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Paula
Reply with quote  #1 
I am new to this group.  I have a 96-yr-old aunt who has been on a PEG (feeding tube) for the past 4 years.  She had been an incredibly lively and active person until the PEG tube was inserted.  She had developed numerous problems with her esophagus which were preventing her from keeping food down, drinking, and taking her heart and other meds.  She hid this fact from me for quite some time, and by the time I figured it out, her esophagus was beyond repair.  Within a couple of months of inserting the PEG tube, she took a severe and immediate decline: depression, progressing dementia.  She is now in a nursing home: unable to speak, unable to walk, and my assessment is that her quality of life is extremely poor.  I do not know what her wishes are regarding continuing to live - she always refused to talk about it with me or others.  (I am PoA.)  On the other hand, she still knows me and other family members, and she lights up when we come to visit her.

Now she has yet another Urinary Tract Infection (UTI) and at this point in time I am weighing the pros and cons of not treating it.  If we leave it untreated, would she endure discomfort or pain?  Could the discomfort or pain be alleviated with palliative care?  Would it be appropriate to allow this infection to take its course?

I would welcome any comments from people who have had experience in this area.  Her doctor and other docs in the clinic have been distinctly unhelpful.  I am in the process of seeking the advice of a local palliative care nurse, as well.

Thank you for your consideration of this post and I look forward to hearing back from you.

Sincerely,
Paula

Janice W
Reply with quote  #2 

Hi Paula and welcome! You do have a hard decision to make. I think if it were me I would treat the infection, mainly because she will get a high fever and be in pain. When my Mom was under Hospice care she was treated with Antibiotics for a UTI. I would have a very hard time not at least trying to prevent pain. On the other hand, my Mom did want to live as long as possible, and maybe your Aunt doesn't. God Bless you as you decide what to do. I know you must be pulled in both directions.

skunkdodger
Reply with quote  #3 

Welcome, Paula.  I, personally, would treat the UTI.  My mom (90 this month) has had numerous ones over the past year and they produce quite a bit of pain and discomfort and can drag on and on and are usually fairly simple to treat.  This is the kind of dilemma we face when we get into this kind of situation.  I guess you just have to go with your gut feelings in each case.  Not easy, I know.   --t.

NSN1
Reply with quote  #4 
Paula, I go with the others on this.  I would treat it.  In our elders there are other problems that go with a UTI.   Sometimes they don't present as you would expect but show up as paranoia, aggressive behavior, even hallucinations.  Those effects go beyond mere pain (bad enough)but indicate fear and  losing touch with reality.   It is not a good way to spend what time is left if it can be helped.

Good luck making this and other decisions.   It is not easy.    
Jane in MA
Reply with quote  #5 
Treat it. A UTI won't probably be the thing that takes her- but it can make things a whole lot worse for her while she declines.

Best wishes, Jane

Mary E.
Reply with quote  #6 
Hi Paula,

I think it would help you decide if you spoke to the nurses or doctors or even brought Hospice in for advice and help with your aunt's decline..  I wouldn't think that a UTI would help your aunt pass away - I agree with others that it would make her miserable while she was in her last days or weeks.

My mother recently had mysterious symptoms - lack of ability to move, sudden and complete loss of bladder control (she had had some incontinence, but this was severe), and complete and utter exhaustion and lack of appetite..  I thought she was dying, seeing these symptoms and thought about honoring her wishes to NOT take her to the ER..  But she was very uncomfortable and frightened, so I called the EMT's after a day or so of hoping she'd get better..  The hospital ran all the tests and diagnosed a UTI - she was given antibiotics and got back to the point she'd been before - and was able to come home. 

When people in their decline get pneumonia, I know that occasionally, depending on the instructions they had left and their family's wishes, they are sometimes not treated and put on morphine which eases their passing..  But I don't think a UTI would be the same situation..  I, like others, would treat that.  But do speak to a professional and if your aunt is not already on Hospice, you may feel so much better with their advice and help..  Good luck and will be thinking of you.

steve
Reply with quote  #7 
I am in a similar situation with my dad (89). He is in Hospice care following brain surgery for trauma (over 2 years ago) and mini strokes.  He is on Dilantin.  He can no longer walk and his memory is steadily declining but he is still talkative and friendly.  He chokes a lot when he eats so he must be watched at all times.  He has been getting repeated UTIs and when treated with antibiotics, he gets Thrush and rashes, etc.  He is in no pain from the UTIs.   I know he will never be the man he was and he has a living will which asked that we not prolong life once he reaches that point, but I am having a very hard time dealing with the thought of not treating him again and just letting nature take its course.  Your advice?
Equality
Reply with quote  #8 
Be aware that if the UTI is treated with an antibiotic the chances of acquiring another, possibly worse, infection increases - C -difficile comes to mind. Ask if the infection can be treated with D-mannose. D-mannose works and has no side effects, it comes in powder form. There is lots of information on the web regarding the efficacy of D-mannose.
Middlegirl
Reply with quote  #9 
I agree with the others. Treat the UTI. Those are really painful. I know someone on hospice who declined to be treated for pneumonia, thinking that would be the end, but then the person recovered naturally. But when the person got a UTI, all were in favor of treatment due to the pain involved.

Paula, welcome to this group. I hope you find the help that I have here.

Steve, welcome to you too. You are in a tough spot since your dad seems to not be in pain. Can he express his wishes regarding this specific matter?

Strength to us all,
MG
BC
Reply with quote  #10 

UTIs often present unusual symtoms in the elderly. Many times there is not the "pain" that we associate with them.. Often what we notice first is unusual or combative behavior...sometimes full blown hallucinations. Sometimes it increases dementia. I hope you decide to have this treated.

 

And Equality has a point about the repurcussions of antibiotics. When Mom needed them I always made sure she got high quality probiotics to prevent C-diff and yeast. I never tried the remedy she suggests, but I have heard of it.

 

Please make sure your elder is properly hydrated as defense #one. Difficulty with toileting is a common cause of reinfection, but passing urine does help flush the urethra. "proper" hydration is key.. For a while we overdid the fluids and Mom become low in several electrolites including sodium. (Talking about dehydration, Steve, that can also be a cause of fatigue)

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