IV Fluids at End of Life?

[avocadofruit]

Question...

So... man this stuff is hard.

My question is - has anyone had experiences with the decision of whether to put someone on IV fluids in hospice, or whether to keep them without IV fluids?

My grandmother, 102 years old...is struggling. As of last week, she was doing better, but - her body is continually fighting infections, a bedsore, etc. For the last 3 days she has refused food/drink.

I am wondering whether to get her on the subcutaneous IV fluids. The hospice team is very pushy about what they believe, which I find incredibly frustrating to deal with, and different than any other nurses I've dealt with before.

Their logic is that a "dry death" is preferable, but experience seems variable - I want to know what others think, although obviously these decisions are impossible.

Thank you...

 

[jaymor]

Hospice care is very different to hospital care. Hospital nursing is doing everything possible to make someone well, hospice nursing is making someone as comfortable as possible in their last weeks, hours or days .

Your grandmother is a great age and she has dementia and my thoughts are you will just be delaying the inevitable

My husband was in the very late stages and was once again in hospital being given oxygen. There was nothing they could do and after talking with the doctor looking after him we decided that the best place for him was to be back at the nursing home. The doctor arranged that the local hospice would send a nurse to the nursing home the following morning to help the nursing staff and us over the next few days. He returned to the nursing home and as a family after talking on the phone to the doctor at the hospital decided to take my husband off the oxygen. We were told the oxygen was just prolonging the inevitable.

Two hours later my husband died peacefully with his family with him and his carers close by. We will never regret our decision, he had suffered dreadfully at times over the 11 years he battled the disease, my husband was 72.

It is not easy and it has to be your decision. I wish you and your family and your Grandmother some peace of mind and a gentle journey forward.

 

[jorgieporgie]

I agree it would only prolong the inevitable. We watched my BIL die this year and hospital did prolong his death and it was unbearable for the family.
Let your grandmother go peacefully, she is in the right care and managed to live to a grand old age, her body is tired now.
Keep swabbing her mouth and, put vasaline on her lips, all these little things will make you feel better and grandmother comfortably. Hope peace resides soon, god bless.xxxx

 

[Grannie G]

When my husband was dying he lived days without food or drink and was given medication to dry up the fluids to make breathing easier for him.

The medication to dry the fluids made him more comfortable.

Now I`m no medic but logic tells me it may be counter productive to give IV fluids which may collect on the lungs , if the body is shutting down.

I could be completely wrong here but perhaps that is why the Hospice prefer a `dry` death. The fact your grandmother is in a Hospice means she will be receiving palliative care and the Hospice movement is so respected for their care I would trust their judgement, hard as it is.

 

[LadyA]

I agree too. I know all our instincts are not to let go of the person, and to fight to keep them "alive" - but your grandmother is no longer able to take food or drink because her body is shutting down - she is dying. Giving fluids will prolong her death, not her life. When my husband was dying I opted not to have subcutaneous fluids administered. I felt I was going to have to face up to losing him, and there was no point in prolonging it for him because I didn't want to face that final loss - and it would only have prolonged his death by several days at most anyway.

 

[cragmaid]

There comes a time in the progression of a terminal disease when you have to call "enough".
Dementia is one such disease....and indeed Life is Terminal...well, finite anyway.

It is our responsibilty to help to lift the suffering. Sadly, sometimes this means having to be the one to make the difficult decisions.

I think that your Grandmother is ready to go now, her very old body has zero strength left. Her bodily functions are stopping, fluids are not needed now.
As long as she is not suffering pain and discomfort, and I'm sure the Hospice staff will take care of that, then I would say sit with her, talk to her and say goodbye.
You are being a kind Granddaughter.x.x.

 

[jasmineflower]

Hi
My son is a medical student and he was telling me that current best practice is not to continue IV fluids.
He did explain why but I can't remember the details.

 

[avocadofruit]

Thank you everyone for your thoughts... and a positive Update

Hello everyone,

I wanted to thank you for your thoughts on this hard topic...

The hospice Doc did confirm that giving her IV fluids at this point would be a sure path to cardiac distress, since her body already has some fluid collected from a previous IV.

However... the good news, which I felt compelled to report, is that although we do have her enrolled in Hospice care, is that she has started drinking again as of yesterday.

One of my grandmother's old aides is back, and she is truly working miracles with Sylvia.

I just wanted to report the bad & the good; that, on the bad side, we can't get IV fluids at home probably, but the good news is that we may not need them.

These journeys are hard & full of ups and downs, but I truly feel we now have a committed, positive approach in Sylvia's aide...and one I will be following as well.

(Our engagement with Hospice is a little different than many people's, since Sylvia was approved for it mostly due to her age, but I'm not honestly sure we are at the very end of her journey... but, of course we shall see what the world holds.)

Thank you all again...

 

[Quilty]

The lierature i read said that fluids can make death more painful and difficult. Your body starts to shutdown. 8 would listen to the advice from the hospice.

 

[eiffel]

It is very difficult when you want the best for a loved one .you want them to be with you for as long as possible ,but sometimes it is helpful to get advise from specialist care providers and i agree that maybe the hospice will give you help and support and advice in giving fluids when someone is so poorly.

 

[rajahh]

If your grandmother is drinking again then that is fine, but I agree with all the others about IV fluids. I stopped all intrusive treatment for my husband for anything but pain relief and have no regrets.

My GP thought the same and said that she did not believe in prolonging death.

I feel if we lve them enough we will let them go.

Jeannette

 

[Molly75]

I've fluid confusion

My mum was diagnosed 3 years ago, this is her second visit to hospital in 4 months initially with a water infection and dehydration. Her kidney function fell to 5% and sodium levels were out of the norm. I am pleased to say all levels are now as near to normal as they are going to get but she has been on IV for 3+ weeks and has not eaten in nearly four weeks. I am now being told the IV fluids are going to stop and she is to be discharged with her new base level being mostly unconscious and unable to take on enough fluids and not swallow. Totally confused where this is going or what to do next.

 

[lemonjuice]

My mum was diagnosed 3 years ago, this is her second visit to hospital in 4 months initially with a water infection and dehydration. Her kidney function fell to 5% and sodium levels were out of the norm. I am pleased to say all levels are now as near to normal as they are going to get but she has been on IV for 3+ weeks and has not eaten in nearly four weeks. I am now being told the IV fluids are going to stop and she is to be discharged with her new base level being mostly unconscious and unable to take on enough fluids and not swallow. Totally confused where this is going or what to do next.

Having just watched father in law die in a hospice (not with dementia bit cancer though) it does sound as if with that sort of kidney function and unconscious you may have to prepare yourself.
Keep moistening her lips and keeping her comfortable.
Look after yourself at this time.

 

[nicoise]

My mum was diagnosed 3 years ago, this is her second visit to hospital in 4 months initially with a water infection and dehydration. Her kidney function fell to 5% and sodium levels were out of the norm. I am pleased to say all levels are now as near to normal as they are going to get but she has been on IV for 3+ weeks and has not eaten in nearly four weeks. I am now being told the IV fluids are going to stop and she is to be discharged with her new base level being mostly unconscious and unable to take on enough fluids and not swallow. Totally confused where this is going or what to do next.

Dear Molly75 - do you know where the hospital plans to discharge your mother to? It sounds as though you need to have a conversation with the ward doctors and other staff so that you get a lot more information about what they feel is going to happen with your mother.

 

[Molly75]

IV fluid confusion

Dear Molly75 - do you know where the hospital plans to discharge your mother to? It sounds as though you need to have a conversation with the ward doctors and other staff so that you get a lot more information about what they feel is going to happen with your mother.

No they just discussed no more can be done in hospital, all issues medically have been corrected and we have to start looking for nursing care. Surely though within another week we will be returning to hospital with mum dehydrated and kidney/sodium issues again help.

 

[Beetroot]

Go to patients' liason at the hospital and ask them to find out for you, or be present at a meeting between you and the doctor. The doctor must be preparing a discharge letter - what's he putting in that?