Ideas on how to help my mother lose weight?

Sea Jay

Hello,

My mother has mild/moderate dementia with etiology of Alzheimer's (Dr.'s words). She lives in a senior community, still in Independent Living. She is overweight and has multiple health issues that could be alleviated to a degree if she lost weight (arthritis in the knees making walking painful, bladder issues, hiatal hernia resulting in almost constant belching, difficulty swallowing and sometimes regurgitation). Knee replacement surgery or surgery to fix the hernia both seem like awful ideas given her dementia-I feel like recovery, physical therapy, all of that would thrust her into a rapid decline in a cognition and she'd be miserable, not to mention the significant impact on my life (I see her almost daily).

I can't get her to the exercise classes offered and for awhile I was making her breakfasts and lunches and taking them over, in an effort to get her to eat a little healthier and maybe lose some weight, but that wasn't sustainable.

Has anyone been in a similar situation who can offer any effective strategies/solutions?

Thank you,

Sea

M1

Hi Sea. that's a tough one. This may be a situation of picking your battles. In an ideal world yes, you would try to control her calories--but truly it may not be worth the effort it would take to do the monitoring. Arthritic knees hurt no matter the amount of weight put on them--but a knee replacement is a huge operation, even for someone without dementia. And the day may soon come when you'll be glad for any calories you can get in her.

I'm curious as to how old your mother is? I don't mean this flippantly--but when I was in primary care practice and had patients who came in after their 80th birthdays, I would teasingly tell them that they could now do what they darn well pleased--and of course, they loved to hear that. I mean, when you've made it to 80, what the heck? What are you going to do, live longer? That would always make them laugh and feel good (and that was the point of course). This may apply to your mom. That horse may be out of the barn, and I don't know how hard I would fight it. Unless you're ready to move her to a higher level of care and she was restricted from having food in her room....

Sea Jay

Thanks so much for your response, and you're right about picking my battles-I learn that lesson daily! Which is also why I stopped making her meals and suggesting food choices. I noticed we both relaxed and enjoyed more when I was able to let that go. It's hard to watch her go through all of this when she's fortunately been relatively healthy and issue free throughout her life and it seems as the cognitive decline increased, so did her issues. She intentionally refrains from hydrating because she has bladder issues and has accidents when not at home, she belches almost constantly and now walking is becoming a challenge. My biggest concern at this point is the hernia and the regurgitation/choking potential. Mom is 78. It's tricky because she's not yet quite ready for a higher level of care and I don't love where she lives now, so when it's time for her to move into assisted living and rely on this place more, the thought is unsettling.

I really appreciate your thoughtful feedback.

M1

Welcome to the forum btw, you've come to a good place.

harshedbuzz

@Sea Jay

Hi and welcome.

That's a tough one. If her knees have gotten to a point where they're candidates for replacement, she probably isn't going to be easily goaded into moving around. Have you tried other interventions like cortisone or Synvisc? Could PT now help? The knees, combined with the tendency of PWD to crave sweets, forget they've already eaten and their limited ability to enjoy other pastimes is going to be hard to get to a healthier weight.

I wonder if she'd be better served in a MC now. There would presumably be more activities that might engage her rather than eating in her own apartment. While her calories wouldn't be restricted in MC, she wouldn't be as able to graze as she is now.

HB

Sea Jay

Hi there, HB.

Thanks so much for responding. She gets both cortisone shots and Synvisc, though unfortunately, she fell into the 50% of patients for whom it wasn't effective.

I've ruled out PT with her doctor mainly because she won't remember to do it on her own.

She's not ready for MC yet as that's a locked facility and she's still functioning on a higher level in enough ways. I am looking into AL as a bridge, but I have concerns about the place she lives now and their ineptitude in general, so I'm really not wanting her to go to AL or MC there, but there aren't too many affordable alternatives in the area and I'm not sure they'd be any better.

Thank you for your thoughtful questions and suggestions.

harshedbuzz

@Sea Jay

I'm sorry she doesn't get any benefit from injections; I didn't either for my right knee which was bone-on-bone in 2 compartments. My left knee isn't as bad and hasn't responded well to injections but PT has helped it considerably.

Since you're there daily, any chance you could do the PT with her? I know this is a big ask. My own mom, who doesn't have dementia, is doing out patient PT currently and there is some balance work she can't safely do unless I am with her which means I drive her to PT twice a week and then work with her 3-4 times weekly at home.

FWIW, when my younger aunt (YA) obtained guardianship of my older (OA) one because of vascular dementia, she arranged TKR. OA's knee was swollen to twice the normal size and interfered even with sleep. The surgery went well but OA had a stroke in recovery and never walked on her new knee. This was not the outcome we'd hoped for, but the pain was relieved even without the usual post-op PT.

TKR is not for sissies and I am not one who would normally sign a PWD up for surgery. If she's truly in a stage early enough that she is OK in an independent living setting, she could have 10 or more years to be living with debilitating pain. My aunt had her TKR in 2008; she died in 2018.

HB

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