My mother is 92 years old and is in the final stage of kidney failure. She has difficulty moving and spends most of her time sitting on the couch watching TV. A year ago, she was released from the hospital with a poor prognosis, given only one to four weeks to live. I brought her to my home and put her on a no-sodium diet. Now, she is stable. Recently, she has expressed that she is tired of living this way—being dependent on me and eating a bland diet. She mentioned that she would prefer to eat what she enjoys (which is high in sodium) and pass away sooner rather than continue her current lifestyle. Should I continue to enforce her bland diet, or should I respect her wishes?
She deserves that much.
I would do 2 things in your case.
1. Get Hospice in to help you. Honestly she would have qualified a year ago if not longer ago. Hospice will provide you with all the supplies and equipment that you need. They will offer support for both you and mom. (and any other family members)
2. Modify mom's diet so that she can enjoy some of the things that she may not have been having for the past year.
My mom and I didn’t see any point in trying to force him to eat better just to live longer with all those conditions — nor did his hospice nurse. We offered him a lot of options. We were already in conflict with him about other things for basic safety reasons and did not want to add more conflict.
Has she spoken to her nephrologist or primary about her plan? Has she had an opportunity to be treated for depression?
She will probably not have much of an appetite for anything very soon. Hard to measure quality for another.
We are all different. Aspirationally I would rather eat a bland diet than have to deal with the symptoms until the need came naturally as more decline occurred. Since she was in the hospital with it perhaps you could ask her doctors if they would anticipate similar levels of discomfort as she has experienced before? Hopefully symptoms would be mitigated with morphine and oxygen from hospice. It sounds like a big decision but she may not be as stable as you think.
In Atul Gawande’s book, “Being Mortal: Medicine and What matters in the End” he gives guidance on questions to ask a person to help sort out what is important to them. You might find it helpful.
You should respect your mom's wishes and get her the food she wants to eat. You might also get her to drink a lot of water after she eats something high sodium. Anyone 92 has earned the right to at least eat what they want.
But, at this point (declining health), I’m just happy if he will eat period. Anything goes. Daily milkshakes (I do sneak in high protein ensure), and whatever else will entice him to eat. As long as you have had the conversation with your mom about dialysis and how much you personally are willing to support her if that is something she would want to do, then maybe consider taking a step back and allow her to choose what to eat and not eat? (Of course, if after doing so she would want you to do dialysis for her, which I understand can be grueling, then it is no longer just her quality of life in question—but yours. If it were me, then I would be more reticent about overindulging in sodium.)
There are many types of delicious foods and snacks that are no or low sodium and healthy. There is a whole world of flavors and seasonings without salt.
If she wants the bad diet loaded with salt that will make her sicker, let her have it. Make sure she knows that it may not result in her passing a few months faster in your home though. It may result in worse illness and placement in a LTC facility.