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Mother in law - Carers UK Forum

Mother in law

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I am currently caring for my mother in law, she has vascular demenca. Unfortunately she has given up eating and drinking, it looks like she has trouble swollowing food. We have taken her to the hospital but they put her on a saline drip for six hours then sent her home.
We live in Spain , so we haven't got a lot of support . Any one any ideas what we do next?
Welcome to the forum. Sadly, this is probably the time for you to Google "Signs of Dying" because thd dementia is so advanced. You will find some articles written by people from the hospice movement which explains how the body slowly shuts down. I found these articles when my own mum was very poorly, they were both helpful and comforting and helped me understand how staff were nursing mum.
This is the time to think about what arrangements you need to make, who to tell, her favourite music for the service, etc. It is difficult now, even more difficult when she has passed away.
Kay, am I right in thinking your mother in law is out in Spain with you? Or is she still in the UK, and you sent an ambulance round to her?

If she is in Spain with you, then really you need to talk to the doctors at the hospital who treated her, as to why they sent her back to you, and what they think is happening - ie, do they think that, as Bowling Bun fears, she is nearing the end of her life? If that is so then she MUST have some kind of medical attention, even at home!

The thing is, what happens in Spain in these circumstances? I believe in Spain there is far less 'professional nursing care', even in hospitals, and that families are 'assumed' to do a great deal more 'nursing', even when a relative is in hospital.

The key thing is, has your MIL started eating and drinking again? And why had she stopped? Was it as BB says, because she may be starting to die and the body closing down, or has the dementia made her 'forget how or why' to eat or drink?

Surely, if she is NOT dying then she MUST take some nourishment or liquid, or lack of it will kill her anyway! (I'm not sure how long the body can last without liquid, but it's only a few days!)

If, alas, she is not eating or drinking now because she is dying - (ie, from the dementia, not from lack of nourishment and fluid!) - then it will be actually dangerous to try and get her to take in any food or liquid. This is because a day or so before death the body loses 'the swallowing reflex' and therefore anything in the mouth that is introduced can go down the windpipe, not the gullet, and she will choke. If this is so, then her mouth can and should be kept moist say by wiping it with a damp flannel, or little 'damp lollipops' (that the nurse should give you.)

Whatever the situation with your MIL, it seems completely bizarre and unacceptable that she was just sent home from hospital without any explanation as to what is happening to her and what care she now needs!

Can you get a local GP-level doctor out to see her and make an assessement of her condition to guide you through what you need to do next?
Hi Kay
Presumeably the hospital wouldn't have sent MIL home so soon if they had not seen significant improvement or unless they had put an adequate social care package together for mum which is unlikely in that time span -or is there one already in place?. What were you told by the hospital?
Thank you all for your replies, yes she is in Spain with us. She won't eat at all but she will take a sip of water but that's it. We asked the hospital how they can send her home but was told to make an out patients appointment take her to some juice clinic . But still haven't got an appointment for that.
Iv read up so much on demencia but don't really know what to expect. The hospital said nothing about more care than that .
Kay, if she can't drink what good is a juice clinic going to be?
I just don't see how they can possibly just send her home to you with no advice or explanation. I've never been to Spain, so can only assume it's a cultural thing? Is there a GP you could talk to? Or an ex pats group?
Many people on the forum say that the Alzheimer's Society in the UK is very good. Maybe you could give their helpline a ring?
Hmm, you may have to ask your neighbours what the 'drill' is in Spain when it comes to care for a frail, elderly person with dementia. It could be that the 'norm' there is that of course a parent will 'go home' for the brief remainder of their lives, and they would be horrified to think in the UK people are 'sent to hospital to die' or whatever.

I do appreciate there's probably a language problem as well as a 'cultural norm' problem, but I think that the first task is to discover whether the doctors believe your MIL has reached the end of her time, or whether she is just supposed to 'start eating' on her own 'spontaneously' without further medical assistance or concern!

Apart from not eating, how 'ill' is your MIL?

PS - this might sound somewhat morbid, but I'm wondering whether if you asked your local priest to call, that might shed some light. If Spain is a country in which the elderly tend to be at home for 'the end' and also to have a priest to give the last rites, it would indicate that the priests become adept at knowing just how close the person is to the very end. Sorry if this sounds too morbid!
HIya, I don't know how long she has been living with a dementia nor do I do know her current state of health apart from the brain disease you mention. So I will not be talking about end of life care. (My late husbands dementia started in 2000 and he survived till 2015'despite other significant health problems including cancer of the bone marrow and of course blood, significant sight loss plus a 40 year history of unstable type one diabetes etc).

Saline drip obviously indicates she was rehydrated in hospital. You obviously know the cause of that. Simple....not enough fluid intake and perhaps a problem with digestive tract. Here in the UK I would suggest you need to contact a SALT specialist (speech and language therapist) who are the ones who can actively examine and assess mouth throat diaphragm, her abilities to chew, suck and or swallow.

But don't forget the more obvious checks......teeth, dentures, mouth ulcers, ability to hold drinking vessels or straws. And of course be aware that dementia does not preclude clinical depression which alone can have very adverse effects on appetite and the will to survive.

Wish you and her all the best for the future. Hey, dementia or not, she needs to feel loved, ok? Xx
This is most probably my last post on this forum.
Not knowing how advanced your MIL's dementia is, I can also say something about eating difficulties and end of life. My brother, who died last December, did not have dementia, or only slight dementia. For the last few months, he ate less and less. He did have tooth problems, but he also had throat and swallowing problems. In 2013 his throat was examined (barium swallow, video) in hospital and no problems were found. Towards the end of 2016 we approached the SALT team again, because after saying he could not chew (but he was able to chew before) he said he could not swallow. By this time he had not eaten anything at all or taken his meds for three weeks! Again a video was taken of his swallowing and no problems found. He was recommended a particular grade of mashed food. We had to take a banana and he could swallow that, but would not do so at home. Two days later he died.

This is just as evidence why your description of your MIL sounds like an end-of-life situation. Putting her on a drip in hospital only prolongs the process. However, of course, I don't know enough about your situation. My brother definitely wanted to be treated, but looking back I can see that his body had given up.

Dancedintherain, goodbye then, for whatever reason you are leaving. I know you don't agree with a lot of the advice posted here, although I'm not sure why, but I hope the new users can make their own minds up so even if I don't agree with all the advice I read, that's what forums are about. I am really grateful for the members who post frequently to advise new members on the basis of their own experience.