to resuscitate her and the doctor seemed sincere but I was there all night to oversee her recovery and argue her case at the time. BTW no accountability for the nursing home in question - that's just how Surrey County Council likes it! - and the day before one of the consultants had argued Mum could return to the care home asap, they're all lovely aren't they? Mum had aspiration pneumonia.

Three years later - and I'd have settled for that at the time tbf - in Kingston hospital with the awful then manager of Galsworthy House secretly plotting - I agreed to DNR for Mum thinking that we were there every day and could keep tabs on it. The look of relief on that cow of a manager's face should have told me something, and Mum was dead that autumn.

So it depends whom you're dealing with.

One family I knew had their elderly mum in for respite in a care home, she was DNR but the paperwork wasn't there so when she had a fatal heart attack the paramedics were forced to resuscitate her. (This one instance shows the total disparity between paramedics and the rest of the medical profession - they will be conscientious to a fault but other care home residents under some consultants or care home managers or Safeguarding heads will be allowed to die with no comeback at all.) She was a zombie in pain for the next 24 hours and the daughter had to get the hospital chaplain to urge the doctors to 'see to it' i.e. finish her off or put her out of her misery. There's no suggestion on anyone's part that this was the wrong thing to do. It also is highly unlikely it will be in her medical notes.

The not eating and drinking thing is more the body isn’t getting the messages from the brain they loose the ability to eat and the body can’t process the food
palliative care can run you through this

once it got to that point trying to feed them will kill them they will aspirate and food it ends up in there lungs they'll chest infection

I've come to the conclusion we're an odd family because to us, DNR should be the norm and you should have to make a special case to have resuscitation tbh. I really don't think medical teams should have to do it. I genuinely don't understand why anyone wants resuscitation of a stopped heart for a relative or for themselves. It is a brutal procedure that hardly ever works unless you are in hospital and even then the outcome isn't great. It's lucky i guess that I'm not involved with the decision except for myself and my dm, and I know her wishes.

I’ll just reading about DNRs and other advance wishes / planning in Dear Life. She says that while 85% of people, when asked, say they would want to die at home, only 4% actually write it down somewhere. So thanks for that website @TheSilveryPussycat

the other complicated thing is that all the terminal patients she’s (Rachel Clarke, palliative care dr) dealing with have capacity. When she asks them what’s important to them in the time left to them, they can tell her. But MIL wouldn’t be able to do that. FIL has never got his head around the fact that having POA means making decisions that are in MILs best interests - rather than his. His response to any questions about it would be driven by his fear of her dying rather than considering the quality of life that she actually has.

I guess I just have to accept that the system is duty bound to keep her existing in her current state for as long as they can.

I've written down in my advanced directive that I want to die in a hospice or a nursing home, or in hospital if that can't be achieved. My top aim is to avoid ds having to nurse me at home. My cousin is still traumatised years after nursing her husband at home until his death. They asked him where he wanted to be but they didn't ask her what she felt about it.

It's true that the elderly can lose the ability to eat and drink, but my point is that the State can and will force the issue - there's little to chose between someone in that condition, and someone who has been denied drink in a care home, as the post mortem will not be able to tell the difference. This saves money but the family will be unawares, or if 'awards' they'll be made out to be a trouble maker.