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My 89-year-old father was super active and healthy until a renal cyst ruptured and put him in the hospital. After being trusted for 3 weeks for pneumonia, bacterial infection (sepsis), and ICU delirium, je was stabilized and discharged for rehab. He is uncooperative. Refuses treatment, PT, OT, food, meds, and now oxygen. His 02 levels are down to mid to low 80s. He won’t keep oxygen mask on. What can happen? What can I do? Rehab says they cannot force or restrain him. They are saying it may be time for hospice. He has been in rehab for 10 days and he keeps saying he wants to die. I have been unable to help him understand that rehab is for getting better, and if he would try. He could regain his strength and still have more time left with us. But he refuses to believe that he is capable to regain some function. He says he’s lived long enough and wants to quit. What can I do?

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If dad is serious about this respect his wishes. Please no feeding tube or IV's
Talk to him about what his wishes are.
He may be just tired of being sick and tired.
Contact Hospice and he will be evaluated. Let Hospice help you and him.
((Hugs))
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Have a calm conversation with him. Find out his wishes. Do not impose your wishes on him. Don't tell him he has to stay alive just for you regardless of his quality of life.
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If I were in your shoes, I would continue trying. Hire a private caregiver who puts on the O2 mask? Encourages him not to give up?

Your dad might not be thinking straight: he’s O2-food-meds-deprived. People can’t think clearly like that. If he had food-O2-meds, he might want to live, because he would feel better, think more clearly, make better decisions.

Tell your dad all that, too.

I would try some more. He might later be very grateful you saved his life, in a moment when he wasn’t thinking straight.
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I would have him tested for a UTI, right away. These often cause behavioral symptoms in elders. Get him taken back to the hospital if necessary.
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Could also have some bad delirium from the infections and hospitalization.
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lealonnie1 Jul 2023
Hes refusing meds, perhaps you missed that?
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Of course it will hasten his death. But perhaps he really is tired and just wants to call it quits. Who can blame him?
I would certainly get hospice on board and if by chance he does bounce back, hospice can be stopped at any time.
This is now about your fathers wishes not yours.
God bless you both.
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I have to agree that Dad has been thru a lot. Pneumonia will cause delirium and for a while after its been cleared up. This is usually what happens, one day they are doing well, and the next day they aren't. Their bodies can no longer fight the infections ur Dad has.

No, the facility cannot force him to do anything. Rehab also is not Skilled Nursing. If he is still showing signs of pneumonia and maybe sepsis, I would have him taken back to the hospital. If the facility won't do it, u call an ambulance.

A pause ox of 80 is serious. At his age, I would not suggest a feeding tube unless they can say its just to get over a hump but not to keep him alive. My DD an RN does not recommend them in the elderly. Pneumonia in the elderly is also serious as is sepsis. Again, this facility is not skilled nursing, call the ambulance. Then if the Hospital says there is no more to be done, call in Hospice.

If ur having a problem sending him to a hospital, I will tell you what my DD, who was an admitting RN in Rehab told me. Medicare tells Hospitals when they need to discharge. They send patients to Rehabs still sick and Rehabs are not equipped to care for these patients. When patients are discharged to Rehab, its for PT and OT not skilled nursing. My daughter has sent patients back to the Hospital where I think your Dad needs to be.
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Yes, the refusal of oxygen, and foods will lead to his death. The meds? Depends on what they are for. Cholesterol meds? They're not doing a lot at age 89.

Why would you want him to keep hanging on? I watched my mom slog through the last 2 years of her life with a good attitude and 'enjoying' life as much as was possible in a tired, broken body, but she would have been HAPPY to die at age 85 or anything after that!

People always say "But he was in pretty good health UNTIL...(fill in the blank)...". This is what happens, People get older and some sickness, a fall, a surgery..whatever..takes them down.

To the day he died my husband said of his father "If he hadn't had Leukemia, he would still be alive." well, probably, but he DID have leukemia.

I'd respect his wishes. Being old and sick, day after day--to what end?

I hope you love your dad enough to look into Hospice care for him. At this stage, keeping him comfortable should be your greatest concern.
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Popsicles enjoy 1 or 2 with your dad
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anonymous1732518 Jul 2023
@MD1748

It is, maybe he may have a change of heart, plus it gives both of them a chance to talk while enjoying the sweet treat.
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Rather than being uncooperative, dad is likely tired and ready to leave this life. Seniors often take a turn from which they cannot recover from after a severe illness such as dad's had. Please have a heart to heart talk with him and don't automatically assume he's not thinking clearly bc he's ready to transition. If he's able to convince you that's his true wish, then call in hospice to keep him comfy. I understand this may not be your wish, but sometimes we children don't get a say in these matters.

Wishing you the best of luck with a difficult situation.
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anonymous1732518 Jul 2023
Exactly, talk while having popsicles, the good ones made with real fruit, grape preferred if possible.
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It is difficult for us to accept and understand that our elders are often tired, exhausted by fighting for life, and wish to/are ready to go. I saw this with many patients who told me, their RN, that they could not speak honestly with families about their wish for their lives now to be over. They were forced to discuss this end of life wish with their nurses.
My own father told me that he had had a wonderful life, but was so exhausted and just longed for the last long nap.

Honor your father's wishes. Whether he is totally rational or not he sounds ready. I would ask MD for Hospice referral now and concentrate on comfort for your dad. Try to understand that while you will never be ready to lose him, he cannot stay with you forever and the best gift you can give him is telling him that. That you won't ever be ready but you will support his wishes.

I am so sorry. I know the pain firsthand. My heart goes out to you.
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Let him quit.
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<((((((((((((HUGS)))))))))))
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Respect his wishes. You sound as though you are trying to live his life for him according to your wishes. That is not helpful. If a person is in poor health and tired of the suffering their desires should be respected over what you want. Allow them some peace.
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The body gets tired. If dad is ready to go, let him make his own decisions. It may not be what you want, but it is his decision.

I have a brother who is eighty-one who had a terminal diagnosis cancer diagnosis. He was okay about five weeks ago and quickly descended into not being able to walk. The psychiatrist put him on anti-depressants. I'm praying that he pulls through. The cancer right now is dormant, so the problem is his thinking. He's just given up. Right now the rehab is teaching him to walk again with a walker, shower, dress and he is still getting the cancer treatment. I'm not sure how he got the two the three year diagnosis if his cancer is dormant for now.
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What MD said responding to my post is probably right. My DD did tell me by not admitting a patient and returning them to the hospital meant that the Hospital and Rehab may get penalized for doing so.
For my peace of mind, I would sent him to the Hospital. Then u will never wonder if you did the right thing. Let doctors check him out and say, they can't do more for him.
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I'm 3 years younger than your dad, and if I'd been through all that he has, I'd most likely be where he is, too. There comes a point where the body and mind simply have had enough. This may be the case especially if the older adult had been relatively active and healthy before a major adverse health event occurred and is now contemplating a remaining life of increasing helplessness and dependency.

By our mid to late 80s+, most humans have pretty much done what we're going to do in life; we are likely experiencing physical and mental decline and will continue to do so although no one can predict the trajectory. It should be each individual's right to approach end-of-life with as much comfort and dignity as possible--under what are, for the elder and family, difficult circumstances.

Did your dad have a healthcare directive, or did he ever verbally express his wishes for end-of-life care? If so, these could be a guide. IMO, it is time to call in Hospice. As I see it comfort, cleanliness and dignity are the most important considerations for him now.
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Rehab is useless for him at this point. Ask your Dad if he would consider going back to the hospital. If not , I would do hospice.
My FIL is 89, has had 3 identical near death episodes in the last 6 months. He is in rehab again, He is telling us no more trips to the hospital because it lands him in rehab . He just wants to rest .
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Talk to him about your best shared memories. Talk about fun and funny stuff you most loved growing up. Let him know what you do that you learned from him. Ask him questions about his past that you'd like to know. Bring family picture albums of earlier times. You may warm him up to staying a little while longer. In the least you'll let him relax and not harp on him during what may be his last days.
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