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EXTREMELY low weight elderly (23kg)...


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#1 TillyTake2

Posted 23 December 2012 - 01:47 PM

A relative of mine is very elderly (mid 90s) & has been petite all her life. She has recently gone into hospital for dehydration & it turns out she weighs only 23kg!! I calculated her bmi & it would be around 9-10.

She can walk (with a walker) & apparently all her tests show that medically she is completely fine (apart from bloodworm showing signs of malnutrition).

There is a whole heap of background that I won't go into but I'm wondering how this is even possible?! How long can your body really live at that weight? I can't see her gaining any significant weight any time soon (she's been in hospital for 2 weeks and has not gained any weight). There is no medical reason for the weight loss, she is just fussy & would prefer not to eat than to eat something she doesn't want.

#2 Mousky

Posted 23 December 2012 - 02:05 PM

Sounds like my 91 yo grandma, she has mostly lost her sense of taste, so barely eats anything.

#3 TillyTake2

Posted 23 December 2012 - 02:07 PM

Any medical type people able to offer insight? Is this a long term sustainable thing? The nurses in the hospital seemed shocked. We are trying to work out what we should do in terms of planning. Obviously plans for her will be different if it's likely a matter of weeks or months vs potentially years. The thing that gets me is that they say medically she is "fine". How can you possibly be medically fine at 23kg?!!

QUOTE (Mousky @ 23/12/2012, 03:05 PM) <{POST_SNAPBACK}>
Sounds like my 91 yo grandma, she has mostly lost her sense of taste, so barely eats anything.



I'm sorry to hear that sad.gif Is she in a nursing home or at home?

#4 snuffles

Posted 23 December 2012 - 02:08 PM

Not much you can do then I guess??

My Grandma lost a lot of weight before she died, she had Alzheimers and just stopped eating eventually.  All I can suggest is that you do what you can to make her last days/weeks as happy as possible.

sad.gif

#5 TillyTake2

Posted 23 December 2012 - 02:10 PM

I should add that mentally she is totally with it & has been living (alone) at home up until I made her go to hospital a fortnight ago. She is still of the impression she will be going home. Unfortunately the wait list for in home help is huge & she's not even had an ACAT assessment yet.

#6 porkchop's mama

Posted 23 December 2012 - 02:24 PM

As scary as those numbers sound, it's reassuring that your relative is still able to mobilise.  Without prying, does she have a history of depression or low mood that may be causing her to lose interest in food?  Her treating time are probably looking into whether her medications could be causing her to lose her appetite.  Does she have swallowing issues or poorly fitting dentures that make eating difficult or painful?

It can be difficult for people to put weight on even in hospital because the nutritional supplements prescribed are not to everyone's taste.

Without knowing the investigations performed, their results and what other illnesses your relative may have, it's difficult to prognosticate but as I mentioned earlier, if she is mobilizing and cognitively well, she doesn't sound in danger of deteriorating rapidly.

How long has your relative been at this weight?  Obviously a gradual decline would have different causes to a more rapid one.

With regard to the ACAT assessment, this would usually be done when medical and allied health teams are satisfied that she has reached her best functional capacity.  The actual assessment takes a few hours and once you have the paperwork and know what level of care she may require then it takes a while to organise service packages or placement depending on what your relative wants.  She sounds like she does have capacity to make this decision.

If there are concerns about discharge planning from the hospital's perseptive, a family meeting can be arranged where relatives can meet with the patient and the treating team (medical, OT, PT, nursing and social work) so that everyone's side of the story can be heard.

Hope this helps and isn't too vague.


#7 porkchop's mama

Posted 23 December 2012 - 02:26 PM

Forgot to mention, for some patients, ongoing rehabilitation in a dedicated unit (as opposed to the medical wards of acute hospitals) may be suggested to give them more time to reach their best function and avoid nursing home / high level care.  This would be suggested if the allied health team identify rehab goals for your relative that would be amenable to therapy.

#8 TillyTake2

Posted 23 December 2012 - 02:30 PM

She's been moved from a acute care unit to a rehab hospital but they can't give any indication on the plan.

She doesn't have a history of depression but they are trialling some antidepressants. Unfortunately she's not very compliant with medication & will just throw it away (& even though the nurses say they will supervise they don't).

She apparently has a history of abusing laxatives (although we only found this out recenty).

She has lost probably 10kg in the last few months & 10-15kg in the few years before that.

#9 Mousky

Posted 23 December 2012 - 02:36 PM

QUOTE (TillyTake2 @ 23/12/2012, 03:07 PM) <{POST_SNAPBACK}>
Any medical type people able to offer insight? Is this a long term sustainable thing? The nurses in the hospital seemed shocked. We are trying to work out what we should do in terms of planning. Obviously plans for her will be different if it's likely a matter of weeks or months vs potentially years. The thing that gets me is that they say medically she is "fine". How can you possibly be medically fine at 23kg?!!




I'm sorry to hear that sad.gif Is she in a nursing home or at home?


She is currently in hospital as she had knee surgery but otherwise she is at home by herself.  I work in very high care disability and when someone is under weight, there are things like Ensure puddings and drinks that you can order from the chemist. Aparently they are quite nice, but nan wont have them.  Other than the knee, she is quite well, very with it, so hopefully will be like the durocell bunny original.gif


#10 snuffles

Posted 23 December 2012 - 03:13 PM

It does sound much more hopeful than I thought.  Hope she keeps on!!!  original.gif


#11 Froger

Posted 23 December 2012 - 03:20 PM

I know an elderly person like this (a relative on my ex's side). She has been seriously underweight for a good two decades now. She seems to exist on cups of tea and takes great delight in cantankerously refusing all the lovingly prepared food that her close relatives, friends and neighbours make for her. She is in her mid 90s now, and continues to be in reasonably good health (although she did break her leg once) despite seemingly existing on pretty much nothing.



#12 skylark

Posted 23 December 2012 - 03:26 PM

My grandmother was a chainsmoking alcoholic and anorexic and managed to live into her mid-90s at a weight in that range. She was a couple of inches under 5 feet tall to start with, and like a tiny shrivelled skeleton. She was very proud of how thin she was. She was active and lived at home alone right until the last 6 weeks of her life.

I have no idea how any of that is even possible, it defies all kinds of logic. She used to cackle and say "My hate keeps me alive." She was an awful person.

#13 Dylan's Mummy

Posted 23 December 2012 - 03:37 PM

Regarding the puddings that a PP mentioned. When my Dad was in hospital recently, we found that he had lost a lot of weight and lost more during his hospital stay. He had these pudding/custard type meals in hospital and ended up putting on a bit of weight. He doesn't really eat much due to having cancer, being very tired and also because the type of can we makes it almost impossible to eat solid food. He liked eating the puddings and they helped him gain some weight. He wouldn't eat the other puréed they made for him (meat, veges).

The puddings are expensive so Mum researched on the internet and managed to order the same ones a lot cheaper from overseas, so have a look I to that.

#14 TillyTake2

Posted 23 December 2012 - 03:45 PM

QUOTE (skylark @ 23/12/2012, 04:26 PM) <{POST_SNAPBACK}>
My grandmother was a chainsmoking alcoholic and anorexic and managed to live into her mid-90s at a weight in that range. She was a couple of inches under 5 feet tall to start with, and like a tiny shrivelled skeleton. She was very proud of how thin she was. She was active and lived at home alone right until the last 6 weeks of her life.

I have no idea how any of that is even possible, it defies all kinds of logic. She used to cackle and say "My hate keeps me alive." She was an awful person.


Lol. I had to laugh as my grandmother is also a horrible person (as awful as that is to say). I have joked with my husband that evil preserves you.

#15 TillyTake2

Posted 23 December 2012 - 03:48 PM

We have tried the puddings (& the 2 cal drink) but she refuses.

She insists the food is disgusting (it's not, she's in a lovely private hospital & I've personally sampled some of her food). She also has complaints about the "foreign" staff etc but we won't go there. All in all she's not particularly popular on the ward!

#16 #YKG

Posted 23 December 2012 - 04:06 PM

Keep in mind that as you get older your appetite does de tease significently. While you may be starving after 2 crackers and a cup of tea many older people in their 90's will find it filling. TBH with many over 90 year olds I have experience with eat very little, weigh very little but are active and medically ok. Your body as you get older appetite does decrease and weightloss in older people is common.

Have a chat to her Dr they will be in a better position to explain the good,bad or indifferent to her current needs.

#17 TillyTake2

Posted 23 December 2012 - 04:48 PM

Yeah tube feeding etc has been ruled out & at the end of the day it is her choice to eat or not. At this point our biggest fear is that she will be sent home without the support in place (as the waiting lists are too long) as they believe she should go into a nursing home which she refuses.

If they send her home then we will be forced to go morning and night to help her (or leave her to die on her own which obviously we can't do). She lives an hour from us & has only 2 living relatives (myself & my dad). Well technically my brother too but she alienated him many years ago.

It sounds horrible but at this point I think the best thing is for her to just peacefully go off to sleep & not wake up but the fact she seems to be "healthy" & surviving at such an insane weight makes me think this is pretty unlikely.

The fact she has refused any help in the past puts us in a really hard position as she's not had any of the assessments or gone on any of the waiting lists for help.

#18 Guest_LeChatNinjah_*

Posted 23 December 2012 - 05:00 PM

If she's not interested then it's going to be really hard, but if she could force them down those Ensure and Sustagen drinks really help my mum, who battles with being underweight as well.

Good luck, it must be so difficult for family  sad.gif


#19 TillyTake2

Posted 23 December 2012 - 05:18 PM

Yeah we've tried making everything from puddings to biscuits to pies to lemon tarts, quiches etc. She will take a couple of bites & toss it or say that it lacks salt/pepper/herbs, has too much salt/pepper/herbs etc!!

Apparantly she also takes laxitives so basically even of she does eat something it just comes out. They (drs) think she's probably been doing it a long time.

I don't think she's trying to die (she's still very concerned about her clothes/makeup/appearance & makes sure we are caring for her huge gardens and pool!) so she doesn't seem to have lost the will to live.

It's just so crappy as she's so manipulative & selfish & she will just insist that we have to come every day or leave her to starve sad.gif

Is there any emergency way of getting care at home when you haven't served the 6-12 month waiting list?

#20 Fenrir

Posted 23 December 2012 - 05:24 PM

QUOTE
Keep in mind that as you get older your appetite does de tease significently. While you may be starving after 2 crackers and a cup of tea many older people in their 90's will find it filling. TBH with many over 90 year olds I have experience with eat very little, weigh very little but are active and medically ok. Your body as you get older appetite does decrease and weightloss in older people is common.

This. You also lose taste as you get older and eating becomes a chore rather than a pleasure. My MIL couldn't have weighed more than that when she died either.

The other option to get nutrients into her is Sustagen. The nursing home where  my MIL spent her last days used to supply these and they could have as little or as much as they wanted when they wanted.

Another possibility, as much as it may upset you, is that this is her way of saying she has had enough. There comes a time when life is not what it used to be for our elderly. They have aches and pains and have seen and done all that they wanted. It could be that she is just tired of life and wants to do it in her own way.

I remember how crotchety and stubborn  MIL got towards the end. Food had no taste so she didn't eat nearly enough. The staff were the wrong kind of person. They were mean and horrible to her etc etc. She was put on AD's as well but there was no improvement.

By all means push for ACAT but do not be surprised by what they may say.


#21 TillyTake2

Posted 23 December 2012 - 05:31 PM

She orders the laxatives from the chemist who home delivers. Because she is of sound mind we have no say in anything apparantly sad.gif

I was told there was a 6-12 month wait by the 3 different social workers I've spoken to & they said the only other option is a nursing home which she refuses.

The biggest "problem" is that she is deemed to be of sound mind so she has total control over all decisions.

She has signed an advanced directive (but even this only happened a week ago & she still talks about how that was a mistake). My dad will have power of attorney but that only comes into effect if/when she is incapable of making decisions.

#22 TillyTake2

Posted 23 December 2012 - 05:33 PM

QUOTE (Alpha_Chook @ 23/12/2012, 06:29 PM) <{POST_SNAPBACK}>
My guess is that they have a done a heap of blood tests and they have all come back normal...she is cognitively OK, doesn't have any complaints regarding pain so theres not a lot they can say I guess.


She has plenty of complaints regarding pain lol

She has a bad back & takes panadol & iboprophene.

She reports she is "allergic" to almost every medication under the sun so this makes things difficult.

#23 TillyTake2

Posted 23 December 2012 - 05:37 PM

I guess if we had any idea how long this could go on for we could make decisions like paying for private help etc but the problem is, we can't really do that if this could go on for a year or more.

I can't believe she can continue to live in this state but my gut says she will still be chugging on this time next year so we can't really go paying for private help for years to come.

#24 Peanut

Posted 23 December 2012 - 05:58 PM

QUOTE (Dylan's Mummy @ 23/12/2012, 03:37 PM) <{POST_SNAPBACK}>
Regarding the puddings that a PP mentioned. When my Dad was in hospital recently, we found that he had lost a lot of weight and lost more during his hospital stay. He had these pudding/custard type meals in hospital and ended up putting on a bit of weight. He doesn't really eat much due to having cancer, being very tired and also because the type of can we makes it almost impossible to eat solid food. He liked eating the puddings and they helped him gain some weight. He wouldn't eat the other puréed they made for him (meat, veges).

The puddings are expensive so Mum researched on the internet and managed to order the same ones a lot cheaper from overseas, so have a look I to that.


Gosh, this is pretty much my Dad too.  I'm so glad I stumbled over this thread because I'd never heard of the Ensure Puddings before.  My Dad has put on weight with each hospital stay but loses it almost immediately after returning home despite all the meals my Mum tries to get him to eat.

Can I ask where you were able to order them through?  Would you mind pm'ing me if its not allowed to mention it publicly?

Sorry OP, didn't mean to butt in.

Edited by Peanut, 23 December 2012 - 05:58 PM.


#25 ednaboo

Posted 24 December 2012 - 09:26 AM

QUOTE (TillyTake2 @ 23/12/2012, 03:30 PM) <{POST_SNAPBACK}>
She's been moved from a acute care unit to a rehab hospital but they can't give any indication on the plan.

She doesn't have a history of depression but they are trialling some antidepressants. Unfortunately she's not very compliant with medication & will just throw it away (& even though the nurses say they will supervise they don't).

She apparently has a history of abusing laxatives (although we only found this out recenty).

She has lost probably 10kg in the last few months & 10-15kg in the few years before that.

Is it possible she has had a life long Eating Disorder, which has deteriorated significantly with age?  If so, it will be difficult for her to change now.  Her BMI defes logic.  Most people would be at deaths door by about 11.  Are you sure you calculated it correctly?

The hospital should have access to a dietitian who can prescribe a variety of supplements such as Resource Plus, Ensure Plus, TwoCal etc.  I find Sustagen Hospital tasted the best though.

Peanut: you can buy Ensure Puddings from most pharmacies.

Edited by ednaboo, 24 December 2012 - 09:28 AM.





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