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Surgery while still septic is a bad idea. Surgery concurrent with fluids around the heart is an additional risk. It's a 45 minute surgical procedure that adds nothing to life expectancy. Just say no.
PEG? Does she have a DNR? Ahh a feeding tube? Are you her POA? Does she have a living will? What are her wishes? I sure would not have one placed for my mom with Alzheimer's. She has a living will. I know mom would not want it.
Agree with Pam that surgery with sepsis should not be attempted. Wait till she is out of the woods. I had missed the fact that she has dementia and is 96. Ask lots of questions then make a calm rather than an emotional decision.
This is from an article on this site: "For people with severe dementia who can no longer eat on their own, feeding tubes are sometimes recommended to ensure adequate nutrition and avoid aspiration. However, the AGS, the AMDA and the American Academy of Hospice and Palliative Medicine (AAHPM) all caution against the insertion of feeding tubes for those with dementia. Instead, they suggest oral assisted feedings as the preferable option. "Contrary to what many people think, tube feeding does not ensure the patient's comfort or reduce suffering; it may cause fluid overload, diarrhea, abdominal pain, local complications, less human interaction and may increase the risk of aspiration," according to the AMDA."
If Mom is being fed with a tube through her nose a PEG tube will be much more comfortable for her. It is a minor process to have it placed. If she is not close to dieing and wants to live it is a good decision to make. Feedings can be done overnight so daytime activities can be continued. Medications can be given through it either in liquid form or pills crushed. For someone with advanced dementia it may be a different decision because the patient will not be able to understand the process and may pull the tube out. Allowing her to continue to take things by mouth will ensure aspiration pneumonia which will result in death fairly quickly. A PEG tube is easily managed at home or in a facility. The main problem is the tube blocking so it is important to flush the tube as instructed. If it is pulled out it is not a big deal to put a new one in. If Mom is likey to pull out the tube constantly then different decisions need to be made which may include hospice. Hospice does not usually support this type of feeding but will usually allow it to continue. It is really quite simple to manage once your have received instruction. If Mom is coming home try and be at the bedside a few times when a feed is set up. I have had one now for over a year and manage it easily on my own. The patient can continue to eat by mouth if it is safe to do with the goal of eventually discontinuing the tube feedings. Medicare does cover the cost but only approves about 25% of applications. If Mom has already failed swallowing evaluations and is aspirating she sounds as though she will be approved. The tube is attached to a small pump which is programed to adjust the flow to the correct rate. It is electric but has battery back up. I was also supplied with a gravity feed bag which would be used if there was a prolonged power outage. As the Drs are recommending a tube I can only assume they feel Mom will benefit from being fed. Not knowing Mom's overall condition I would recommend giving it a trial. Easy enough to discontinue at any time. it does not even have to be removed. Tubes do need to be changed about every three months so that does mean Mom has to spend a few hours at the hospital but family can remain with her except for the 20 minutes or so she spends in the proceedure room. They will use sedation if she is very anxious. I personally am a real scardy cat but this has become routine with no anxiety
My brother, not yet 60, had throat cancer several years ago. He had a feeding tube. The full intention was that he would eventually be able to eat again. He did. He no longer has the tube, of course. In my mind that is a perfect use of a feeding tube. A temporary measure to get over a temporary problem.
But for a person with advanced dementia? When there is no chance of ever being able to eat on his own? And if swallowing is now impaired and he is too weak to cough he is most likely close to the end of life? For this population I agree with the "experts" who have seen this over and over.
PEGS should not hurt if all goes well with their placement, but the gist of the NEJM article is that on average, providing them in the setting of advanced dementia may improve neither quality nor quantity of life. They may not even prevent aspiration due to either reflux or vomiting. If the person would have to be restrained from pulling the tube out, that almost always tips the balance towards not getting one. If it helps any, having a PEG otherwise would not limit mobility and tastes of favorite foods can typically still be given by mouth just for pleasure.
I am very "pro" feeding tube in the right setting, even if it will not be temporary, but for the specific population mentioned in the article -severe, advanced dementia - they are largely correct, though a very few cases could be exceptions.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I had missed the fact that she has dementia and is 96.
Ask lots of questions then make a calm rather than an emotional decision.
"For people with severe dementia who can no longer eat on their own, feeding tubes are sometimes recommended to ensure adequate nutrition and avoid aspiration. However, the AGS, the AMDA and the American Academy of Hospice and Palliative Medicine (AAHPM) all caution against the insertion of feeding tubes for those with dementia. Instead, they suggest oral assisted feedings as the preferable option. "Contrary to what many people think, tube feeding does not ensure the patient's comfort or reduce suffering; it may cause fluid overload, diarrhea, abdominal pain, local complications, less human interaction and may increase the risk of aspiration," according to the AMDA."
You can see the entire article here:
https://www.agingcare.com/articles/treatments-older-adults-may-not-need-162262.htm
If she is not close to dieing and wants to live it is a good decision to make.
Feedings can be done overnight so daytime activities can be continued. Medications can be given through it either in liquid form or pills crushed.
For someone with advanced dementia it may be a different decision because the patient will not be able to understand the process and may pull the tube out.
Allowing her to continue to take things by mouth will ensure aspiration pneumonia which will result in death fairly quickly.
A PEG tube is easily managed at home or in a facility. The main problem is the tube blocking so it is important to flush the tube as instructed. If it is pulled out it is not a big deal to put a new one in. If Mom is likey to pull out the tube constantly then different decisions need to be made which may include hospice. Hospice does not usually support this type of feeding but will usually allow it to continue.
It is really quite simple to manage once your have received instruction. If Mom is coming home try and be at the bedside a few times when a feed is set up.
I have had one now for over a year and manage it easily on my own. The patient can continue to eat by mouth if it is safe to do with the goal of eventually discontinuing the tube feedings. Medicare does cover the cost but only approves about 25% of applications. If Mom has already failed swallowing evaluations and is aspirating she sounds as though she will be approved. The tube is attached to a small pump which is programed to adjust the flow to the correct rate. It is electric but has battery back up. I was also supplied with a gravity feed bag which would be used if there was a prolonged power outage.
As the Drs are recommending a tube I can only assume they feel Mom will benefit from being fed. Not knowing Mom's overall condition I would recommend giving it a trial. Easy enough to discontinue at any time. it does not even have to be removed. Tubes do need to be changed about every three months so that does mean Mom has to spend a few hours at the hospital but family can remain with her except for the 20 minutes or so she spends in the proceedure room. They will use sedation if she is very anxious. I personally am a real scardy cat but this has become routine with no anxiety
But for a person with advanced dementia? When there is no chance of ever being able to eat on his own? And if swallowing is now impaired and he is too weak to cough he is most likely close to the end of life? For this population I agree with the "experts" who have seen this over and over.
I am very "pro" feeding tube in the right setting, even if it will not be temporary, but for the specific population mentioned in the article -severe, advanced dementia - they are largely correct, though a very few cases could be exceptions.
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