Based upon everything written above, if I were in your shoes, I would say yes to an antibiotic, but no to invasive procedures (like surgeries) that involve anesthesia, because anesthesia frequently produces negative results in those with Alzheimer's or Dementia, and because surgeries create pain and suffering.

Since she has specified that nothing is to be done to extend her life, and has a DNR, then one of the questions that needs to be asked when evaluating procedures is: "To what end?" Thankfully, you're already asking that question.

My husband is a retired doctor, and many years ago, he declined surgery for his father, who had cancer that was in an advanced stage, because at that point it would not have been curative, only assaultive. I'll never forget how he explained to me that when you're a hammer, everything starts to look like a nail -- and surgeons are hammers sometimes. His point then, and my point now, is that just because something CAN be done doesn't always mean that it SHOULD be done.

I hope this helps you with the heavy burden you're bearing.

@A myALZteam Member your cousin is blessed to have you care for her so well. You mentioned, "but I know she would never want to live in the condition she is in now...." which I feel is said with certainty, love, and desire to follow her wishes. I find myself in the same situation except my loved one is my 61-year-old husband who is firmly in stage 6. We have his advance directives and out-of-hospital DNR for which I am grateful. So many caregivers don't have advance directives to help them know what to do.

We are currently living the "keep him happy, comfortable, and safe" way. Last fall I weaned him from Donepezil and Memantine...now he only takes an antidepressant (20mg Escitalopram/Lexapro) and recently had a 1mg/3days Scopolamine patch added because saliva was pooling in his mouth and made him anxious. The patch has helped a lot, and he's no longer stressed when he periodically forgets how to swallow. A recent chemical stress test revealed he's probably already had a heart attack. The cardiologist offered aspirin, statins, and heart catheterization which I declined. The only future medication I'll allow is something that will help him with pain or anxiety. Last week he began palliative care and the nurse practitioner and social worker are aware if he goes septic, for example, antibiotics will not be part of the plan.

As my husband's full-time caregiver and person responsible for carrying out his end-of-life wishes, sometimes the burden feels a bit heavy. Even so, I'm able to have tremendous peace knowing I'm doing the best I can to advocate for him. When I advocate for my husband and explain to medical folks why I'm making the decisions I'm making on his behalf, the vast majority of time their response is great respect and understanding...and in some way there's a burden lifted from their shoulders because we all know the trajectory of the disease. In other words, as @A myALZteam Member said, we must ask ourselves "to what end?" Do we want to allow treatment--of any kind--when we know our loved ones with Alzheimers don't want to extend their life in this situation? For my husband and me, that means he's in the stage of the disease where he'll only receive comfort care.

Wishing you all the best as you work to determine the boundaries your cousin would want you to set on her behalf. Many hugs to you!

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