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

[Mini712]

My DM has been in hospital for a week for dehydration & breathlessness. She had been refusing food & drink at home which why she ended up in hospital. She agreed to go into hospital as my DD & GP told her it would be for one day!
She went on a drip for a day & the cardiac team tweaked her meds & prescribed a high doses of vitamin D for the breathlessness but so far we have seen no improvement and if anything she is getting worse. She is now saying she is unable to stand without support & is pretty much declining most food and more worryingly fluids. The nurses think it’s behaviour & are getting frustrated with her because they think she is not cooperating deliberately. Dad & I have desperately been trying to encourage her to eat & drink but she makes up excuses or just says no. The general medical team are trying to find out what’s wrong but all her bloods are fine & her CT scan that she had in July is clear.
What will the hospital do if she continues to not eat or drink? She doesn’t have a diagnosis for dementia but clearly something is not right!

Sorry to hear that @Mini712 I'm not an expert but do have (very) elderly parents and didn't want to leave you unanswered.

That is worrying. Could she have an infection? That often makes older people act out of character. My own mum is currently in hospital after a fall, and is just recovering from an urinary infection which caused all sorts of issues and confusions, even though she doesn't have dementia.

Presumably the hospital will support with fluids etc. Can you speak to an actual doctor?

Is she old or frail? Is she depressed or wanting to die?

Could you take her in some ice lollies or ice cream, that might tempt her. My mum would not eat the hospital food but she did suck on some chocolate.

How old is your mum as it does sound like depression.

i don’t think the nurses should be getting frustrated as they must know this behaviour is quite common. As to what happens next. They are likely to continue with the fluids intreveniously. My mum lived for 4 weeks on just fluids this way.

My heart goes out to you as I know how powerless you must feel.

If it continues there’s not really a lot we can do in elderly medicine. It would depend if appropriate for artificial feeding but if she’s refusing, she may well just pull out NG tubes and they’re not a long term solution. There’s only really so much iv fluids you can give and sometimes after iv fluids when patients have dehydration and infection they pick up, sometimes it’s just their new baseline but once they start refusing food and fluids they start to decline as it’s an endless cycle of fluids enough to be fit for discharge, readmitted again with dehydration. You do have to remember however that appetite does tend to be low as they’re not using as much calories as they used to, so in the meantime whilst waiting to see if they pick up, we literally recommend relatives bring in anything! We don’t worry too much about balanced diets as long as they’re eating and drinking something, be it their favourite snacks, cakes etc at home. Has she had a dietician assessment to consider calogen and fortisip type drinks or is she refusing those too?

It would depend on her frailty. I presume she has heart failure from what you are describing. Is is advanced? If her bloods are all ok then I would not think she has an infection.

Sadly some elderly people do decide to 'give up' and refuse diet and fluids. As pp have said IV / SC fluids can be given but if she is refusing and her heart failure cannot be brought under control then she may be heading towards palliative care. Does she have a respect form?

Mum is 79, so not that old. About a month ago the GP assessed her and she did show as moderately depressed but again she refused any medication or help.
She has had a lack of appetite for months now but in the last two weeks it has got much worse and she is only eating a few mouthfuls and this has continued in hospital.
We have tried everything, but she just says she doesn’t fancy anything & isn’t hungry. She says she wants to get out of hospital but can’t seem to grasp that they won’t release her until she starts eating & drinking. The doctors have taken more bloods & are re looking at the CT scan but we have had no one see her today.

@DarkLion refusing the fortified drinks too

Has she had a review with the palliative care team?

Palliative care are consultants are God-tier at getting the picture on whether someone has had enough and just wants to be left alone, which might be the case. Sometimes though, asking the medics for a referral causes everyone to up their game a bit.

@PermanentTemporary no not yet. No one from the medical team have mentioned EOL.

Mirtazepine is often used for depressed older people with depression because it increases appetite.
Might be worth asking if there is a mental health liaison team who can review her?

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

@Jaffaisitacakeorbiscuit thank you for the suggestion. Unfortunately, I’m 3 hours away so don’t get to see the doctors. I’ll mention it to my Dad.

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.

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.

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.

@Rictasmorticia I have been think EOL for awhile but have not mentioned it to Dad as it would break his heart & he is still hoping she’ll get better and hope is all he has😢. Thank you the suggestion of a third party that could certainly help.

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).

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.

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.

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

@Fraudornot she wasn’t frail up until 6 months ago. The breathlessness has caused her to become frail, worn out from the slightest task until she spent all day on the sofa. She has never exercised & used to have a very healthy appetite. She was 15 stone at her heaviest & is now about 10 stone.

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?

@Hairyfairy01 yes, they are monitoring food & drinks & the dietitian has been to see her & prescribed the special drinks but Mum is just not interested. They sit by her bed all day untouched, maybe the odd sip if we or a nurse can push her to drink.

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.

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?