Month: October 2022

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The hardest word

— Study finds doctors, families avoid saying ‘death’

By Paul John Scott

A new study has found that conversations between families and physicians who treat critically ill infants avoided direct language in 92% of all references to death and dying, but that the two parties did so through different linguistic evasions.

The study, conducted by Duke University researchers between September 2018 and 2020, analyzed 68 recorded conversations between physicians and 24 participating families of infants hospitalized for neurologic conditions in an intensive care unit.

It was published in the journal JAMA Network Open.

“This study was really inspired by a recognition that it can be hard to talk clearly and directly about challenging, high-stakes topics,” said Dr. Monica Lemmon, an associate professor of pediatrics and population health sciences at Duke and lead author of the paper. “We aimed primarily to characterize the way death is discussed.”

While it is commonplace to use softer language for death and dying in day-to-day conversations, in order to minimize confusion, consensus guidelines within medicine the paper noted “emphasize the importance of clear communication, including avoiding euphemism use.”

In the new study, researchers found 33 out of 68, or 45% of all family meetings, involved a discussion of death. There were 406 recorded references to death within those meetings — 275 made by clinicians, and 131 made by family members. Of those, the words “die,” “death,” “dying” and “stillborn” were used just 15% of the time by family members, and 5% of the time by physicians.

“What was most striking was the direct use of the words themselves … were used quite rarely,” Lemmon said. She said that “families often used colloquialisms or common phrases to reference death,” while “clinicians instead most often used medical jargon, which may be less clear to people who aren’t medically trained.”

Physicians used medical jargon 43% of the time when discussing death during the study, which included as examples terms for death such as “event,” “code,” “episode,” “arrest,” or “irretrievable drop” in heart rate.

Families preferred colloquialisms 34% of the time, the paper found. These included phrases such as “pass away,” and “not make it.” The paper identified two other forms of euphemisms: expressions referring to survival — like “don’t live,” or “not survive” — and the use of pronouns in place of death, such as “it,” “this,” “that” or “something.”

In an accompanying commentary, a trio of pediatricians from the University of Minnesota Medical School placed the findings within a larger problem described as “jargon oblivion” in medicine. For lead author Dr. Michael Pitt, the new study provides physicians with a framework to better understand what that looks like in practice.

“I think what this study adds is actual proof to what we expected,” he said. “Which is that we tend to avoid these difficult words — death, dying — at the bedside during important conversations with families. They elegantly quantified that in a study where they recorded and transcribed these transcripts, and showed that providers rarely used these terms.”

The harm, Pitt says, is that families may need to hear the word death to understand that death is what is being discussed.

“They hear ‘we did everything we could’ (and) they might want to reply, ‘OK, get somebody else to do something, then.'”

Pitt recalls that when his father recently died, “the nurse called my mom and said, ‘He’s no longer with us,'” he said.

“She initially thought that meant that he’d been transferred, or gotten lost … you’re having the most serious conversation of a family’s life, yet they may not understand what you’re saying unless you use clearer language.”

Dr. Brenda Schiltz is a pediatric critical care specialist at Mayo Clinic who has had numerous conversations with families in which she was required to discuss the actual or possible death of a child. “I think it’s a good paper,” she says of the Duke study.

“It wasn’t surprising at all, to be honest,” she adds. “We teach trainees all the time about when we’re breaking bad news … to be very concrete, to use the word ‘death.’ But even when do all those teachings, it’s a hard thing to tell somebody. It’s a very hard thing to tell somebody.”

Schiltz says that while clear communication about death is critical, it often is a shift in thinking for physicians.

“Not only is it hard,” she said, “as a physician and everybody that’s on the medical team, we’re trying to save these babies. No one wants to feel as if we lost that battle. We’re always fighting. We’re always trying to keep hope alive, and try one more thing … It’s tough to admit when, despite our best efforts, we can’t save somebody.”

The study did not look at whether the families studied preferred direct language about death, Lemmon notes, or whether the euphemisms identified produced any confusion in the conversations.

“Some euphemisms might be quite clear to all the parties involved,” she said. “Especially when they’re used by a family member and mutually understood by the clinical team. That said, it’s important there’s a shared understanding of what we’re all talking about, and for this particular study, the outcome of death is something critically important for everyone to be on the same page around.”

Complete Article ↪HERE↩!

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When a patient wants you to help them die

By Kristen Fuller, MD

We are dedicated to helping our patients, but there are limits to what we can do to help.

A clinic patient of mine was dying of pancreatic cancer. He was as orange as a pumpkin and had an implantable morphine pump for pain. He was in palliative care and hospice, and regardless of medications to help alleviate his symptoms, he was miserable.

His suffering was unbearable. He wanted nothing more than to pass away sooner, in peace, and no longer be in pain.

“‘This is not living,’ he told me. ‘I am just waiting to die.’”
— Kristen Fuller, MD

He voluntarily stopped eating and drinking, refused a feeding tube, and eventually developed severe psychosis. I consulted with his medical team members about offering him “death with dignity,” but they were uncomfortable with this.

He passed away on day 12 by starving himself. His loved ones were beyond scarred by this experience.

The COVID-19 pandemic has exposed the profound tragedy of people dying alone in hospitals, suffering and scared, without the comfort of their loved ones. The pandemic demonstrated modern medicine’s limits in relieving suffering and granting someone peace.

How can we best serve our patients in such situations?

Ways to help patients at the end

Medical aid in dying—also known as death with dignity—is the voluntary act (for both physician and patient) to help end the suffering of a mentally competent adult patient who is terminally ill with less than a 6-month life expectancy (hospice-eligible). The patient has the right to ask for a prescription medication they can self-ingest to die peacefully.

Individuals who want this end-of-life care option tend to be offended when it’s called “assisted suicide,” because they desperately want to live, but are going to die whether or not they utilize this avenue.

The Journal of Palliative Medicine published peer-reviewed clinical criteria for “physician aid in dying”—not assisted suicide.[1] The term “physician-assisted suicide” is archaic and stigmatizing to physicians and patients who have experienced death with dignity.[2]

In the US, death with dignity or medical aid in dying are explicitly distinguished from euthanasia.

Euthanasia, also called mercy killing, is administering a lethal medication by another human being to an incurably suffering patient.[3]

It may be voluntary (requested by the patient) or involuntary. Euthanasia is illegal in the US, but voluntary euthanasia is legal in Colombia, Belgium, Canada, and Luxembourg, and is decriminalized in the Netherlands.

History and guidelines

Medical aid in dying was first passed as legislation in Washington state in 2008, and has since become available for patients in Washington, DC, California, Colorado, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and Washington.

Multiple safeguards are in place to prevent cases of abuse or coercion.

The patient must be deemed competent, two physicians must authorize the medication, and there’s also usually a 15-day waiting period between the first and second doctor’s approval before a medication is authorized.

Suppose the patient chooses to take the medication after authorization. They can ingest the pills at their chosen time, choosing the manner and location of their death—one last act of control in the face of a debilitating illness.

What does the AMA say?

The AMA adopted a neutral position on death with dignity in 2019, affirming for the first time that “physicians can provide medical aid in dying according to the dictates of their conscience without violating their professional obligations.”[4]

The Association stipulated that physicians who participate in medical aid in dying adhere to professional and ethical obligations, as do physicians who decline to participate.

Other well-known national medical associations that have taken a neutral stance on death with dignity by withdrawing their opposition to the practice include the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine, and the American Academy of Neurology.

Empowering patients

According to the Oregon Health Authority, approximately one-third of patients who receive prescription medication to pursue death with dignity in Oregon do not take the medication.[5]

However, they are said to be relieved that they are in control at the end of their life, which helps alleviate some anxiety about potential suffering in their last days. Each patient should be empowered to make end-of-life care decisions based on their unique culture, beliefs, and spiritual values.

“The power should be in the patient’s hands.”
— Kristen Fuller, MD

Hopefully, we can be conduits to give our patients respect, autonomy, and privacy during their last days.

Complete Article ↪HERE↩!

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What happens if you’re incapacitated?

— How to get your advance directives in order.

By Morey Stettner

It’s not fun to do advance directives. But there are ways to make it simpler and easier.

There are some thorny tasks that everyone knows they should tackle.

Every so often, they think, “I should do this.”

Then they don’t.

Take advance directives. You’ve surely heard that you should think ahead and consider the type of healthcare and medical treatment you’d want if you become incapacitated.

If you don’t make these decisions now–and complete the necessary forms to state your wishes–someone else will make the decisions for you later. You know that, right?

For some of us, procrastination isn’t the only barrier to checking this off our to-do list. Confusion plays a role as well.

Just as it’s hard to track our immunizations (when did you get your last tetanus shot or pneumonia vaccine?), it’s tricky to recall when (or if) we filled out advance directives.

“People sometimes forget they filled out the forms,” said Scott Brown, president and chief executive of ADVault, a Richardson, Texas-based provider of advance care planning tools

If you did sign them, where are they? Who knows about them? Are they easily accessible if you’re suddenly unable to convey your wishes?

Advance directives typically consist of a living will and a power of attorney for healthcare. Each state has its own statutory advance directive form. To find your state’s legal form, use the menu bar at PREPARE for Your Care.

Because these state forms are legal documents, the wording can be dense and formal. The Five Wishes advance directive, which meets legal requirements in most states, is written in plain English.

After completing the proper forms, you might think you’re all set. You’re not. The forms won’t magically plop into the hands of medical providers as they’re weighing whether to, say, resuscitate you during a medical emergency or administer artificial feeding or hydration.

“Most people adopt a ‘set it and forget it’ mentality,” said Scott Halpern, M.D., director of the University of Pennsylvania’s Palliative and Advanced Illness Research (PAIR) Center. “They may never revisit it. That’s why advance directives tend to not have an impact because they get lost” and complacency sets in.

Halpern suggests that individuals initiate conversations with both their physician and their family and close friends about their “concerns, values, goals and fears” as they relate to advance care planning. For example, tell them what forms of medical intervention you’d find acceptable and unacceptable–and what level of life-sustaining treatment you’d like if you’re deemed permanently unconscious.

J. Randall Curtis, M.D., is director of the Cambia Palliative Care Center of Excellence at University of Washington School of Medicine. He’s also been diagnosed with ALS.

“I’ve completed a living will and a durable power of attorney,” he said. “But I think much more important than these documents is having in-depth and ongoing discussions with my wife, closest friends and my palliative care physician to make sure they understand my values and goals and my current views of ‘states worse than death.'”

When sharing your end-of-life wishes with your doctor, it’s likely that your clinician will enter your comments into your electronic health record. Once that happens, any other healthcare provider with access to those records (such as a hospital system) can retrieve them.

What if you’ve completed multiple forms over time? Perhaps an estate-planning attorney or doctor prompted you to fill out advance directives years ago. A decade later, a financial adviser urged you to do so. Now you have duplicative forms that may contradict one another. Laws vary by state when it comes to which end-of-life wishes take precedence.

“It’s usually last-in-time,” Brown said. “The most recent document” holds sway.

To be safe, review your advance care plan every year or two. Changes in your health, personal relationships or attitude about life-sustaining treatment can lead you to change your directives.

Complete Article ↪HERE↩!

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5 Meaningful Ways To Remember A Beloved Pet

By jackmartin

One of the most painful things a pet parent can go through is the loss of a beloved pet. Even if death is inevitable, saying goodbye to an animal companion can be a challenging process. After all, your pet has already become one of the treasured members of your family. This indeed makes the grief more intense and complex. Thankfully, some ways can help you grieve healthily and honor the memories you had with your pet during their lifetime.

But how can you do that? Read on to learn the five meaningful ways to remember a beloved pet.

  • Hold A Memorial Service

Organizing a memorial service is one of the most traditional yet special ways to cherish the memories of your furry companion who has crossed the rainbow bridge. It can be an excellent opportunity to gather all the people who love and care for your pet. During the memorial service, you can request these people to share a good memory of your pet.

Moreover, there are ways to organize a pet memorial service. For example, if you choose to bury your pet, you may pick a burial spot in your garden or anywhere near your home. You can create a memorial garden where you can add a paving stone engraved with your pet’s name or image.

On the other hand, you may also decide to cremate your animal companion with the help of cremation providers like Lawnswood Pet Cremation and other similar options. In doing so, you can scatter the ashes in any natural spot or opt to keep the ashes with you at home, where you can rekindle your pet’s beautiful memories anytime.  

  • Buy A Customized Pet Jewelry Item

Another meaningful way of remembering your beloved pet is to customize a jewelry item for them. For example, with your furry companion’s name, you can buy things like brackets, cuff links, lockets, rings, and other similar products. You can also personalize the jewelry item by having it shaped like a paw or engraving your pet’s photo on it. However, if you want to be closer to your pet’s memories all the time, you may consider buying a jewelry item like a necklace, which is designed to keep a small number of your pet’s ashes in it.

  • Put Together A Pet Remembrance Book

It’s hard to forget your happy memories with your beloved pet. Hence, if you want to remember them even if they’re gone, you can create a photo album book containing all your pet’s photos throughout their life. Indeed, you’ve taken many pictures of your pet during their lifetime.

So, use these images to create a pet remembrance book where you can compile them and provide a brief description of the events depicted in the photos. For instance, if the pictures are stored online, you can use a photo editing app to create a digital pet remembrance book. However, if you want a physical copy of the photo album, you can buy a photo book in the store and create your own.

  • Hang Your Pet’s Portrait In Your Home

Painting your pet’s portrait can also be one of the meaningful ways to cherish their memories. You can hang it in the central area of your home, like the living room. This will always serve as your last memory with your beloved pet, who has passed already.

To get started, you can commission a pet portrait artist in your area to create the painting for you. You can find these professionals online, particularly on many social media platforms. You can also ask your veterinarian or some pet stores for some recommendations if they have any.

  • Make A Donation In Your Pet’s Memory

Donating money to animal shelters and other pet organizations can be a meaningful and powerful way of remembering your beloved pet. It can make you feel better because you can help other animals in your furry companion’s memory. You can use the money you would have spent on your pet to fund abandoned animals’ needs, including their food, medical care, treats, and even toys.

By doing all these things, you can make your pet’s passing more special. You can turn your grief into hope and love for other animals in need.

Final Thoughts

Mourning for a pet’s death can be a tough process. But you don’t need to dwell on that pain for a long time. Although you can never bring their life back, some ways can help you commemorate their life. You’ll have plenty of ways to remember a furry friend if you keep the information mentioned above in mind. These methods will allow you to say goodbye and maintain your connection with them for the rest of your life.

Complete Article ↪HERE↩!

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Seven Common Requests From Dying Patients

Patients want comfort and peace at the end of life, but each one defines this differently. Death is a deeply personal journey, and more than anything when facing death, patients want medical providers and loved ones to hear and value their unique needs.

By Sharleen Lucas, RN

  • Dying patients want comfort and peace. Each patient defines this differently, but there are 7 common requests they make.
  • They want dignity and open talks about their illness and their treatment.
  • They want to be comfortable.
  • They want relief from burdens, time with loved ones, and a legacy that outlives them.
  • They may even want to die alone.

Death is a sacred journey, unique to each person. Knowing what a dying loved one wants is what matters.Patients with advanced illnesses may have a few days or years to live. The phrase “end-of-life” refers to the final stage of an incurable disease or injury. A time frame does not define this last stage of life because it’s a unique journey for each person.

“Every death journey follows along the same path in different ways,” explains Delta Waters, a death doula, and registered nurse. Like birth, each patient has unique symptoms and desires.

Patients, end-of-life specialists, and researchers agree on these seven common requests from dying patients.

1. Dignity

Dignity refers to a person’s inherent nobility and worth. Respecting a patient’s dignity is one of the most common values held by patients, loved ones, and medical providers alike.

But dignity is not an objective, one-size-fits-all concept. It means something different to each person.

“To most end-of-life patients, dignity means, ‘Until my dying breath, I feel like you treat me as if I’m alive and cared for,'” said Beth Patterson, a certified end-of-life doula, and veteran palliative care chaplain.

To one patient, feeling alive and cared for might mean staying on a life-saving machine until they die. To another, however, removing devices is more dignified. Some patients may want a family member to care for their bodily needs, while others may hire an objective caregiver.

Either way, honoring a patient’s wishes whenever possible is the best way to honor their dignity.

2. Open talks

When you’re well, you don’t care to talk about sickness. But when you’re sick, almost everyone wants to talk.

According to a 2011 study of Californian’s attitudes toward end-of-life, 79% of people would “probably” or “definitely” want to talk with a doctor about end-of-life treatment if diagnosed with a serious illness.

Most patients want frank discussions, but some don’t, asking doctors to give the hard truth to their loved ones instead. Many want to know how the medical team will treat their pain and symptoms. A few want to know what the end will be like. Sometimes patients want advice on talking with family or finding meaning in their final days.

Studies confirm that when medical providers talk openly with patients and their loved ones about their dying journey, it improves the quality of life for the patients and their families. It also decreases excessive treatment – which often causes greater patient suffering.

The 2011 study in California found that a quarter of Californians faced language issues with their medical providers, drastically reducing their quality of care. To prevent this, medical providers are required to provide interpreters.

But not all talking needs to be about a patient’s end-of-life treatment, Waters told me. A simple chat over a cup of coffee about whatever comes to their mind helps dying patients feel normal.

3. Comfort and symptom relief

It’s not surprising that dying patients want to be comfortable. Most importantly, comfort means symptom relief, but it also includes how and where they want to die. Most people prefer to die a natural death at home rather than in a hospital connected to machines.

Common end-of-life symptoms include pain, shortness of breath, increasing weakness, anxiety, nausea, loss of appetite, and thirst. Some patients want these symptoms controlled to the point where they mostly sleep. Others choose to endure some discomfort to be awake with loved ones.

Doctors and nurses provide many medical tools for managing symptoms. Patients may also find relief from complementary and alternative therapies.

The goal of symptom relief is comfort – as defined by the patient. Not clearly understanding a patient’s symptoms and desires for comfort can increase their suffering.

4. Relief from burdens

End-of-life patients worry about their families, their finances, and what the end is like. Most of all, dying patients want to know their loved ones will be okay.

One of the best ways to ease these burdens is hospice care. Hospice offers holistic care and counseling for patients facing their last six months of life. With care provided by nurses, aides, medical social workers, counselors, and volunteers, hospice is typically free of charge thanks to Medicare coverage and hospice fundraising.

Sadly, however, most patients wait too long to start hospice. Instead of using hospice for their last six months of life, about 50% of patients only use it for their final 18 days or less.

Contacting hospice sooner helps relieve patients and loved ones of their worries. At a time when every day counts, hospice may even lengthen patients’ lives for up to 29 days.

5. Time with loved ones

Most dying patients want to spend as much time as possible with loved ones. Many want to strengthen relationships, resolve old hurts, and pass on love, wisdom, and stories.

In his book, Dying Well, Dr. Ira Byock says there are five necessary statements to say to your loved ones at the end of life.

  1. Forgive me
  2. I forgive you
  3. Thank you
  4. I love you
  5. Good-bye

These statements help relieve the spiritual and relational burdens of both the dying and their loved ones.

6. A legacy

Loretta Bruening, Ph.D., founder of the Inner Mammal Institute, writes, “You are hard-wired to care about what you leave behind when you’re gone…The neurochemistry that drives animals to promote their genes is what drives you to care about your legacy. Understanding that is important to your happiness.”

Contributing to others and leaving a legacy is called generativity in psychology. It refers to the need of humans later in life to leave their mark. They want to create something that will live after they die.

End-of-life studies support this, saying dying patients show a need to contribute to their community to feel needed, significant, and remembered. Some patients create gifts, start projects, continue to work or make financial donations. Others offer time and knowledge to their community and loved ones.

After working with thousands of dying patients, Patterson knows the importance of a legacy unique to each person. She told me about one patient who left a legacy of “words and actions” by earnestly creating videos for his wife and the first responders he led as captain of the fire station. In contrast, Patterson also recalled a Buddhist coworker who felt no need to create a legacy because her “life was her legacy.”

7. Maybe to die alone

As Waters reminds us, “In the end, even though death is a universal human experience, it’s still a solitary journey for each person.” And some want it that way.

As an RN, I cared for a dying patient in the hospital who lived days longer than his family expected. At age 90, with a failing heart, we thought death would come quickly. His family sat with him each day, taking turns at night. They grew exhausted after several days but were grateful to be with him.

They wondered why he held on so long. We discussed that perhaps he wanted to die alone, so the family decided to go to dinner together, leaving the patient with our staff for an hour.

Not long after they left, his breathing changed and slowed, eventually stopping before the family returned.

Patients who want to die alone are common, according to hospice staff and death doulas. It can be hard on loved ones, but letting patients die alone if they want to is another way to honor their wishes and dignity.

There’s no “right” way to die. Death is an individual’s sacred and one-of-a-kind moment. What matters is honoring each patient’s unique dignity and desires.

Complete Article ↪HERE↩!

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How to Improve Death Anxiety Using CBT

By abraham smith

The fear of death has been shown to play a causal role in a variety of mental disorders. Although fear of death is transdiagnostic, it is a particularly prominent feature of fear of health. And that’s not exactly surprising. Aside from being a victim of violence or an accident, the vast majority of deaths are due to disease-related causes, right?

Well, most people don’t like the idea of ​​their death. But while it’s unsettling, they can, to a certain extent, accept that death is an inevitable part of life and more or less leave it at that. However, many people with health anxiety find that their fear of illness and infirmity stems, at least in part, from fears related to death and/or the dying process. Only recently have researchers and clinicians begun to address this issue in their understanding and treatment of health anxiety.

Western culture doesn’t help.

Denial and avoidance of death-related concepts only increases fear of it. As a society, we have a responsibility to promote the avoidance of death and dying. Death is something that is not accepted or openly discussed in our culture. In fact, there’s a whole movement against it, sometimes referred to as “death positivity,” which advocates for greater acceptance of death in our culture by encouraging people to speak openly about death and dying (acknowledging, understanding, and speaking about our fears about what we want and the organization or planning of our death). There are many examples of this movement taking place. In one, people hold death dinners to discuss mortality. More than 200,000 people attended these dinner parties. In a way, this “death positivity” movement fits well with the core principles of exposure therapy, which is to expose yourself to the feared stimulus in order to learn that it is not as frightening as one might think.

Treatment for fear of health includes treatment for fear of death.

If we’re trying to improve your fear of health without addressing your fear of death, we’re just putting the proverbial band-aid on your wound. Researchers refer to this as the “revolving door problem”. Essentially, if a client comes to me for health anxiety and I don’t address their fear of death in treatment, the problem will likely recur and they will return for treatment at some point in the future.

So how do we treat the fear of death?

In cognitive behavioral therapy (CBT), we use cognitive restructuring and exposure tasks to overcome fear of death. With cognitive restructuring, we help someone to question their maladaptive assumptions about death and dying (e.g., fears about the dying process, fears about the ‘ultimate goal’, fears about leaving loved ones behind). In exposure therapy we help to systematically expose oneself to death and dying in different ways, slowly and steadily seeing death as a normal part of life and not the “scary monster in the closet”.

For example, we would design expositional tasks (such as the following) to help you systematically familiarize yourself with the idea of ​​death:

  • Watch movies/read books that show scenes of dying people.
  • Go through hospice materials – many of them talk at length about the dying process.
  • Read about people who lost loved ones and cared for them during the dying process (find some books).
  • Write (and discuss) an imaginary story about your children’s lives after your death.
  • Write (and discuss) an imaginary story about you on your deathbed with loved ones around you.
  • Develop a plan for your dying process if you could choose. Where would you be, who would be there, what food and drink would you like to enjoy and what type of activities would you like to do?
  • Read more about death food.
  • Attend a death dinner and share how you would like to die if you died from a disease-related cause.

In summary, the main roles in treating fear of death with CBT are (a) to help you challenge rational fears through cognitive restructuring, and (b) to help you become more comfortable with death by addressing yourself Involve exposure tasks that normalize death avoiding it. Death isn’t something we look forward to, but it shouldn’t take over your life!

Complete Article ↪HERE↩!

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Dementia: How long can a person live without eating or drinking?

By Belinda Weber

Many people living with the later stages of dementia may not eat or drink. They may also develop dysphagia, which prevents them from swallowing effectively. How long a person can live without food and liquids varies, but doctors believe that sufficient end of life care may help improve their quality of life.

Dementia refers to a group of neurocognitive conditions that can permanently damage the brain. Alzheimer’s disease is the most common type, accounting for between 60% and 80% of dementia cases, according to the Alzheimer’s Association.

This article explains why someone living with dementia may stop eating and drinking. It also suggests ways carers can support them.

There are many reasons a person may stop eating and drinking. As a neurocognitive disorder progresses, most people become less active and do not need to consume as many calories.

According to the National Foundation of Swallowing Disorders, at least 45% of people living with dementia also experience dysphagia, which refers to difficulty swallowing. This can cause a person to be unable to consume adequate nutrition and liquids.

People living with dementia may also notTrusted Source be as diligent about their oral hygiene as they once were. This can cause them to have sore mouths, teeth with infections, or ill-fitting dentures.

Another reason may be that the damage in the brain has spread to the hypothalamus, the area that regulatesTrusted Source food intake. Alternatively, it could be that the person no longer recognizes things as food or forgets about eating.

Age can also play a part as the muscles involved in swallowing lose mass, resulting in a loss of strength and range of motion. The person may feel as if they are choking on food or cannot move it out of their mouth.

No one can say for sure how long someone can survive without eating or drinking, as it involves many factors. These include the person’s age, overall health, and how well their immune system can fight infections.

If someone has dysphagia, this can indicate that their neurocognitive disorder is progressing, as dysphagia usually occurs in the later stages. This increases the risk of a person inhaling food or liquid, leadingTrusted Source to chest infections.

While it is impossible to predict exactly how long someone can live without eating or drinking, having dysphagia can mark the beginning of end of life careTrusted Source.

People living with a neurocognitive disorder may benefit from end of life care for days, weeks, months, or years.

Artificial nutrition and hydration (ANH) is a procedure where doctors deliver nutrients and fluids intravenouslyTrusted Source into a person’s body via a tube. This tube runs into the stomach from the nose or a device fitted into the stomach.

However, these doctors need to administer these treatments in a medical setting, and many people with a neurocognitive disorder find the experience distressing. Some individuals may try to remove the tubes.

Doctors do not agree about recommending ANH for people living with late stage dementia as it is unclear whether it provides any overall benefits.

The American Speech-Language-Hearing Association notes that tube feeding does not improve the quality of life of a person with a diagnosis of dementia. Additionally, it states that tube feeding does not reduce their risk of developing a chest infection.

The Alzheimer’s Association recommends people living with a neurocognitive disorder plan their late stage care while they can still express themselves and make decisions. This can include whether or not they want ANH.

When someone living with dementia is nearing death, they tend to deteriorate more rapidly. They may develop incontinence and agitation.

According to the United Kingdom’s Alzheimer’s Society, signs that death is near for someone living with dementia include:

  • loss of consciousness
  • irregular breathing
  • restlessness
  • rattly sound in the chest
  • cold hands and feet

A 2019 study listed pneumonia as the cause of death for 50%Trusted Source of people who required hospital care due to dementia.

Doctors recommend helping someone eat and drink for as long as they can, even if they eat in small amounts. The Alzheimer’s Association suggests:

  • offering soft foods
  • thickening liquids with cornstarch or unflavored gelatin
  • alternating bites of food with sips of drink
  • offering sherbet or ice cream
  • serving finger food if someone has difficulties using cutlery
  • helping the person sit in an upright and comfortable position

Many people living with a neurocognitive disorder may stop eating and drinking. This may be due to infections, but it may also result from individuals experiencing swallowing difficulties.

Swallowing difficulties, or dysphagia, often indicates that the person’s neurocognitive disorder is progressing and may have reached the later stages.

Doctors believe that the person’s body adjusts to the reduced food and liquid intake and that people do not feel hunger or thirst.

Swallowing difficulties increase the risk of inhaling food particles or fluids, which can lead to chest infections, including pneumonia.

Complete Article ↪HERE↩!