When to stop hospital trips for 93-year-old parent with dementia who has frequent UTIs?

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parentson457 Asked April 2023

When to stop hospital trips for 93-year-old parent with dementia who has frequent UTIs?

My mother is 93 and is on her 4th hospital trip in the last 2 years. 3 times for a UTI and another for a skin infection that turned into sepsis. She is a strong person, but has dementia. Her advanced directive says no life support if it only temporarily prolongs the dying process. Each time she returned to long term care from the hospital she was worse mentally. I dont think she would want to keep going back to the hospital. She still knows me (son) and knows who my daughter is. I can chat with her about the weather, my job, my daughters college plans although she is very forgetful and requires constant reminders and explanations on things. Quality of life is not great. She is alone a lot, is unable mentally to read and turn on the TV. She lights up with a big smile when I visit her.

There is a DNR in place which currently allows hospital trips. There is an option to avoid hospital trips if possible and instead provide comfort for them in long term care instead of sending them to the hospital. Its to avoid, not prevent. I assume if she breaks her leg for example she will go to the hospital.

Wondering what people do in this situation. Has anyone had or has a parent that still knows who you are where you have chosen to avoid sending them back to the hospital? If she was completely gone mentally it would be an easier decision to make. Watching things in the hospital the last few days makes me think it's undignified for her with the dementia, confusion and all the tests.

Care Decisions Do Not Resuscitate (DNR) Hospital Urinary Tract Infection (UTI)

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score 1 · Answer 1

They can treat UTI in long term care .
Maybe have her on palliative care or even hospice at long term care . Do you or anyone else have MPOA?

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score 1 · Answer 2

My husband (and I) signed our state DNR forms when he had just begun to having problems -- sundowning. So he signed during the day when he was clear-headed. We both opted for no treatment, no ER except for palliative care (such as when you break a leg; they splint you up and give pain care but no admission, no surgery) and then immediately go home with hospice. I am his health and Durable POA so now I can say "no treatment" for him, because I know this represents his wishes when he was normal. If a patient is having continual UTIs I THINK he might qualify for hospice (and pain management) if he refuses treatment. He might also qualify for anti-UTI antibiotics at home. Check with your PCP about this...in our state the PCP or the ER docs are the ones who can send people home with hospice

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score 2 · Answer 3

Don't know what state you are in, but in our area, Indiana, we have 360 Care that is a company of dentist, eye care doctors, and podiatrists that will make house calls. They do not have an independant practice and Grace at Home is a company of physicians that make house calls, again no brick and mortar offices. Surely there is something like these care givers in your area that can help your aged mother without her going out all the time? Walmart has UTI test stips and Uristat helps with the UTI symptoms. More showers are needed and using flushable wipes instead of toilet paper may help keep the area cleaner to prevent UTI. Pure cranberry juice is a good prevention drink also. UTI's are very unpleasant, and makes the elderly angry and hostile till it clears up. Could be life threatening for elderly with dementia. Take them as a serious condition to be treated quickly with you mother!

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There are cranberry pills as well. They also have UTI test strips on Amazon. If they show a uti on the strip, the dr. Can order a urine test. You pick up a sterile cup, then bring it back with a sample. They can give her oral antibiotics called into pharmacy. There are other preventative care options as well. I bought a bidet attachment which helps with cleaning (often the cause of uti). If you don’t get treatment for uti in can turn into sepsis and kill her.

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score 2 · Answer 4

parentson457: Perchance hospice care would be a better option for your mother.

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score 1 · Answer 5

Gosh, I could've written this exact same question OP, just sub in I am the daughter (only child) and it's my dad, almost 91. I have been struggling with this too, though my dad is in a nursing home, and they keep wanting to send him out for doctor's appointments or to the hospital for everything little thing, and it causes his dementia to worsen and causes delirium, which is off the charts. It's hard on him and me. He also gets recurrent UTIs and is on the daily supplement of cranberry/D-Mannose, and they have lessened but not stopped entirely. When I ask the social worker or other NH staff about is it time for hospice they say no, but I think I need to bypass them and get a hospice evaluation - we are private pay at the SNF so I think them telling me no to hospice has more to do with them getting as much $ as possible off of us -- maybe I am cynical but this is how it feels. I don't know if I can call hopsice on my own but I am going to look into it, all of these responses have been helpful for me too.

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score 4 · Answer 6

My mother just passed away while on hospice. She has dementia for a long time but began refusing food and medication. The last time I took her to the ER was for aspiration pneumonia. I did not want her to stay because of lack of staffing and they have her IV medication in the ER and sent us home with the test. My sisters and I decided she would never go back to the hospital. As she began dwindling we contacted Hospice. She met the criteria for acceptance based on the dementia criteria. It was a relief for us and our terrific crew of care givers. Any changes we called them. They provided her medication and supplies. In three weeks she became more restless, confused refused all food, liquid or meds. She died 10 days later. Hospice for our family was the right decision.

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score 3 · Answer 7

My uncle could no longer go up and down his stairs. He was living in his basement without showering. He got a UTI that became septic.

My uncle nearly died. His children told him once again that he must enter a facility. He wanted to hire full time ‘in home’ help.

His children said, “No, dad. It will end up costing more than a facility and you cannot afford to hire in home help. We aren’t going to quit our jobs to help. So, the only choice left is for you to go to a facility.”

He agreed and he was well cared for. He died at age 96.

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score 2 · Answer 8

My MIL is prone to UTI's, Now she is on Hospice Care, my understanding is that they will be treated at home by the PA who sees her several times a week.

More trips to the ER for something easily treated at home would just make her angrier and worse. BUT...dying from a massive infection caused by a UTI sounds just awful.

Do encourage her to drink and keep 'flushed out'. It's a balancing act, once someone loses the desire to drink and stay hydrated and if you don't drink, you're also not peeing and then the urine can get toxic pretty quick.

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score 1 · Answer 9

What you do is try and prevent the UTI. They can become very serious and can kill. They cause Dementia type symptoms that normally go away once antibiotics are administered. Best way is thru IV. For a person already suffering from Dementia, it could be worse.

Start her using cranberry tablets. Mom was on a probiotic too. In my Moms last year, she never had a UTI. Alva, a forum member, saus D-Mannose is good at preventing UTIs and has not had one since she started using it. I too agree on looking into Palliative care.

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score 7 · Answer 10

When my Mom went into respiratory arrest and had two UTI’s back to back she was put on Hospice.

Palliative Care or Hospice can treat her without having to go to the hospital.

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score 1 · Answer 11

The UTI can be diagnosed and treated without going to the hospital.
Have you considered Hospice?
They would provide comfort care, they would also provide the medications needed to treat the UTI's without a trip to the hospital unless it were necessary. (Hospice can authorize a hospital trip)
She would have another set of eyes on her with the Hospice team coming to see her a few days a week.
Hospitalization can cause even more confusion and it will take longer and longer for her to recover from the hospital visit each time.
Ask yourself this...if mom did not have dementia what would she chose to do. Or if this was you what would you want done? I would opt for no more trips to the hospital. I would want to be under the care of Hospice

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score 9 · Answer 12

I was in the exact same situation as you are. My mother was sent to the hospital for a septic infection, was there for 10 days during Covid (so no visitors), sent to rehab for another five days of antibiotics (no visitors), then sent back to her memory care. She had no idea where she was at any time, had dementia and was terrified, and all I could think of was "to what end are we doing this?"

That's the point at which I decided we were done with hospitals and put her on hospice care. I said we would treat her in place as best as possible, and she had phenomenal care. She was treated for treatable issues that cropped up such as wound care, a bout with Covid, and gout, and she lasted another seven months with infinitely less distress and far better care than she'd had in a hospital overrun with Covid cases.

I would say it's time to consider similar measures for your mom.

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I think your comment about to what end are we doing this hits home with me. I think my mom would say the same thing.

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score 2 · Answer 13

I would avoid hospital trips for your mother and focus on keeping her comfortable. A palliative care assessment and plan would be a good first step. And if she were to break a leg, she would be in pain and it is unlikely that the hospital would be able to do much of anything that would improve her quality of life without promoting further cognitive decline, without distressing her, without exhausting her, and without running the big risk of her dying in the hospital. At 93, she's lived a good long life. Hospitals may prolong her life but at what cost to her emotionally?

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Thank you for your thoughts. It is awful for her. I keep thinking about her alone and confused at the hospital.

(3)

score 1 · Answer 14

Hospice or palliative care. Ask for a consultation and see what they say.

With my mom, she was in and out of hospice care for 2.5 years. In the interim periods, when she was not allowed to be on hospice, she'd go to the hospital when something serious happened. She didn't like it, and she had a DNR at her request. She hated needles. She had an in-home caregiver who stayed with her in the hospital, but not around the clock. Mom would go home to resume life with the caregiver when she recovered enough to be discharged.

It was not the best way to handle it, as far as I was concerned, but there was family pressure. I believe Mom would have been better off in a long-term care home and avoiding hospitals at that time. She had dementia and didn't know much of anything. She was bed-bound and couldn't really talk.

So that's my experience for what it's worth.

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