Question:
My father has had alzheimers for about 3-4 years. His memoryhas gotten really bad the past few months and within the past 3 weeks,he ahs started urinating on himself and his speech has gotten reallybad, He has to use a wheel chair more now. The nursing home calledtonight and said that his appetite has decreased very badly and hereally needs a feeding tube. The place he is at is really good andthey have been really good to him and his weight has decreased alothere recently. He was a 38 in the waist 2 months ago and now maybe a28. So I know something is wrong. It seems like his condition hasprogressed rapidly the past couple on months. Is this normal? Mymother passed away 3 years ago last week and he has no idea about it.At least it seems like he doesn't. People have told me that when aperson is in bad health and they are ready to die that things likewhat is going on with him start to happen very quickly. I just needsome insight on if this is normal or what?I was 32 when my mother passed away and had to do everything bymyself. My older brother could not handle it and now I feel like I'mgoing to go through it again. But it just seems too soon.

Answer: As your father enters the final stages,there are painful realities to face, and difficult choices to grapplewith.

If you go to Google.com and run a search on feeding tubes anddementia, you will see that there is very little evidence that afeeding tube prolongs life OR alleviates suffering - in fact, most ofthe evidence suggests it actually causes suffering. Very few doctorswho are experienced with later stage issues for Alzheimers patientswould recommend such a measure - the majority would support handfeeding and palliative support as the most humane.

Absolutely, you do not have to permit this to be done to him. The factthat you are asking the question tells me your gut is talking to you.Ipersonally would never permit a feeding tube or IVs unless it was asituation where the person was temporarily impaired and would recovertothe point where they would be shortly unnecessary - but as you know,no matter how he is fed, your father is not going to regain muchground. However, some of his current state may be from lack ofnutrition.

If you run the google search you will also see that there have beenstudies done on nursing homes that push feeding tubes. They tend beignorant of late stage Alzheimer's issues and the current research,motivated by fear of law suits - and they also tend to be for profitand see the time required for careful hand feeding as an expensiveburden.

As Alzheimers progresses, it is common for decreases in appetite tooccur. Beside loss of appetite, brain impairment also contributes todifficulties in using utensils and in chewing and swallowing.

Some suggestions to get more food into your father include- maintaining as much physical activity as you can for the person tostimulate appetite (having said that, you don't want them pacing allday, since they may be burning more calories than they can take in),- providing regular meals and snacks that follow a routine,- try more frequent smaller meals and snacks - sometimes that can keepthe weight on better than larger meals three times a day- eating with the person (seeing someone else eating can get themgoing as well),- preparing familiar and favourite foods (hey whatever works - if theywill eat spagetti 5 nights a week, go for it)