Do I stop taking Dad out to eat??

Q:Hello Dutchy,

Thanks for all your informative posts!

My father has AD and has been in a nursing home here in Texas since March 1. My brothers and I have been visiting weekly and taking him out. I take him for a drive each Saturday and out for lunch. My brother takes him to a Wednesday evening church service and dinner. Sometimes we take him to our home on Sunday.

The nursing home says he has lost 10 pounds and they would believe we should not take him out for a few weeks. The nurse feels that the cause for the weight loss is that he is not eating the meals they provide, and spends time waiting for a family member to come and take him out.

I'm a little concerned because my father does seem to enjoy these little outings and expects them. I hate to withhold the one activity he really enjoys. Also, as I understand it, weight loss is to be expected in this case?

The question: Is this a reasonable request from the home?

Fredda Holmes, daughter

A: What a great question!

First of all I would like to say that you and your brother are to be commended for taking your father on so many outings! It is obvious that he enjoys the outings!

A request from a nursing home to stop taking him out, shows a great lack in troubleshooting on their part. While it is true that your father may look forward to your outings and tend to wait for outings to eat a good meal, I would suggest that there are many other factors that may be contributing to his weight loss.

These questions are a good place to start with.

1. Does your father have food preferences that the nursing home has considered?

2. Does your father like the food in the nursing home?

3. Would it be helpful if your father were to have snacks that were much more to his liking? i.e. pudding, crackers or fruit?

4. Is your father served his meals alone in the nursing home? Or is he served with company that he enjoys?

5. Has the nursing home considered supplementing his diet with Ensure or boost to help him maintain his weight?

6. Has the nursing home tried circling the dates on a calendar indicating the dates that you will be picking your father up for dinner?

7. Has the nursing home considered that his weight loss may be attributed to an adjustment period from the move? Meaning his weight loss may stabilize after a while?

The weight loss is not your problem and the nursing home should be looking for other ways to remedy his weight loss.

As you suggested weight loss is very typical in those with Alzheimer's and Dementia. While we strive to maintain our loved ones weight by increasing their calories and getting as much nutrition in them as we possibly can, combating the weight loss is very difficult. Our job as caregivers is simply to do the best we can to help them eat!

Let me know if I can help you further~ Dutchy

Dehydration in the elderly

A timely article for those who are trying to beat the heat!

Dehydration in the Elderly
Dehydration in Elderly Nursing Home Residents

Dehydration in the elderly nursing home residents occurs when a person does not have the necessary fluid content in their body to perform normal and crucial bodily functions. Most body systems and organs are drastically affected by water deprivation. Dehydration can be especially harmful in the elderly, causing harm faster than starvation. A 10 percent loss of body fluids is serious. A 20 percent loss can result in death due to dehydration
Elderly More Prone to Dehydration

1. Elderly people have 60 percent water content in their bodies, as opposed to 70 percent for younger adults. As the elderly lose their lean body mass (muscle mass), the water levels in their bodies decrease, making them more prone to dehydration.

2. The elderly also have a lowered thirst response. This condition combined with other possible effects of aging, including physical dependence on others, such as nursing home staff, often results in failure to maintain a safe level of hydration.

3. As a nursing home resident gets older, their kidneys do not concentrate urine as well as they used to. With aging, our kidneys allow glucose and sodium to escape along with the necessary fluids to stay healthy, causing increased chances of dehydration.

4. Those who suffer from congestive heart failure or high blood pressure may be taking a diuretic. Diuretics affect the body's fluid balance by eliminating excess fluids. It is very important to maintain proper fluid levels for elderly nursing home residents who are taking diuretics.

5. Swallowing difficulties and generally poor food intake - common problems among the elderly - also add to dehydration problems. Remember that many foods contain fluids needed to prevent dehydration.

6. Warm environments or slight increases in body temperature create a need for up to 10 percent more fluids. When it starts to get hotter outside, make sure to increase fluid intake of elderly nursing home residents.

7. Many elderly people go to bed very soon after eating dinner or their last meal of the day. This often creates too long a time frame between fluid intake. Elderly people should be encouraged to drink plenty of fluids before bedtime to prevent dehydration. When possible, elderly nursing home residents should have a glass of water available if they wake up thirsty during the night.

8. Elderly nursing home residents dealing with incontinence may resist drinking fluids before outings and bedtime to avoid accidents due to incontinence. The effects of incontinence and the lack of fluid intake can cause dehydration. [See urinary incontinence.]

9. Elderly nursing home residents who suffer from constipation often use laxatives on a regular basis. Laxative use causes a loss of needed fluids, causing dehydration, and should be compensated for by increasing fluid intake.
Guidelines for Preventing Dehydration in the Elderly

Preventing dehydration is easy if you follow the following guidelines.

* Make sure an elderly nursing home resident drinks at least 6 cups of fluid each day.
* If an elderly nursing home resident has diarrhea, vomiting, bleeding, edema, infections, bedsores, increased activity levels, fever, increased exposure to warm environments, or is taking diuretics, he or she needs to increase their intake of fluids to prevent dehydration. Important Note: This does not apply to people with heart and renal conditions who are on a doctor ordered "fluid restriction." In this case, consult with the doctor for detailed fluid instructions.

Increase Fluid Intake in the Elderly

1. To increase fluid intake in the elderly, use larger, but easy-to-handle cups and glasses. Consult with an occupational therapist to fit the drinking device to the grip of the person who is trying to increase their fluid intake.

2. Add fruit ices, fruit juices, popsicles, and gelatin desserts to the diet of elderly nursing home residents. These provide important fluids, and help increase overall fluid intake.

3. Establish schedules for increasing fluid intake. Gradually build up to the safe and effective levels of daily fluid intake.

The source for this article

Nursing home lawyer Jeffrey H. Rasansky is committed to improving the health and well being of nursing home residents. While dehydration is common in elderly nursing home residents, dehydration can be caused by lack of care, neglect, or negligence of nursing home staff. If you feel a loved one has suffered from dehydration due to the neglect or negligence of their nursing home staff, contact an experienced nursing home lawyer at the Law Offices of Jeff Rasansky. We can help.

Elderly People Living In Filth

Here is a great post from My Care Link.net.

It is hard to see our parents living in filthy conditions. Forum member nduke has a few wonderful suggestions for helping parents who live in less than desireable conditions out, while helping them maintain their pride and dignity.



My stepmother won't let anyone clean her house either. A year and a half ago my dad's insurance program kicked in and I saw all the opportunities to use the benefits to get their house clean and get a part time caregiver to help me... you know... a dream. I started with a caregiver and sold her as a "housekeeper" because I knew that neither believed that they needed a watchful eye over them. Well, that lasted about three weeks of two days a week.

I sat them both down and told them that we WERE going to get them a housekeeping service and that it was "free" to them. Dad was OK with it... he's an old fashioned "male chauvinist pig" :wink: My step-mom wasn't. She flipped out at the THOUGHT of someone coming to clean her house. They would be doing HER job and then she would have nothing. I explained (at the time they were both a lot more "aware") that I was going to get a cleaning service and if I had to take her for a drive every week when they came I would do that, but she had to accept that others could do the deep cleaning and she could keep the house during the week. She was almost literally frothing at the mouth.

I thought about it and decided to take a different tack. I checked around for services and found one that could clean the whole house in an hour and a half *max* and usually an hour or less with more people. (They now clean the house in half an hour with 4 people and do a GREAT job!) I asked if they could work with me on time and told them I had a set time slot when my step-mom had her hair done weekly. I talked to the beauty shop and explained that I needed her time to be very consistent and why, and they have been wonderful about it since. If the hair has to reschedule for a different time, I either cancel the housekeeping or shift it when possible, but I get a weeks notice from either now.

I then told my step-mom and dad that I had found a service that was going to come in for a day and do all the deep cleaning and that would give my step-mom a "fresh start" with the house. She balked, but I set up an activity (shopping) the day they came and kept them most of the day while the initial "top to bottom" cleaning was done. After that, we started the once a week cleaning and it was OK... but sometimes when my step-mom came home she would see things "out of place". It finally dawned on me that I had to tell the cleaning service that even though it was against their nature to leave clutter, they had to put everything back exactly where it was and leave a little clutter. Over the past year we have successfully removed most of the pointless clutter with a little more going away every week.

It's tough with the time issue but I can, if need be, pick my step-mom up at the beauty shop and run some errands before we get home... or even just stop for gas. :) My dad is reminded often that the people who come to clean are a secret from his wife and he hasn't spilled the beans except for a few times. She gets upset for a very short while and (thank you for the occasional Alzheimer's blessing) forgets as soon as you get her on a new topic. Despite the work to get it all coordinated and established, it's been working now for a year. My parents have the only "self cleaning" house in the area and my step-mom is content to "clean house" by rearranging her nik naks just as she was doing before this all happened.

Oh... and I might add... my dad is totally incontinent and the house stays so clean now that you rarely ever get a whiff of urine. Neither has much of a sense of smell so the cleaner/disinfectant smell has never been an issue. :)

Thank you for your helpful advice~ Dutchy