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I do my mom suffers from Dementia and she is not drinking enough water so what I do is when she finishes her water I have her put them on the counter then I call her and ask her "how many empty bottles are on the counter" so that I can keep track of it also she has a Home health aide which helps out a great deal.
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Are there swallowing difficulties?

My Mother will now only drink milk & sometimes juice (nectar thickness). Anything thinner causes coughing & choking which is awful for her (& awful to watch).

Jelly & icecream seem to be very popular with many who won't drink although these require effort (spoon, coordination & concentration). Also cordial instead of water. Sorry I haven't found an answer to this either.
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My own experience is to have a jug that contains the daily ‘ration’, and pour all her fluids from this. Then you, and she, and any other carers can see how much she is actually drinking. Give her lots of positive reinforcement if she is getting through the jug. That is of course unless you are sure that it would be better if her body did close down for end of life.
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I don't think it matters how 'advanced' your mother's Alzheimer's is when you ask for a hospice evaluation.............it's about how many times she's schlepping back & forth to the hospital where they are rehydrating her dehydrated body. For what purpose? To drag out a terminal disease and extend her life even further??? At some point, the interventions have to stop, you know? I'm almost there with my mother who's only at the 'moderate' stage of dementia. She has other health issues in place (CHF, AFIB) that make the whole scenario a nightmare to deal with, and all of her issues just make everyone's quality of life non-existent.

So. The next time she goes to the ER for whatever issue is happening, that is when I am asking for a hospice evaluation. So we can end the insanity of the hospitals, the rehabs, the tests, all of it. She deserves comfort care at this stage of her life (93) and disease. She also refuses to drink liquid b/c it 'makes her pee' and she's incontinent on top of everything else.

Leave your loved one alone, get a hospice evaluation the next time she's off to the ER, and let God take over. When it's her time to go, she'll go. Your job is to see that she's as comfortable as possible during the journey.
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Tiredandweary Feb 2020
Totally agree. At some point, you have to decide who is benefitting from keeping someone living through this awful disease that has no cure and no positive outcome. It sure isn't the person going through it or the families that have to watch the process. The Healthcare Industry was making money off of my mother's suffering. To the tune of over $100,000.00 for one year, which was just my mother's out of pocket costs. I have no clue what it cost taxpayers for the medicare coverage when it came to the medical bills. Was keeping her alive at all costs worth it? Not in her condition. If we could have fixed her and she gone back to living a normal, happy, healthy life, sure! We were just spending a fortune to ensure she couldn't die in peace after 91 years. We faced reality and made a decision to do the kind thing. I know she would have thanked me for doing so. I can't imagine anyone wanting to live like she did her last year.
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I agree memory care would be the best placement for her. Another option to consider is palliative care only; no curative measures or drugs to be given. That would mean no more diagnostic tests, blood draws, etc, and she'd go off stations and other meds that try to cure disease. She'd still get treatment for broken bones & illness. While she's talking, someone needs to read Dr Atul Gawande L's book, Being Mortal, and lead her through the question of quality of life. It may be too late, but the family needs to consider this. If it were my mthr, I would not allow the ER to give her fluids but respect her action of not drinking and let her pass on her timetable.
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Is it possible to encourage eating high fluid items.
Popsicle's, jello, pudding, (keep in mind none of these are good if the food has to be thickened.)
Meals like soups are another great way to increase fluids.
Fruits
Between meal shakes like Boost, Ensure or other nutrition drinks might also help.

Is it possible that the AL is not able to monitor enough and the better choice would be Memory Care?
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Careblazer310 Feb 2020
Thank you so much for your reply. Yes, we try our best with soup and high water content foods but she is not really eating well anymore either. She won’t drink Ensure or Boost because she thinks it is for older people. She has her ideas about things which are hard to break through.
I agree that memory care is probably a better option for her at this point but it’s convincing her children to make that move for her that’s stalling the process. I hope they see very soon that it is the safest option.
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This doesn't mean its the end stage of life. This can happen in the early stages. Their brain no longer tells the body that its hungry or thirsty. This is how Dementia is found in some. Its not not wanting to drink its not knowing they need to drink. The AL should be going around every so often with water for residents. They should make sure the residents are drinking at every meal.

Now there does come a time when not drinking or eating means the body is shutting down. They no longer can swallow. Forcing them to do either does more harm than good. This is the "end stage". This is where Hospice can be called in. They will keep the person comfortable.

And they don't decide, they can no longer do that. The brain is dying and losing controll of the body.
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Careblazer310 Feb 2020
Thank you. I understand this. She is not end stage, I agree. I also know she is not purposefully deciding not to drink. So many medical professionals and family have spoken to her about this. She still doesn’t drink so I know it is part of her dimentia.
I wanted to know if anyone has advice for how to deal with this since it is causing a lot of medical issues for her.
we are concerned that it will worsen.
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At some point, you have to come to terms with the fact that this is fatal and there is no getting better. Quality vs. quantity. You can't make her drink but you can continue to go to the ER for them to pump her back up. For what? To go through it all over again? I would consider Hospice care at this point. I say this because the same thing would happen with my mother. We'd end up in the ER and spend 2 days in the hospital, which just created more confusion and discomfort for my mom. The last time she went, I had to ask myself who was I helping? I was only ensuring she had more suffering. The kindest thing I could do for her was to let nature takes its course and do whatever I could to keep her comfortable. Hospice was called and there were no more trips to the hospital.
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Isthisrealyreal Feb 2020
That is the perfect answer to this dreadful disease.

Careblazer, I am sorry that you are facing these difficult choices. I think that tiredandweary nailed the reality of the situation perfectly.
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