Advice needed - 91 year old dad is suddenly exhausted and has no appetite

[Anonymous]

OP here with an update. We did go to the hospital. Went to Inova ER next to GMU campus (can’t recommend them enough - they saw him right away, were incredibly patient with his hearing loss, etc). He was given fluids, chest X-ray, more blood and urine tests. They allowed him to go home - he was diagnosed with CHF which explains the fatigue and lack of appetite. He’s resting and home and feeling a lot better. We have to follow up with his GP on Monday. I got him set up with a fall alert button (which he refused to wear in the past, but he’s willing to now that he spent time on the cold tile floor in the bathroom...).

I’m looking into home health aides for him. Also looking at apartments (they do not want to move to assisted living - it’s a fight I’ve had already). But getting them in an apartment with no stairs, closer to me and closer to the hospital would be a good first step.

I’ve been reading about CHF and it is scary, but am trying to be realistic. Hopefully his GP of 30+ years will go into more detail about what we can expect and how we can best help him.

It’s astonishing to me how quickly a person can go downhill. Just last week he was upbeat, tending to the yard, walking on the treadmill and eating well.

[Anonymous]

Something similar happened to my father. One week he was living rather independently. The next his body shut down. Not eating drinking. Eventually because he just couldn’t swallow. Loss of all bodily functions. Walking, talking, heart rhythm, blood sugars. And underlying illness caused brain swelling, underlying illness was treated he eventually recovered. He pulled through with massive medical intervention and rehab, but he was also 68 so theoretically many years ahead of him. If he had been in his 90s he may have opted to just go into respite care as without intervention and he would have died fairly quickly.

[Anonymous]

OP if your dad is not eager to have lots of interventions, talk to the GP about palliative care and/or ask for a referral to a palliative care doctor. We met with one when our elderly father was hospitalized and they were so helpful in thinking through lots of different options and focusing on how to ensure his comfort and quality of life.

[Anonymous]

I’m glad you got to the bottom of things and that your dad got good care, without having to stay in the hospital. Now you know what you’re dealing with, which I imagine is a relief, to some extent. Wishing you all the best.

[Anonymous]

OP, thank you for the update - I've been thinking about you, your mom & your dad. Having been through a similar situation with my ILs, I think a home health aide is a great idea.Take care of yourselves!

[Anonymous]

I know how hard this is, OP. My dad has late stage Parkinsons, and falls a lot. He has been clear that he would rather die than go into the hospital, and he has good reason - his care is complicated and he ends up having too many tests and assessments, he can't sleep, his mental state declines, which he finds utterly intolerable. After having spend days with him in the hospital I totally understand - in his shoes I'd rather just call it a good life and hit the road.

What we have tried to do is scenario plan with my dad and mom. "Okay, if we go to the hospital now, after this fall, to check if there is a break what will happen? If the bone is broken will you allow surgery? No? Okay, well then what do we hope to get out of going to the hospital? Can we get any other treatment at home?" Etc. It is a slow and difficult process, and takes a lot of sitting with emotional discomfort. You also have to have come to a point as people and a family where you know (as Professor Dumbledore said) there are things much worse than death.

[Anonymous]

Anonymous wrote:This is the OP. My dad fell overnight, my mom found him this morning covered in his own feces and vomit. She got him cleaned up and in bed (he doesn’t want her to call ambulance) and I talked with him - he was cheerful and upbeat. I have no idea what to make of this, I’m horrified for him that he fell and spent time on the bathroom floor, alone, I’m horrified for my poor mom and at the same time, he’s happy and feeling better and resting in bed. We will get the results of his blood work later this morning....

Call the primary care doctor's emergency line. And make it clear he doesn't want to go back to the hospital--assuming you clear that with him, that he's really willing to die rather than go.

Depending on the outcome, if this isn't something easily treated with antibiotics, get hospice involved pronto.

[Anonymous]

Anonymous wrote:OP here with an update. We did go to the hospital. Went to Inova ER next to GMU campus (can’t recommend them enough - they saw him right away, were incredibly patient with his hearing loss, etc). He was given fluids, chest X-ray, more blood and urine tests. They allowed him to go home - he was diagnosed with CHF which explains the fatigue and lack of appetite. He’s resting and home and feeling a lot better. We have to follow up with his GP on Monday. I got him set up with a fall alert button (which he refused to wear in the past, but he’s willing to now that he spent time on the cold tile floor in the bathroom...).

I’m looking into home health aides for him. Also looking at apartments (they do not want to move to assisted living - it’s a fight I’ve had already). But getting them in an apartment with no stairs, closer to me and closer to the hospital would be a good first step.

I’ve been reading about CHF and it is scary, but am trying to be realistic. Hopefully his GP of 30+ years will go into more detail about what we can expect and how we can best help him.

It’s astonishing to me how quickly a person can go downhill. Just last week he was upbeat, tending to the yard, walking on the treadmill and eating well.

Ask blunt questions of the primary care doctor--particularly about hospice. If it's reasonable to expect he will die in the next six months, you can get hospice services. They will help you manage this in a way that's least traumatic for your dad.

[Anonymous]

OP again - I just wanted to thank everyone for their advice. Last night around midnight he really started struggling, couldn't drink, couldn't get up and his fever was 102. He asked to go to the hospital. They decided to admit him - they couldn't really determine what is going on with him in the ER - his tests are ok, but he had elevated BNP (which apparently is a marker of a stressed heart). I left town yesterday morning for a work trip and am feeling anxious to get home, but apparently he's stable now and resting. I feel so sorry for him though. it is so hard to see him suffering. I know this is something many of us have to face at some point - and he has had a good, long life. But it is still really hard.

[Anonymous]

Following this thread. My 86- year old dad has has similar symptoms for several years now. In and out of the hospital and rehab constantly for the past 2 years. And yes, my 86 year old mom takes care of him completely on her own. We 3 "kids" do not live anywhere near our parents and they cannot afford to or are unwilling to have home health care aides in the house.

[Anonymous]

OP, I just wanted to say I am sorry. This sounds really hard on many different levels. My Mom died when she was 66 of mucosal melanoma. I had a couple of months to get used to her being gone - and then she was. I know she was scared but she put on a brave front. At age 91, your Dad can’t bounce back like someone younger and I would encourage you to take some time off work and be with him. It sounds like his body is preparing him for transition (I don’t remember the words hospice used but fevers and falling and vomiting - his body is for lack of a better word - failing).

I was pregnant when my Mom was sick and I did not take time to be with her as much as I should have. I had some pregnancy complications and I was saving leave for postpartum. It’s a huge regret of mine but it was so hard to see my Mom frail and incoherent. So I also avoided it.

I just wanted to encourage you to spend time with your Dad now if you can. Hope your work trip is short and you’re home soon. Sending strength.

[Anonymous]

Anonymous wrote:OP, I just wanted to say I am sorry. This sounds really hard on many different levels. My Mom died when she was 66 of mucosal melanoma. I had a couple of months to get used to her being gone - and then she was. I know she was scared but she put on a brave front. At age 91, your Dad can’t bounce back like someone younger and I would encourage you to take some time off work and be with him. It sounds like his body is preparing him for transition (I don’t remember the words hospice used but fevers and falling and vomiting - his body is for lack of a better word - failing).

I was pregnant when my Mom was sick and I did not take time to be with her as much as I should have. I had some pregnancy complications and I was saving leave for postpartum. It’s a huge regret of mine but it was so hard to see my Mom frail and incoherent. So I also avoided it.

I just wanted to encourage you to spend time with your Dad now if you can. Hope your work trip is short and you’re home soon. Sending strength.

Thank you for this. I’m so sorry about how things happened with your mom and I hope you’re doing ok. My dad is doing much better - fever gone, appetite coming back and back to his upbeat, cheerful self. He is currently trying to bribe everyone who comes into his room into letting him go home.

With a new diagnosis of CHF there’s a few days of hospitalization even when someone is stabilizing, and I’m grateful for though he wants to go home) because it is giving us time to figure out what to do. Since it is the weekend we haven’t really had any contact yet with a geriatrician - apparently they’ll be the ones who help us figure out home care, hospice, etc depending on his prognosis.

To the PP just above this with the 86 yo Mom, I am thinking of you and hope things are ok. Part of what has been so “easy” to this point is that my mom is still so active, healthy and capable at her age. But it’s unrealistic and unfair to her to expect her to keep up this superhuman level of strength and I know she needs help or else her health will be compromised.

Thanks again to everyone who has weighed in, you’re all really kind and your words mean a lot.

[Anonymous]

NP. I'll be thinking about you, OP. I went through this with both my parents, but at a much earlier stage in my life than most, because they were much older than typical when I was born.

It's hard. You will struggle with when to take on a parenting role, and that's super hard because these are Your Parents. But sometimes you have to protect other people -- if they are driving and putting others at risk, or as you said, making sure your elderly mother isn't shouldering too much.

I now work in healthcare and learned afterward about geriatric case managers. I don't know if this is an option for you, but it might help bridge that impasse where you have very independent elders who are open to making changes if it is presented in the right way, in the right time, and by someone with whom they have less complex emotional relationships.

Here's an article: https://newoldage.blogs.nytimes.com/2008/10/06/why-hire-a-geriatric-care-manager/

PS: I have no financial or other involvement with GCMs. I just wish I had known it was an option when I was going through this, and I made a note to mention it in the future for ohers.

[Anonymous]

^^^Correction: geriatric CARE managers, in case you google

Best wishes.

[Anonymous]

Anonymous wrote:^^^Correction: geriatric CARE managers, in case you google

Best wishes.

Really helpful - thank you SO much for your advice!!!