[TillyTake2]

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.

[Mousky]

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

[TillyTake2]

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?!!

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

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

[snuffles]

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.

[TillyTake2]

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.

[porkchop's mama]

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.

[porkchop's mama]

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.

[TillyTake2]

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.

[Mousky]

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 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

[snuffles]

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