Horrible decision to make with ill Nan. Advice pls?

Question

My 88 year Nan had a stroke 6 months ago, and has just been moved to a rest home from hospital. My Grandad died in October of this year, but she doesn't really understand, as she's also developed dementia.

She has lost a TON of weight, and is now literally just skin and bones- you can see all her ribs and she looks awful. She's just point blank refusing to eat- even her favourite foods.

The dr has suggested that she has an operation to insert a tube into her stomach, to feed her that way.

However, me and my Mum, (Nan's daughter), are the only family left, and don't know what to do. On one side, of course we do not want her to suffer and starve to death, but on the other hand, I do not want to force an operation on her that she wouldn't want. It's impossible to talk to her as she's so ill with the dementia.

Does anyone know much about this peg feeding, or been in the same situation and able to offer advice?

Thank you,

Eva x

Answer 1

Step 1: Ask yourself what she would want. If you come up with an answer, follow that.

Step 2: If you just don't know what she would want, then do what's best for your family. You know if she were still able to tell you that herself, she would.

Answer 2

This is a terrible decision to have to make and yes it is one I had to make - although it was actually made for me really - but not with an elderly person but with my eighteen month old baby. It's a long story but after an operation that caused severe brain damage my daughter could no longer suck or eat so one hospital inserted feeding tubes. When she was returned to the original hospital that had treated her, the senior nurse said to me "if she has lost the will to suck it is crazy to artificially feed..." They removed the tubes and gave her a bottle which she didn't really get much if any nourishment from. At the time it made sense to me as the nurse had explained that when the will to eat and drink is gone it is wrong to force feed as it is all a natural process - to no longer want to eat. It was only years later that the full implication of this "decision" hit me, when a "friend" commented "so you starved her to death!"
Obviously there are those who would see it this way and it has left me wondering if it was the right decision.
But I still believe that the medical profession often goes overboard in keeping people alive who are actually ready to die. Just as I do not believe in deliberately forcing death on anyone, I also do not believe we should go to extremes to force life. When damage to the brain (as in stroke or dementia or by other means) has rendered a person no longer really functioning - what is the point in forcing something as fundamental as taking food - as the nurse said to me, if the will to eat has gone, a person gets no pleasure from food forced on them - and it is an indication that they are ready to die.

Answer 3

I am so sorry to hear about your Nan's condition. Dementia patients actually forget the need to eat and don't feel hungry as they lose the hunger reflex. Unfortunately the dementia will progressively worsen.

Placing a peg tube is a relatively simple procedure, usually done under local anaesthetic, and patients with peg tubes often survive for many years.

The alternative is to make her as comfortable as possible as she slips away gradually (she will not "starve to death" as she has no concept of hunger now).

I'm afraid that only you - with advice from the nursing staff - can make that decision based on her present quality of life.

I have discussed your question with my wife who has been a nursing home manager for many years and has nursed several peg tube patients.

I hope that this has helped. If you would like any further information please feel free to email us.

Answer 4

My father just died on Monday. He had advanced Alzheimer's. We made the decision not to give him a feeding tube when he was no longer able to eat on his own. He had said many times when he was still able to speak that he wanted to die. He had that drug-resistant staph infection as well, and he was allergic to the only antibiotic that can treat it. He was also in kidney failure. After talking to some Hospice nurses, my mom & I made the decision last Friday to remove his hydration IV. He had no quality of life and he was suffering terribly with fevers of 104-106 from the infection. The nursing home gave him a 3 drug cocktail (morphine, adavan & something else) to ease his pain and relax him. I saw him the day before he died and for once he seemed at peace, no longer fighting, and the call came the next morning that he had left us.
Honestly I don't believe anyone with advanced dementia should be on any kind of aggressive life saving measures like feeding tubes, dialysis, etc. It's not like they can ever get better. They suffer, and we, their loved ones, suffer too, watching them live like that.
It's awful to think of your grandmother starving to death, I know. But if she is refusing to eat, that is her way of saying she wants to go.
Good luck in whatever you decide.

Answer 5

I am so sorry for you and your family. How difficult this must be. Whatever you decide I'm sure it will be about keeping her as comfortable and pain free as possible.
Many people stop eating on their own before dying and it's not painful. You might ask the people at Hospice what their experience has been.
This is a powerful incentive for us to tell our families and doctors what we would prefer if we are in similar circumstances. It might make things simpler for our loved ones to have our decision in writing, in a living will.
Don't mean to be morbid, but it might make for a truly meaningful New Years resolution to do this when we can.
God bless you Eva and your family.

Answer 6

I will echo those who say not to prolong her life artificially. This is not to be mean, but because I truly believe that the demented who have decided that they want to leave us can only choose this way to end their suffering. Think of it, if you knew in your heart and/or soul (and they do still have one) that your time was up and you wanted to move on, but had no way to actually "let go"? How might you feel if someone kept you here--would not let you move on--out of their own guilt? Maybe it is time for her to be with your Granddad again?


In our society, we tend to prolong the inevitable. Drugs for one thing or the other. Not that we should go play in traffic, but maybe 88 years is enough, eh? She has lived a long life. I hope you can remember her the way she was and not as what she has become.

Good luck with your decision.

Answer 7

Hi Eva. It is hard decision to make. I know. What I will do or maybe ask my mum to do is to go to hospital. Find quiet moment , maybe when Nan is dozing off and calmly tell her all that, like you would to a person not affected of dementia. Maybe somehow after that you will know or your mum will know what to do.

Answer 8

that's so sad. if it was my granny i know she wouldn't want to live but we have discussed it. did y'all ever talk to her about it before she got so bad off. like would she want life support and what kind. that's whats so hard not knowing what she would want u to do. my grandfather passed when i was 10, she has never remarried and sort of in a way looks forward to the end so they can be together again. maybe at least if she passes she wouldn't hurt and she could be herself and with him again. pray about it and see what the lord tells u to do in your heart.

Answer 9

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Answer 10

I am so sorry. We have elderly relatives too, and it's so hard. One thing I do know is that starving to death is a horrible thing, so you most likely should do what is medically best for you. I suggest you spend as much time as you can visiting her and making her as happy as possible at this difficult time.