Dementia - section 3 - not drinking enough, now in hospital

[CharlotteBog]

My MIL has been in psych hosp on a section 2 and now a section 3 for a couple of months now.
She is more settled, but has not been eating or drinking enough.
She collapsed and was taken to hospital to be put on a drip, she then collapsed again (kidney failure) and was taken to A&E.

I understand that frail, elderly people can deteriorate very quickly, but not eating and drinking enough has been going on for a while.

I don't understand how someone in a psych ward on a section can become so seriously unwell. Isn't there something the medical team can do before kidney failure? She does not have capacity.

I am not criticising her care, I just don't understand.

My dad was on a section 3 for dementia and in a psych hospital for 11 months. In those circumstances I would have expected absolutely for them to be monitoring things like fluid intake, food intake and to be communicating concerns and discussing supportive options well in advance of collapse. Having said that, dementia does affect thirst and hunger . However I would expect medical professionals to intervene with supportive measures before a patient is seriously unwell and I would be asking expecting wtaf.

Or have they put her on some kind of death pathway? I'd be asking a lot of questions right now.

Thank you @FabricPattern

I do know that NOK have been asked about resuscitation, however during the last weekly meeting they have been talking about completing her assessment (which couldn't be done until she was more settled) and being moved to a care home.

Her husband is the main contact with the hosp so it will be him asking questions. She has a daughter who will not hold back.

It’s because the NHS is pretty awful at the moment. It seems the only way to ensure people with dementia have enough to eat and drink in hospital is to do it yourself. This is going on the proviso that they are not refusing of course.
We were told staff were “too busy” to make sure my father was supported to drink regularly. Hopefully she’ll be out and in a care home ASAP!

We can monitor and prompt food and fluid, use comfort rounds or enhanced observations to try and improve things. Knowing preferences can help. Monitoring observations and bloods to pick up early signs of deterioration. Medics should have been reviewing regularly.

Most psych units can’t do IV fluids. General hospitals can be really reluctant to accept psychiatric patients and send them back really quickly without a real plan in place which can make it really tricky.

It’s a really hard one. They need to try to get to the bottom of whether there is a physiological reason for not eating or drinking or whether it is dementia or other mental illness related and address this.

Thank you for the information, this is all new to me.

She is more stable now, which is encouraging.
She has been refusing food and drink, saying she isn't hungry/thirsty.
I just don't understand - they're well able to tell her over and over that she can't go home, can't do this, that and that other and can administer meds etc, but then this can be allowed to happen.

She is quite a distance from the 3 people who have visited (her husband, daughter and me) so it's not easy to be with her. I also have a full time job and am a lone parent. It will be much easier if she can be settled in a care home near where her husband lives (which is near me, too).

When people have severe dementia they usually die of or with kidney failure.

This is because they no longer feel thirsty or hungry, and it's impossible to force feed people orally if they won't cooperate.

Is it really in her best interests to have IV fluids now? As she's been sectioned she must be in the latter stages of the dementia.

What do her NOK want to happen? Keeping people alive when they're terminally ill isn't good practice, on the whole.

And in psychiatric hospitals, of course it's easy to tell patients what they cannot do.

It's almost impossible to make them eat and drink though, and could be classed as assault.

I’d agree; this must be really traumatic for you all, but they cant force feed her if she’s insisting she won’t eat or drink.

Have they talked to NOK about next steps?

While I'm not suggesting this is the right thing, if someone is under a section then feeding them via IV or NG tube would not be classed as assault, would it?

I'm just shocked that it's gone from the meeting (with all the agencies) last week where they were talking about completing her assessment and moving to a care home to this. Her social worker is looking at suitable homes.

She has not been eating and drinking enough for weeks. That's what baffles me. If this is one way dementia manifests itself towards the end, then why have the people who love and care for her not told us that this would be a likely progression?

She knows who I am, she talks about my sons and my interests. She is able to look after her own personal care.

I spoke to her husband this evening (he's the NOK) and he seemed reassured.

I am quite pragmatic, I would not wish for her life to be prologued if it would involve invasive and distressing procedures for her, but I've been optimistic that she could be settled in a care home and her dogs would be able to visit her. I'm shocked (and terribly upset) that she could be so near the end. There has been no indication of this from the ward staff.

OP psychiatric hospitals can't do medical interventions

And dementia patients always pull out their NG tubes.

The trouble is that medical staff are hopeless at accepting when patients are dying.

They give antibiotics when dying of an infection is in the patient's best interests.

Thank you @TheShellBeach
I appreciate you sharing your knowledge.
I'd better make plans to go and see her. My sons haven't seen her since she was sectioned - my older has left home and my younger one is too young to go to visit the ward.
I feel like I want to write more, but maybe I'll write it in a journal for myself.

My mum died from dementia. She got frailer and frailer then stopped eating, then stopped drinking. People can’t last long without fluids. Feeding tubes aren’t recommended for dementia patients. I’m sorry.

I am very sorry to read this and understand what a shock this is.
My DM also has a section 3, she is in a nursing home and has stopped eating apart from a couple of hundred of calories per day.
About a month ago I had an appointment with her GP to talk about end of life care, it was a shock to me. I also had to fill in a big booklet for the nursing home. I have told them not to intervene and to keep her comfortable. So this means a DNR is in place, there will be no feeding tubes, no intervention if she has a stroke, the nursing home now have all the hospice drugs in place. I’ve read up a lot on the dying process and understand it a little more now.
I am visiting as often as I can.

Update: she is hydrated and eaten some food and been discharged from high dependency back to the psych ward.
I understand it's only a matter of time, but the immediate crisis has passed.
I will hopefully go and see her on Wednesday, though my son is home from school poorly so I'm stretched a bit thin.

Would it be okay if I join? I don't understand why dementia patients' lives are prolongued to the point where they are sectioned and in a psychiatric hospital. I wondered if there is a way to talk to family and medics to ask that this should not happen. I have a relative who is heading this way and nobody seems to be able to see that endlessly prolonging her life is not kind, but is just sparing the feelings of the people who can't bear to make the decision to stop.

@@Bridgertonne I would be really grateful to know how you got your loved one out of that loop.

Hi @CharlotteBog and @SlowlyForward

Join us on this thread if you like

https://www.mumsnet.com/talk/elderly_parents/5036546-so-bloody-exhausted-waiting-for-someone-to-die-3

She was sectioned to keep her safe and her actions (delusions) to protect others.
She was walking her dogs, enjoying her garden, meeting people (albeit in her owl world).
That life could not morally be ended because her diagnosis is terminal.

• I would be really grateful to know how you got your loved one out of that loop*

My DM was sectioned nearly two years before she started the dying process. She wasn’t sectioned to have her life prolonged she was sectioned because herself and those around her were not safe.

CharlotteBog
Thank you for updating and I hope your visit goes well.