Alzheimer's: Terminal DX?

BabyRN2Be · Dec 27, 2005

I wanted to add this as I got distracted:

My MIL says that she is not talking anymore. She has been saying this for a few months. However, when my dh and I picked her up from her nursing home for Thanksgiving, her speech has not deteriorated at all in my opinion - since I have known her that is.

We walked in, told us who we were (she doesn't even recognize my husband anymore, and she wouldn't even know me as I said before). We told her where we were going, she seemed to be oriented to time and day (Thanksgiving, almost noon), and she said that she was happy to be going to Rosie's. She gave us a tour of the facility, showed us her room, hugged the aide goodbye, told her "Happy Thanksgiving" and she'd be back later. Once we got into the car, I was talking to her and she said something to the effect of, "I remember you. You are so pretty." Whether she really did remember me or she was just talking, I really don't know. My point is, there was no lack of speech.

My MIL claims that she has not eaten on her own in months. She was eating just fine during dinner, but not fast enough for my MIL so she was shoveling it in her.

Anyhow, when is hospice usually called in for something like this?

doodlemom · Dec 27, 2005

I'm not quite sure where this would possibly go, but since hospice is now involved I'll post it here.
Can anyone tell me if Alzheimer's itself is a terminal dx in and of itself or does one die of complications related to Alzheimer's? If yes, what are those types of complications?
My husband's grandmother has Alzheimer's, and a few weeks ago hospice was called to assist her. My dh mom (a hysterical type) insists that she can't speak, however, when I saw my husband's grandma at Thanksgiving, she was speaking to me just fine (although she doesn't know me as I met her after this disease had set in).
If anyone can enlighten me I'd appreciate it!

Yes, Alzheimers or End Stage Dementia are both appropriate terminal diagnoses. At the end stages of dementia, pt's become increasingly unable to swallow. Frequent aspiration pneumonia and/or UTI's (from incontinence) are common complications, as is profound weightloss - if a feeding tube is not placed. See: http://www.ahsmedicare.com/files/documents/HPC-R-0600-01a.pdf for the Medicare criteria

BabyRN2Be · Dec 27, 2005

Thank you for posting that doodlemom. That helps define the criteria, this is exactly what I was looking for.

This is such a sad, sad disease. She seems like she was a wonderful person when she was lucid; this makes watching her go through these stages is very sad.

There have been many times when my MIL has exaggerated something and I just wanted to see for myself what the criteria for hospice is currently.

babynurselsa, RN · Dec 28, 2005

Actually if she is still that funtional she sounds a little early for admission to hospice. They are not usually suitable for hospice intil they are essentially bedbound, total care dependent etc. Way late stage advancement.

Look at the Karnofsky scale. It is used by hospice in evaluating for admission.

http://www.anapsid.org/cnd/diagnosis/karnofsky.html

suebird3 · Dec 28, 2005

perhaps your grandma changes day to day. your mom sees one thing, while you see another. it can, and does, happen. remember, your mother remembers her mom as being so much different.....

and yes, advanced alzheimer's is a hospice dx, but i have seen it when the person is much more advanced.

i will be thinking of you......

suebird

webblarsk · Dec 28, 2005

Actually if she is still that funtional she sounds a little early for admission to hospice. They are not usually suitable for hospice intil they are essentially bedbound, total care dependent etc. Way late stage advancement.
Look at the Karnofsky scale. It is used by hospice in evaluating for admission.
http://www.anapsid.org/cnd/diagnosis/karnofsky.html

I was thinking the same thing. The Alzheimer's patients we admit are pretty far deterioated. Not walking and speech is very limited. Garbled and irrelevant. Weight loss. Frequent hospitalizations. etc.........