Context:
My grandmother has had many strokes in the past, leaving her in a state where she is usually her but a bit childish.

Now, as she is childish she refuses to drink/eat if you want her to drink or eat, not because she doesn’t like what she’s been offered… She does it just to be bitter. But with enough charm you can get her to drink.

When she doesn’t drink, she starts “drying up” and her mental state worsens making her to outright refuse by spitting or throwing whatever you offer her.

Making it spiral into her being super dehydrated and in the brink of dying.

Now doctors:

She was in Palvelutalo Hopeakuu as she no longer could be at home alone, there the nurses outright just said “Hey gramma do you want to drink” – no “okay”. And she got dehydrated cause she didn’t drink for a few days and then the nurses where quote: “Too scared to go in there as they didn’t want to see a dead body” so when my mother (a woman who is old as well) went to check on her one day she found out what I just told, and then she notices that my grandmother was having another stroke which the nurses couldn’t recognise and just wrote “dribbling in the left side of the face”.

She was taken to Jorvi where once again the nurses didn’t want to deal with her and proposed to be taken to this elderly house. My mother had to go to Jorvi everyday twice to ensure that my grandmother ate and drank… This continued for a few months until she was finally taken to a proper elderly house caring.

We thought the nightmare was over, but ONCE AGAIN even with my mother and the doctos from Jorvi informing this place that they couldn’t let my grandmother dry up as she would get harder to deal with and she would most certainly die.

Nurses didn’t want to deal with this annoying granny not wanting to eat or drink so they proposed to my mother to take her to the clinic again. My mother (as I am having a surgery and am in very delicate health) was stressed enough said that yes they could take her to the clinic.

The doctor in the clinic outright said in an email “This is just the natural cycle of life, and giving her serum would be to unnecessarily extend her life”. This evidently brought my mother to tears as we know my grandmother is in bad condition, but she isn’t just a vegetable… she does talk and communicate with us successfully if she is completely hydrated and fed.

We don’t know what to do, my mother has resorted on going to her caring home every signor day to try and avoid her drying up, but this is very consuming for a woman her age.

If anyone knows anything we could possibly do… I beg for, anything.

Edit:

She wants to drink, she can’t hold the glass, but she also doesn’t be wanted to be treated like a baby. My mother tried explaining this to the nurses and they shrugged her off.

My grandmother isn’t in any capacity of choosing anything legally as far as I know. My mother is the sole caretaker of her.

Today my grandmother expressed that she wanted to live and be back on her feet as soon as possible as she was able to walk until last year.

Edit edit:
I even have two videos, one where she just arrived to the hoivakoti* where she is seen sitting down with other elderly people drinking her tea with a spoon and even thought she isn’t getting really anything on her mouth she is quite happy.

Then the other video after like a week of her being there and my mother not going every single day, where my mother voices over something like “Now you can see that my mother is drying up, so you want me to give you something to drink gramma? – juu okay ill try to give you something” and then she showed how now its a bit too late to try to make her drink as the water dribbles out her mouth. That she shouldn’t be allowed to get to that point.

A week later, that’s like now, she is quite in a bad shape and the doctor of the hoivakoti* said that she should be taken to a clinic but doctor of that clinic said “nahhh” but my mother has tried to get her rehydrate by her own. And she has been partially successful.

The thing is my mother cannot dedicate her whole life to making sure that she drinks, if she doesn’t go, she dies. She doesn’t feel like that’s fair. So is there any place or any private nurse?

Edit edit edit:
this is a conversation I had with my mother regarding this situation which gives good context

View post on imgur.com

Edit⁴ : she is currently in a hoivakoti and the nurses there seem to not understand the situation as there’s has been a lot of chain of command communication mishaps.

23 comments

  2. How do you feel when someone tries to force you to do something? Your grandma has had it rough with the strokes and hospitalization and she probably feels she controls nothing in her life anymore.

    Maybe she is not talking about wanting to die already but feels she has experienced what life had to offer for her and is ready. Giving up food and water intake is one of the most pleasant ways to go if you choose it by yourself. And she could be choosing it unconsciously.

    So this could really just be a case of natural cycle. Of course you could extend that cycle by putting her to tubes but simultaneously restricting her possibilities to experience life even more. You can try to openly talk with her about the matter, like does she know that refusing drink will kill her eventually? But don’t try to have any strategy or drive your own agenda. That will just make her refuse more.

  3. Well, there´s a few aspects here.

    Patient has rights and bodily autonomy. If the patient´s mental capacity has diminished, the treatment is dependent on few factors, for example whether they have treatment will, whether the patient has a custodian calling the shots, and finally, what is the medical reason to perform an intervention, and whether that intervention has overall positive effect on the patient´s quality of life.

    To be frank, there are plenty of situations where death through dehydration is improvement on the quality of patient´s life. Is the decision ever easy? No, especially if the patient is not in position do do the decision.

    In your grandma´s case, if she refuses to drink herself, and oral hydration is difficult even with standard level of aid, the only other option is forced intake through a tube or intravenous saline. The latter two are quite intrusive and may not be possible without sedation if the patient is disoriented and irrational. Again, heavy interventions which may transiently improve the situation but the overall effect is negative for the patient.

    From your description, your grandma would need either extremely skilled or otherwise dedicated staff to sweet-talk her to drink enough to maintain her current physical health. In the end, that is incredibly expensive level of care. Is she in the right type of unit for the care to begin with? There are senior houses (senioritalo), assisted living (palvelutalo) and care home (hoivakoti). The latter is basically a hospital ward with some aspects of assisted living. It sounds like your grandmother is not in an environment that can provide the level of care she may need.

    What you can do is to verify the medical aspects from the treating doctor and nurse. Make sure that the will of the patient and caretaker is known. Make sure that the nursing staff and the treating doctor is aware of the situation and that the current place does not give the level of care the patient wants. Mind, even at hospital, there´s three shifts a day, weekend shifts ect. so a gap in the communications may be a cause.

    I feel you. I have elderly relative in poor physiological (but great mental) condition in the hospital and she has had issues with swallowing, ergo she´s been nigh-terminally dehydrated a few times even at the hospital. She wishes to be hydrated, so no problem with occasional morning IV.

  4. I don’t think adults can be forced to do anything unfortunately. She cannot be forcibly made to drink.

  5. Disclaimer: I’m not a medical professional.

    This sounds like a horrible situation for all parties involved. Has she been officially placed in palliative care? If she still accepts certain foods or drinks, then logically those are the ones she should be offered. The situation becomes difficult if the patient refuses food and drink altogether, as it’s challenging to evaluate whether it is okay to force the patient to be administered nutrients. The last doctor you mentioned was referring to the fact that a person who is actively dying should not be given fluids or food against their will, as that does prolong the process and make them feel much worse.

    You said she’s currently in Jorvi, do you mean she’s hospitalised, in a private housing service or something else? Above all else, I’d ask the doctor to explain thoroughly what the situation is and what options you may have.

    EDIT: I read some of your previous replies and this sounds like an issue with the ryhmäkoti, as well. If you know what company owns the establishment, you need to contact the people in charge of that particular unit. Calling them directly would be the best way to do this, since emails could be buried under others. If teaching the staff how to get her to drink fixes things somewhat, then they absolutely should take time to do just that.

  7. Based on you posting here in English rather than in Finnish on r/suomi, I have a question:

    Does your grandmother (and your mother, actually) communicate in Finnish? You seem to expect the nurses to “sweet talk” your grandma into drinking (which depending on the exact situation and your exact expectations can raise questions as to how ethical that would be), so I am wondering if they would even be able to do that and whether they have a common language they can communicate in sufficiently well in.

  8. I don’t want to be rude or unemphatic as I see you have lots of worries. But nurses and doctors there have seen a lot of elderly people who doesn’t want to drink and know that it is often more a symptom than the cause. People close to death stop drinking and there is sadly not much that caring facilities can do to it.

  11. I just noticed that she is in palvelukoti Hopeakuu. I am quite certain that is not the place for her. That care facility is for elderly people who can still mostly manage themselves. You should apply for tehostettu palveluasuminen. That is meant for people like your grandmother since she clearly needs active care. Palvelukoti is not a service that should cover things that your grandmother needs

  12. I’m sorry to hear about your grandmother’s situation. So what I’m gathering is that she’s 78, has had multiple strokes, is left with some cognitive dysfunctions (being ‘childlike’) and some lessening of function in one side of her body? Also possibly dementia as well? Based on all that info, especially the strokes, she might have some other health conditions as well, are those taken care of?

    So from what I’m gathering here it sounds like her condition seems different to you, her family – which makes sense bc she’s your beloved family member – and the medical staff in these different faculties. It might not be a coincidence that multiple nurses in multiple locations say she is difficult to treat and help, that is very common with patients with (severe) dementia. Her doctor, or at least *a* doctor, seems to also think that she is approaching end of life and to keep treating her symptoms over and over might be causing her more suffering than benefit for her quality of life.

    It’s hard to tell from just a post what the reality of the situation is. It might be that she’s still able to live a comfortable life for some time and that she’s being mistreated by different medical staff. Or maybe she is truly sicker than it seems and it’s time to look at how to give her the best end of life treatment as she can get. It’s a difficult thing to face and to think about when it comes to your loved ones and I wish you and your family strength. I would recommend your mother to bring her to see a doctor to discuss how to care for her best and if it’s time to look at palliative care options. A general practitioner (yleislääkäri) or a geriatric doctor would be a good choice for this. They could also possibly help direct you to a care home facility that can best give her the care she needs, as she might need more advanced care than the place she is currently staying in can provide for her.

    Edited to add: I read thru your mother’s texts. What it says there is that her labs and electrolytes are OK so she is not severely dehydrated to the point where she would require any emergent treatment. It says she is dehydrated without other symptoms, she is not drinking much bc she has a lowered sense of thirst and hunger due to aging and with her other illnesses. Iv-hydration can cause temporary help but won’t help with the underlying reason (also it might do more harm than good as putting in a cannula hurts and your grandmother might not understand why one is put into her arm). There is no need for more treatment at the hospital as there’s no medical emergency present, she simply has her other ongoing illnesses and the dehydration is not life threatening. The ER doctor says that the dehydration is a symptom of her progressing dementia and frailty, and normal with the natural progression of one’s end of life. Your mother disagrees with the doctor but the doctor is right – refusing to eat and drink is a symptom of progressing memory issues. Also on that note, her not eating and drinking is not a risk factor for her getting another stroke.

    The texts reinforce my opinion that your mother should speak with a doctor about your grandmother’s condition, she needs to learn more about what is and what isn’t a part of her aging and dementia and where to go from here so your grandmother can live as comfortably as she can. Also it does sound like her current care home is not a good fit for her if the nurses are not even up to date on her having weakness on her right side.

    All the best to you!

  13. Euthanasia is illegal. Hippocrates oath mandates doctors to keep people alive. Maybe this is a case for iltalehti or iltasanomat

  15. I’m sorry to hear about your grandmother’s situation. It sounds like a very difficult and challenging situation for your family.

    One possible solution could be to look into hiring a private nurse or caregiver (Very expensive) who could specifically focus on ensuring that your grandmother is hydrated and well-fed. This could potentially take some of the burden off of your mother and ensure that your grandmother’s needs are being met.

    Another option would be to speak with the staff at the current elderly care home to make sure they understand the seriousness of your grandmother’s condition and the importance of keeping her hydrated. It may also be helpful to have a conversation with the doctor who previously said that giving your grandmother serum would be unnecessarily extending her life, to try to better understand their reasoning and to see if there are any other treatment options that could be explored.

    It’s important to keep advocating for your grandmother’s well-being and to make sure that her needs are being taken seriously by the medical professionals involved in her care. It may also be helpful to reach out to support groups or organizations that specialize in caring for elderly individuals to see if they have any advice or resources to offer.

  17. Sorry about the situation but this might be the best time to sit down with the nurses and doctors. This really isn’t a place for people here to know the situation or be able to assess it.

    Emotions run extremely high in these times, been there before and everyone is looking for someone to blame.

  18. Based on the evidence you have presented you should discuss this with the workers at care home. They should make sure she drinks enough and that’s it.

    People get old and weaker and this is sadly normal. Eventually when people get old and/or sick enough they stop eating and drinking enough.

  19. Finnish nurse here…

    I just want to say its incredibly difficult to judge the whole situation based on a few texts and part of the screenshot of doctors texts, i cant see any labs, any blood pressure etc etc

    From what i can see your grandmother has had several strokes and probably has ischemic dementia and depending on what part of the brain lost oxygen during the strokes she has lost some bodily function and some cognitive function. The childishness and aggression is very typical of dementia, as is forgotting what age you are and so on.

    Patients in this stage of dementia can be extremely difficult to work with, and as others have said before you cant really force anyone to eat or drink. We have a rule that we do basic hygiene at best if the patient refuses, such as changing a dirty incontinence protector.

    Putting her on fluids may cause more harm than help. Fluids will only keep ker blood pressure up and its an invasive proceedure to put in an IV catheter. It needs to be checked daily and changed every 5 days or she risks phlebitis or septis. You dont “just” put a cather in someone. Pumping her full of fluids also might lead to electrolyte inbalances and cause more heart issues than she already has had.

    Her fluid chart looks fine, she is drinking something at least, and the mehukeitto is better than water. Elderly people dont need to drink as much as younger people. “Drying out” tends to happen in the summer when they sweat.

    It really does sound like doing any more medical proceedures will do more harm than good to her and I think you need to reassess your expectations. Its hard to say how much time someone has left until the very end, but she may have a good few years in her still, but walking around and picking people up from school doesnt seem realistic. Ive seen this before and as much as this phase of life is natural, so is strong denial in the family to these changes.

    Will also say that if you feel she really has been mistreated then you have every right to make an application to the potilas asiamies (patient’s ombudsman) who will investigate the case and make a neutral assessment.

  20. One aspect: you are dealing with organizations and institutions that have a hierarchy. It means they have line organisation. You can always ask to speak the person in charge. This is normal. let’s say head nurse or head doctor of the department. These people understand their positions and that sometimes there can be challenges in interaction between the doctors and nurses who actually do the work.

    My mom passed away last summer. When she was in bad condition in the hospital, we had talked with individual nurses and doctors who had not shared the big picture with us. The situation was inevitable how it was going to be and it was VERY hard to understand it and be sure because obviously you Ultimately we were explained what the situation is, by a head nurse who was really good at communicating, compassionate and heard out our questions and answered them.

    You need to find that type of person. Head nurse or head doctor / doctor in charge of the department. Tell them that you have problem of understanding what is going on, what can happen and what are the issues here.

    What you need is to book time to talk with someone in charge and ask them to run through the options for you. (If you don’t get that from the people you have met so far).

    Prepare good questions that increase your understanding of your grandma’s situation and on how the hospital works and medicine works. Ask those stupid questions. AND also don’t be afraid to ask the difficutl questions also.

    Also, validate your concerns. Ie. say you are concerned about this regarding your grandma. what does it mean?

    Also, have the discussion with them so that there are other people there too, so they hear the answers and you don’t have to repeat them to everyone important.

    Finally, if you or someone from your family is feeling very overwhelmed by the situation, tell to the department staff that this is too much for you, can they connect with you someone who can help them in the hospital. Hospital has those kinds of systems in place.

    I seriously hope that you get it figured out, the support you need and your grandma’s wellbeing turns for better!

  21. I’m very sorry OP, this sounds like a tough situation for your grandmother and entire family.

    There are so many comments here, I can’t read through them all. But I want to leave a few suggestions and hope they haven’t yet been made.

    I would try to get one or multiple volunteers to support your mother with your grandmother’s care. There are volunteers who spend time with elderly. I think the red cross is helping to connect volunteers. Or if your grandmother is a member of the church you could also look there for support. All the volunteers would need to do is take over some of the visits, talk with your grandmother, engage and help her get hydrated.

    If volunteers are not an option you could reach out to nursing schools or programs and ask if someone students are looking for a small side job and you could pay someone to help with the care.

    It’s sad that the system can’t seem to give your grandmother the support she needs. It seems unfortunately many people and places are overworked and at capacity. But I’m glad that she has her family looking out for her. Best of luck for you and your family, OP!

  22. I feel like your grandma isn’t drinking as she knows her time has come and usually when the life cycle ends people stop eating and drinking as they know they are dying , you might be emotional and dementia is it’s own issue as well but maybe putting her to rest would be better than prolonging her suffering for a year or two just becuz you are not ready to let her go

  23. Not qualified to answer just posting to wish you good luck and much strength with this tough situation!

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