My mother is 90 years old and is in a nursing home. She is suffering from some dementia and is having reoccurring UTIs. After her dr. appointment today her doctor pulled me aside and started talking about some end-of-life decisions. He informed me that most deaths in the nursing homes come from UTIs and pneumonia. He believes that the UTIs my mother is suffering from will be what ends her life and he said this would be the time to continue to treat the UTIs, which would not resolve them and could possibly end her up in the hospital again or to stop treatment and allow her to slip away peacefully. Is this a common practice?
Four years ago when my mother was put on hospice due to a UTI, the doctor told me that UTIs in full-blown pathogenic mode eventually hit the kidneys and this is the least painful way to go; the patient just falls asleep from the buildup of toxins/bad bacteria not being filtered from the liver and kidneys. My mother recovered due to Old World genetics - she's a fighter! :-) I'm actually waiting for another UTI to come so I can put on hospice and let nature take its course. There's only so much suffering that one person should take. We can't reverse the disease process. And more painful health issues will surface. Its possible for the body to build resistance to multiple drugs that treat UTIs because of a compromised immune system.
You should consider her quality of life now as it is. At her age in a nursing home is she functional, lucid, socializing with others? Some residents are still striving strong but others not so much, unfortunately. If she were to develop sepsis from the UTI, does she want all aggressive measures - very painful/not very pleasant measures - to maybe recover - and then return back to the nursing home until the next medical issue surfaces? We all want as much time as possible with our loved ones but there is a time that the suffering is just too much and its time to let go - because you love them so much that you don't want them suffering anymore. I'm not saying your mother is there yet. But I'm there now with my mother.
Not that this needs to be said again, but it is so d*mn heartbreaking and stressful.
I recall reading that once infections set in, even if treated, they will reoccur repeatedly in those who are already ill and immobile. It sounds like you have a perceptive doctor, who has experience treating those like your mother.
We had a meeting with hospice about two years ago after my mom suffered a second bout of pneumonia in two months. We were able to see clearly that while they were able to clear up the pneumonia, each week long hospitalization set my mother back further and further, both physically and mentally.
Mom was determined to be hospice eligible by her doctor at the nh. We met with the hospice provider and discussed what would and wouldn't be able to be treated. We elected to go with palliative care, not hospice. For mom, this means that they will treat what they can "in house" and not send her to the hospital. She has had pneumonia once and it was successfully treated with IV antibiotics.
Xina, do you have a doctor or NP who comes to the house? Can they simply script antibiotics when she becomes symptomatic?
Think about your mother's quality of life from HER perspective. Did you have discussions regarding what conditions would be acceptable and what conditions would make her prefer not to live any longer? Decisions must be made based on what she would want.
People say my being my mother's caregiver extended her life. The psych Doc in rehab was amazed she was so engaged and focused and responding as well as she did given that there was absolutely no memory there. She would not have wanted to live like that - did I do the right thing? I did my best, but recognize that maybe she would have preferred I did it differently. When I saw signs that she wanted to go, I brought her home and moved to ensure her comfort and let her go as quickly as possible. But there are no black and white answers. You may always wonder if you made the right decision. All you can do is your best, make her desires you guide.
She has a large kidney stone, which is a big contributor to these. Unfortunately, it is large enough that it would require minor surgery and general anesthesia; her urologist thinks she might not be able to tolerate all that, given that she frail and has multiple health problems.
Today her dr asked me if I've considered hospice, which I haven't. I need more info about this. I understand if she had terminal cancer that it would be time to stop treatment, but it's tricky with the UTIs. It is very traumatic for her to keep going to the ER for these; on the other hand, they tend to make her acutely ill - diarrhea, chills, and vomiting. I can't imagine just saying "we're not going to treat this or take you to the hospital," just let you become septic and die. That seems cruel, yet, again, I understand that routine hospital stays for these are crazy too. I'm stuck. What would the scenario be if we didn't do anything? So scary.
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