Mother doesn't want to continue

[aracena]

My mum is 86 and she has fractured the coccyx following a fall which is hugely painful for her. After a rather traumatic time in hospital getting this diagnosed and getting appropriate pain management, she went to a care home for two weeks of respite care. She is due back home in a day or two.

She is much loved and has family ready to help who live very nearby and money to pay carers if she needs them to help her while she recovers. We have adapted her house for her while she has been in care so she should be able to manage getting around when she returns. However, she frequently says she no longer wishes to live and wants to stop eating and drinking. I don’t know how to respond to this. She has all her faculties about her but I can’t help but feel she is giving up too soon. A fractured vertebrae must be hugely painful and she is on a lot of painkillers but the prognosis is relatively hopeful. But she feels that she just can’t face the inevitable deterioration of the next few years. She also suffers from aged related macular degeneration and is slowly losing her sight - although she can still see.

She could overdose on her painkillers but she has said she is not brave enough. I am worried she will not eat when she returns home and she will accuse me of being cruel if I try to encourage her to do so. But on the other hand, she has asked my 16 year old DS to help her prepare food for her - she has offered to pay him like a part-time job.

So I don’t know how to approach this. Am I being cruel if I try to encourage her to try to get better this time? Or is benign neglect the way to go? At the moment I am acknowledging how she feels but then try to distract her with talk about grandchildren etc. I do want to respect her wishes but also feel that she is maybe in too much pain and distress to think straight. If she can just get through the next few weeks while the fracture heals, she should be able to regain a reasonable quality of life. But maybe I am being selfish because I don't want her not to be here anymore. I'd be grateful to hear other people's ideas on the situation.

Sorry you and your Mum are going through this, it’s tough. Be there for her, give her a reason to enjoy life, find ways to enjoy your time together, however long that turns out to be. If she chooses to give up food and drink I wouldn’t intervene though, but get your DS round there preparing food and drinks regularly as she has asked for this. Hunger and thirst are powerful drivers and she will have to be properly determined to stop eating and drinking or genuinely dying anyway ( it’s normal to not want to eat in the weeks running up to death, the body knows that you no longer need to, although it doesn’t sound like she is at that stage at all). The company of her DGS will help too. Good luck.

If she can just get through the next few weeks while the fracture heals, she should be able to regain a reasonable quality of life.

She may feel differently when she is back in familiar surroundings. Being in pain and in hospital can really do a number on your mental health, even for much younger and fitter people.

My Nan used to say she was ready to go a lot… but she made it to over 100! See how she is when she gets home.

My DM sounds very similar - when she has been ill she often wants to die but when she is well she is very motivated to stay well. So I have always ignored the dying talk and pushed her along.

I've come to a kind of emotional resolution about it now as honestly her life is tough with a lot of disabilities, living on her own, she's at an age where she has outlived my DF and is now outliving a lot of her friends.

I don't think she is excited about living another year but she isn't actually dying. But if something happened and she did die, I don't think she would be sad about it.

So am sending you hugs and it's a fine line between encouraging, but remembering what they want and you want may be two different things.

I think you should make the hospital and her GP aware of her views so that they are appropriately recorded on her notes as a concern raised by family. If she is open to have her grandson supporting with food and drinks, that might be the way to go? You can always send him with her favourite meals and snacks and she might accept them from him. I used to take my grandad individually wrapped cakes and biscuits that he could have with a cup of tea - he was more open to that than opening a 'big' cake or packet of biscuits.

Being in constant, chronic pain is horrendous and can trigger depression/low mood (I have experienced this myself). Maybe some counselling or mental health support could help her deal with that?

Ultimately no-one can force her to eat but there's nothing to prevent you offering her food. It would take a very determined person to refuse food and drink completely. If it does get to that stage, make sure it is documented on her medical records, that her GP is aware and that any carers log what was offered and what she refused.

Good luck 💐

Mum had her knee reconstrusted when she was 85, spent six weeks in rehab and then returned home. The carers that came in as part of the discharge from rehab lasted two days before there was a mutual agreement that she was doing what they had come to do. After that she had two good years of total independence, back to doing everything for herself. The year after that was probably ok for her but not for me as dementia took her away from herself. For her it was a few months of pain and recovery for two more years of good life. She would have told you that it was worth the intervention and the work she put into recovery.

Your mum is not back home yet, being in her own bed and making her own decisions might make her feel better about the future. Spring is just around the corner, if she gardens try to get her thinking about the upcoming growing season. Pain and lack of sleep affects your thinking, I'd wait and see what she's saying in three months before worrying about the future.

I think it's a great idea to be cooking with her grandson, it will be good for both of them.

The fact that she’s discussing wanting help/to see your son and for him to assist in food prep speaks volumes. I would hazes a guess that being in unfamiliar surroundings, in pain, worrying about how not to be a burden on family and on painkillers is causing her to feel life isn’t worth living, but then she asks for help from your son - which says that there’s a stubborn streak with a desire to enjoy life within her somewhere. Maybe if you can get her home and pain free, some family tlc will help her physical and mental state improve.
You sound like a loving, tight knit family. Just what she needs.

Thank you so much for all your support. It has been really helpful. I do hope you are right that she will feel better when she gets home. I just hope we are able to support her enough.

She is a pretty determined individual but she also still has a lot to live for if she can see it. She loves to garden and talking about plans for the garden it is great idea.

I have suggested counselling and antidepressants for her before (last time she was ill in fact) but she was pretty resistant to the idea. To be honest, I think she would have benefitted from both at other stages of her life, but I suppose she has a different approach to mental health than people of my generation.

Thank you all again for your support.

It wouldn't be appropriate to make predictions about your mum's state of mind or intentions. However I've spoken with lots of elderly people with vertebral and hip fractures who've said similar things about their will to live at the time around the injury and its aftermath. They can indeed be very painful; it's surprising how restricted your movements can be, and it's frightening to be trapped inside a body that might do this to you again. Elderly patients frequently have other conditions to contend with, like your mum, which doesn't help to raise the spirits.
It sounds like a gloomy prospect. But people can and do get through it in time.