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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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Dear Doctor, I face a serious problem with my mother 89 years

Resolved Question:

Dear XXXXX face a serious problem with my mother 89 years old with Dimentsiya,she does not cooperate for eating drinking taking medecines. it takes me 10 houres every day to seat with her and convince her eat drink take medecines as much as necessary singing to her showing toys telling stories,but at the end of the day i am extremely tired i do this almost 6 months regularily.she cooperates with me but not with her caregiver.
taking into consideration that she lives in my house how is possible to convince her to eat drink and take medecines without keeping me busy and tired during 10 houres every day?
Submitted: 3 years ago.
Category: Health
Expert:  Julia Kizhner replied 3 years ago.

Hello and thank you for your question.

 

You will probably not like my answer but unfortunately there isn't any way to help your mom eat. You are lucky that she is willing to eat at all.

It sounds that your mom has late-stage dementia. Unfortunately you cannot reason with people who have dementia. You cannot rationalize with them, convince them, explain to them. In the late stages of dementia they loose all ability to understand the basic concept of needing to eat to live. Sometimes they even forget how to eat, how to swallow. This is, again unfortunately, very common in end stage dementia.

 

I do hope she takes medications such as Aricept and Namenda but even these medications have limited ability to improve cognitive function.

 

Your other option, although you may not want to do it, is to talk to her doctor about putting a G-tube into her stomach through which she can receive nutrients and medications. It is not considered surgery but rather a procedure and is harmless.

 

I hope you find this information helpful. Please feel free to follow-up with any other questions you might have.

If you are satisfied with the answer, please click 'Accept' button so that I may get credit for my work.

 

Best wishes and good luck,

Julia

Customer: replied 3 years ago.

Dear Ms Julia

Thanks fr yr reply, I am very sad with her situation this is why i spend every day 10 houres with her. The solution of tube we thought about it but is not easy to handle it in the house unless a qualified nurse will be full time in house,do you agree with me ?

 

As to medecines aricept and namenda never hear d maybe you know their commercial names in israel?

 

we tried Respirdal which made her extremely sleepy than slept all the time and doctor said is also ziprexia and senoquel but this is also make sleepy and not good fr my mother who is already tired or sleepy,

than we have medecine MEMOX called here avoids sickness to get worse they say we give her that no bad reaction.

what is yr opinion about medecines?

 

Here we come to other problem she complains about pains in teeths with a broken tooth too but dentists here dont want dementia in their clinic saying can not treat them is too dangerous they dont cooperateother possibility is teeth treatment in hospital they make sleep during treatment which is very dangerous at her age and situation.

 

Finaly doctor please readd these and kindly tell me what is the best solution .;

 

many thanks

Expert:  Julia Kizhner replied 3 years ago.

Yes, it does sound as pretty difficult situation. It is very honorable that you take care of your mom this way!!

 

Memox is the same medication as Namenda in US. We use this medication in late-stage dementia and it does help improve a bit of cognitive function for some time (in several months the cognitive function begins to decline again). Aricept is another drug used for dementia but honestly, I do not feel that your mom will get any benefit from it at this late stage of her disease.

 

The other drugs that you have listed are all behavioral drugs and they are all used in US to help dementia patients be less aggressive. All of these drugs are in the family of anti-psychotics. They dont help at all with dementia but rather, again, helps with controlling behavior. All of these drugs have side effect of sedation so I am not surprised your mom felt the way she felt on them.

 

It is not necessary to have a nurse in the house all the time in order to have a G-tube. Patients who dont have dementia are actually able to take care of their own G-tubes so I am assuming you or a care taker will be able to do the same with proper instructions.

 

I understand the teeth problem as well. No dentist will want to put your mom to sleep to have surgery due to her high risk not waking up from it and no dentist will be able to do anything with local anesthesia exactly because your mom will not cooperate. Also, any stressful event for a demented person, will set back their condition even more so if it is not absolutely necessary, I wouldn't recommend her going through such major procedure.

 

Please let me know if you have any other questions. I will be happy to assist you further.

If I answered your questions, please click 'Accept' button.

 

Best regards,

Julia

Customer: replied 3 years ago.

many thanks talking about memo she takes one a day if she will take 2 will it help?

 

The tube my mother may play with it and take it out or damage it do you think she may do that?

 

my third question is how danger is big fr me to be in stress 10 houres every day giving eat drink medecines to a dementia mother,how long is her life longer at this stage of dementia?

Expert:  Julia Kizhner replied 3 years ago.

I am assuming your mom is taking 10 mg of memox, if so, it can be increased to twice daily. Honestly, increasing it to twice daily may not provide significant benefit at this point in time but it also should not hurt. This medication may help give a boost to cognitive function but eventually it will start declining again. Its like basically buying time.

 

If your mom is to increase Memox, she needs to continue taking 10 mg in the morning and then 5 mg in the evening for a week and then increase to 10 mg in the evening after 1 week. But please discuss this with your doctor first.

 

Yes, it is possible for your mom to pull out the gastric tube. If she does, it does not present danger to her but it will have to be re-inserted by the doctor. It can be somewhat difficult to keep G-tube in if she continues to pull it out but she may not. If it is taped well and is under clothing, she may not get it.

 

In terms of life expectancy...I wish I could answer this question but I cannot. It is so variable. Of course, if you stop fighting with her about eating and taking pills, her life expectancy will diminish quickly. Otherwise she may continue to live. My friend just lost his grandfather at 93 to dementia but the only reason is because his grandpa fell and broke his hip which off set him and he stopped eating and the body just gave out, without such fracture, he could have been living longer. I hope you understand but it is difficult to determine her life expectancy.

 

Please let me know if you have any other questions I can answer for you. I will be happy to assist you further.

 

Julia

Customer: replied 3 years ago.

You are very kind Julia my mother very important frme so is 2.30 morning here everyone sleepsw beside me.

 

So I talk to doctor about increasing memo.

 

The Tube I am sure she will play with it and take out or damage it.

Where they put such a tube?Is operation room?Are there pains or danger?

 

I should continue to fight 10 houres to give drink eat and medecines if this is the only solution. How critical is fr my health this fight with high stress?I am 55 years old.

 

Do you think the care will be better if I place her in s special house where are such sick people or she will not survive there?

 

These are my last questions,I must sleep is very late.

 

Please answer me.

 

Thanks in advance Julia

Expert:  Julia Kizhner replied 3 years ago.

Putting a G-tube is in-office procedure, outpatient and not major surgery. The tube is inserted below the ribs on the left side where stomach is. The tube is soft (rubber) and usually is hidden underneath the clothes. Unless the tube bothers her, she should not be pulling it. The only risk, of course, as with any surgical procedure is a local infection but that would be rare and mostly would be secondary to a poor technique used. Overall, if inserted properly, there should be absolutely no pain from having the tube other then for the 1st few days while healing takes place.

 

In terms of your health...of course, being under such high stress can cause you problems in the long run. It can elevate your blood pressure, it can elevate sugars, overall cause you anxiety and generally will slowly eat away at your happiness. Putting your mom in a nursing home will be the hardest decision you will make. If your mom doesn't recognize you or her surroundings, chances are she wont know the difference where she is at. I dont know what kind of care there is in nursing homes in Israel but in US, the more you pay, the better the service. Of course, her care wont be as good as you can provide but you also need to think about yourself and your health as eventually it will take its toll on you. You can research different nursing homes to see where there is a possibility for her to receive better care and, overall, her life expectancy shouldn't change if you put her there.

 

Sorry for such lengthy response. I hope this helps you.

 

Julia

Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience: 7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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Julia Kizhner
Julia Kizhner
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7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss