cxmoody Asked January 2023
Are you over 70? If so, would you please answer this end of life question?
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In the book “Becoming Mortal”, by Atul Gawande, the author asks some end of life questions. One of these is:
“Do you want antibiotics?”
If you are over 70, would you mind sharing your answer here?
Here’s why I’m asking. A wheelchair bound man with advanced dementia at my mother’s MC was recently given antibiotics for pneumonia. He is 85 years old. He recovered, back to his wheelchair, life in a diaper, unable to recognize or communicate with his wife.
_To ME_, it feels like, recovering just leaves him stuck in a horrible condition, and dying would have brought relief.
If you are over 70, what would you want, if this were you?
Thank you, in advance.
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My LO, who passed away a few weeks ago, was calm and composed and peaceful.
She could still respond when I kissed her and told her I loved her.
I hope that she didn’t feel as though her condition was horrible.
I was very happy to be able to tell her how I felt every time I saw her. She would sometimes say “I love you”, or “I love you too” when I would leave her.
‘’If we are assuming that a nonverbal, immobile person is “suffering” with no indications of distress or discomfort, is it unfair that we would think they might be feeling loved and cherished too?
So, that leads me to ask, what if they WERE suffering?
Just trying to think this through. 🙂
I am not over 70. I am 67. I think that’s close enough to answer this question.
I agree with Ann’s answer. This person may not be miserable in their situation.
If they appear to be completely miserable, then that is a different situation. They may have preferred to die.
I wouldn’t recommend that a person of an advanced age agree to a serious surgery. This is a round of antibiotics so it isn’t invasive and anesthesia isn’t involved.
I suppose there may be legal requirements for notifying family members of care options when health issues arise. Otherwise, lawsuits are a possibility. The family has the right to deny receiving treatment.
Okay, they might not APPEAR to be suffering, but isn’t not being able to toilet oneself, walk, or communicate any needs its own awful suffering?
But when I look at people like Stephen Hawking, who had severe issues relating to his ALS, he was not unhappy with his situation. In fact, he had a wicked sense of humor. So, I believe that it depends on the individual person.
I think it is a balance of trying to give them the best quality of life that you can while knowing that dementia is fatal. When her body began to shut down, then we let nature take it’s course, with a goal to keep her comfortable, with as little discomfort and as pain free as possible. Those last days were precious for both of us.
Sorry for the loss of your mom.
I wish that my mother would not have had Parkinson’s disease or dementia. We have no control over what we will have to endure during our lifetime.
It broke my heart watching her struggle. Like you, I did whatever I could to make her as comfortable as possible. Sinemet, Ativan and Seroquel helped mom cope with her situation.
I was amazed by my mom’s attitude many times over. As exhausting as it was, she tried to make the most of her life as long as possible regardless of how the quality deteriorated.
She died at age 95. She missed my dad. They were married well over 50 years. I am so glad that she is no longer suffering and is now with my father again in the afterlife.
The gentleman you have in mind had the same opportunities as everyone since about 1970-ish has had to state his wishes in advance. Nobody else has the right to withhold treatment, especially not treatment as straightforward as this.
I don’t know how pneumonia feels. Can you describe it?
Thanks!
Fast forward about 40 years and I had that same sensation of my feet not touching the ground.
She was transferred to a rehab facility where unbelievably she is only needing Tylenol for her pain. Every day she has attempted to get out of bed (part of her ongoing "going home" Sundowning). She is amazingly healthy otherwise. Dementia screws up how our bodies process and interprets pain. My goal, as her DPoA and niece, is to keep her calm and pain-free. So I am just taking it one day at a time.
Should an elder with dementia be given antibiotics? It all depends on their individual circumstances at the moment and the hoped-for outcomes of treatment. In my Aunt's case treatment (surgery) would not improve her future situation or return her to her pre-fall condition/abilities... so why put her through it?
I am 80. I have already written in my advanced directive what I will NOT take, and what I will. What I won't take is a lot including dialysis even temporarily, feedings through tube, PEG or IV (TPN or total parenteral nutrition), CPR or vents, IV fluids. I would take all comfort medications including any to decrease secretions from pneumonia, antibiotics for bladder infections, any and all pain and anti anxiety medications.
As people with diabilities cannot make decisions for themselves,, the system has to. I doubt any would recommend CPR for this gentleman. But I think all doctors would treat a bladder infections. Just my guess.
None of these decisions are easy ones to be certain. Sepsis is in some ways a quick way to go, for my brother it was two weeks total, but sepsis can be painful and is to be avoided when possible. When it isn't possible, and something has become systemic it is time, imho, to bring in the "good" meds.
With pneumonia, are patients given blood tests, generally, to ascertain if it’s a virus, or bacteria?
If it’s an aspiration issue, how is that diagnosed?
I appreciate your medical background/knowledge!
Anyone who has pneumonia or a treatable infection have a right not to die a painful slow death.
Now, having major surgery, treating cancer, or dealing with life-threatening issues when other life-threatening issues are also in play is something else entirely.
I absolutely would have wanted antibiotics for such a treatable condition. I certainly don't want to die by suffocation, which is what death by pneumonia would be.
I'm not over 70, but I fail to see how that's relevant to the discussion.
If not having antibiotics would make my condition more painful then I would want antibiotics.
If the antibiotics would not work (drug resistance for example) then I would not want them as it would make the condition worse or more painful.
When my Husband was on Hospice they gave antibiotics when necessary so I guess that would be my Standard for Care. If Hospice would approve the treatment Grandma1954 is on board
I would NOT agree to chemo or radiation.
I have a POLST. I do not want to be intubated. I do not want artificial nutrition. I suppose the exception to intubation and artificial nutrition is IF there is a chance for recovery these can be used for a trial period. I do not want CPR. It breaks ribs, sternum in most cases, may puncture a lung or both and it does not always work. (If it is possible to use an AED without CPR that would be OK)
All this is great BUT if POST forms or DNR are NOT in sight nor available when you call 911 they will do what they have to do as if these documents do not exist. So keep a copy posted in your house where it is plainly visible and keep a copy with you. Keep one in your car make sure loved ones have copies AND they are willing to follow your wishes.
YOU can make your wishes known. It may be possible that this man is a "full code" and the facility and paramedics have to do all they can to keep this person alive no matter the cost (and by cost I mean physically, not monetary cost) You never know what the full story is.....
Even after all that’s been written here, and seeing how my mother is suffering with dementia, I think I would chose the same for myself. I would want OUT.
I so admire your attitude and spirit. Others could learn a lot from you.
I was absolutely terrified while I was in the hospital; my husband spent literally all day with me, but as soon as visiting hours ended and they made him leave, I remember crying like a baby afraid that I wouldn't make it through the night.
I know it has been referred to here in certain threads as a "blessing" to elderly, chronically ill people, but I absolutely would NOT want to have it again without being treated.
I am all for Physician Assisted Suicide.
(I suppose depending on the regulations...) If a regulation/law REQUIRES a person to administer or take a cocktail themselves but they are physically unable to do so but cognitively they are aware, want to have the drug(s) but they can not do it them selves I think that is a flaw in the system.
I would like to hear other opinions about this.
This is far from the antibiotics discussion that "cxmoody" started but I think it goes hand in hand.