[hafod]

I hope this isn't too controversial.
My Great Aunt is in her 90's and after a couple of falls agreed to move into a home. She was a lovely, sweet old lady and although registered blind, very deaf and limited mobility she got on ok.
She started behaving oddly:not communicating, being violent, screaming and throwing things around so was referred for a brain scan where they found 2 haematoma's on her brain. One on the part of the brain that influences personality hence the odd behaviour.
As she is so old and not in great health they don't want to operate so they have said there is nothing they can do for her.

It looks like she will spend the rest of her days in a hospital or nursing home bed, spending most of the time upset, and distressed with very little quality of life as she can't communicate with anyone and when anyone tries to touch her (to examine her, wash her, make her more comfortable or even hold her hand) she just screams. It just doesn't seem right.

The doctors have said that if she continues to be violent they may have to sedate her but this could cause breathing difficulties so they don't want to do that.

I can't help but think that if it was a family pet in this situation that you wouldn't let the suffering/poor quality of life continue but perhaps I am speaking out of turn. I just hate to see her suffering as she is, with no prognosis for any improvement 


Surely something will have to change with elderly care? there's barely a day that you don't hear about the pressures that the ageing population is having on the economy - it would just be nice to think that any change would come on compassionate grounds rather than economic.     

[devonlady]

I agree with you up to a point,hafod.. If your dear old aunt were a dog you would be prosecuted for keeping her alive. But it's the thin end of the wedge, if euthanasia were permitted where would it end? You would have folk taking a troublesome Granny to be put down "My child is allergic!" "She's peeing on the floor and ruining our new carpets" "She's bitten the baby" etc.
Her brain trauma may well subside and she will be back to almost her old self. Dear of her

[john and helen]

 having a mum with alzheimers,i totally understand your thoughts…. where once upon a time i would have said no way, now, my outlook is different, i also look at my little sister annie, she has Cerebral palsy, she is now 57 and her eye sight , hearing and body is all rapidly going down hill…..

i often wish they would just go to sleep…. its horrible to see them suffer, and not to be able to do anything
and then you feel guilty for thinking that….

[benandjerry]

  

[Factotum]

My mother died earlier in the Summer - 2 days after her 89th birthday.

When she was younger, she was vigourous - always helping out the neighbours, looking after the frailer ones. As she got older, things started to go a bit wrong medically and eventually she was the one who needed care.

She was on loads of medication, in lots of discomfort and she said to me shortly before her birthday she didn't want to see 90. Life for her was not good - she couldn't even walk out into her garden and look at the flowers. I think she decided to give up - she stopped eating, then she stopped drinking and she just died in her sleep. Although I am very sad - I can't help thinking that she has her wish - she didn't want to continue as she was - so she went and now she's at peace.

As they say, we wouldn't expect a dog to put up with such pain and  discomfort, somehow, because she was human, my mother was expected to go on, and on, long after she felt well enough to do so. Is that really the best we can do?

Sue

[Lesley Silvester]

I think they should have balanced giving her an operation with all the risks against her quality of life without it. It sometimes seems that older people are disregarded. My mum, who's 84, says that she feels doctors don't think she's worth bothering with at her age.

[pgkevet]

I think they should have balanced giving her an operation with all the risks against her quality of life without it. It sometimes seems that older people are disregarded. My mum, who's 84, says that she feels doctors don't think she's worth bothering with at her age.

Agree.

My Mum is 96 and when folk say to her 'aren't you lucky to have lived this long' her answer is 'you call this lucky?'

One of the problems with the 'PC' world we live in and the lawsuit rates is that everyone spends longer covering their @rses than actually doing anything. As I understand it one of the heart meds we use on dogs was deregulated for human use because while patients on it were more active and functional they didn't end up living quite as long as the folk lying in bed sucking oxygen. getting bedsore and giong slowly ga-ga.

[honeyend]

I think a lot of older people end their own life with subtle self neglect. I do not mean not looking after themselves generally but if you know the chances are you are going to end up parked up in a home after lots of invasive tests and perhaps not very pleasant treatment why bother going to the doctor with symptoms  that you can ignore.
 Older people are not stupid, they have probably seen lots they would rather not remember and if they choose benign neglect rather than not having a choice  they would end their life that is their choice and I respect it although relatives find it tough. There seems to be the idea that medicine fixes everything and a warm home and food is recompense for discomfort, loneliness and isolation.
  My father shortened his life by not doing what the doctors recommended, at the time it was hard he was only 55, but having nursed men with his condition who almost begged to die for him it was the right thing. He died in his own bed having been to work the day before and having a whiskey before bed.

[Possum]

This is a really difficult ethical question, so I contacted my sister. She is a clinical psychologist specialising in elderly care. Here is her response.

I[size=78%]I can absolutely understand why they don’t want to operate, recovery from brain surgery is slow and unpredictable at the best of times, with someone in their 90s with additional disabilities, it is unlikely to be at all easy.[/size]



I suspect there is more that can be done to improve her quality of life. A full BPSD( behavioural and psychological symptoms of dementia), /behavioural assessment needs to be done and an assessment to better understand how to communicate with her. The family also need to be asked what things she used to enjoy. Simple things like smell can be very soothing in theses circumstances, things like lavender, or the smell of wax furniture polish. A full assessment needs to be done to rule out infections and pain, amongst other things. A psychologist or nurse skilled in this field could help, or the Alzheimer’s society, or brain injury charities may also be useful. For some people, anti anxiolytics can be helpful. If you are blind and deaf and have little executive function, the world is a frightening place, but plain sedation is rarely helpful.

[/size][size=78%]Hope this is helpful, if rather brief.[/size]


If you need more information, please feel free to PM me. 

[hafod]

That's really interesting info Possum - thank you. She was being assessed for something today but I'm not sure what - I will find out more.
Thank you all for sharing your thoughts and experiences - it makes me feel like less of a monster for thinking these things.

[Mammyshaz]

I may be speaking with fork tongue after your post possum but so many people say they couldn't do my job dealing with euthanasia.
My answer is always that I think we, in the veterinary world, are privileged to be able to allow an animal, somebody's well loved companion or soulmate, to pass with dignity being softly spoken to and cuddled as they drift off. No more pain, no more suffering.
 I wished I could have done the same for my MIL when she begged OH to do it for her. Diagnosis to death thankfully was only 3 weeks but it was 3 weeks of hell.

Each case is individual and each case should be acted upon accordingly, with the patients thoughts and life outlook taken into account as well as several medical opinions.

I would love to see a change in the current legislation but it would need strict governing because there are always people who abuse the system.

[Possum]

Hi Mammyshaz,


Don't worry about the forked tongue.   In many ways I agree with you. Holland allows euthanasia (with lots of safeguards)for people with a terminal illness and I am not aware of any abuse associated with it. However, there are lots of people who would be unhappy with that approach. In view of the fact that euthanasia for people is not legal in this country, I thought it might be useful to see what the alternatives were.


I must admit I was quite surprised by the the thoroughness of my sister's response. She is my younger sister and it is usually me that is giving her advice. She must be cleverer than I thought!


Hafod - I know that it can be difficult accessing some of these neuro- psychological services. If you continue to have difficulties do let me know. My sister deals with hospitals in several parts of the country so may be able to find out who you should approach in your area.


Best wishes.

[Treud na Mara]

  to you hafod and wishing one for your Great Aunt too.