Weight and BMI

[mhw]

For just your basic body to live ie heart lungs kidney brai function with no physical excercise, and to keep your body temperature you need approx 1200 calories per day. Every pound of fat contains the equivalent of 3500 calories so you have to be deficient 350 calories for 10 days to loose 1lb . If your loved one is consuming approx 850 calories a day. This would be the case. However the body will and can go into survival mode and train its self to use fewer calories to survive but obviously not forever and eventually when there is no body fat left the body starts eating muscle. Obviously this includes muscles which are vital to life ie the heart.

 

[Sterlingtimes]

Today, my mother looks remarkably well and is lively, having regard for all of her circumstances, but her weight is now down to 37 kg (5 stone 11 pounds). How much lower could she reach on the BMI scale?

 

[luggy]

Today, my mother looks remarkably well and is lively, having regard for all of her circumstances, but her weight is now down to 37 kg (5 stone 11 pounds). How much lower could she reach on the BMI scale?

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@Sterlingtimes it can go lower I'm afraid. The last time I checked mum's Care Plan, it was recorded as 12.7. Sadly, it seems that this state of low weight can continue for a long time, which is pitiful and awful for us to witness. I get the impression that my mum is unaware of her malnourished state - I hope this is the case.

 

[Alisongs]

Today, my mother looks remarkably well and is lively, having regard for all of her circumstances, but her weight is now down to 37 kg (5 stone 11 pounds). How much lower could she reach on the BMI scale?

View attachment 71354

Are you going by original height or have you accounted for any shrinkage caused by getting older? My mum was 5'1" in her petite prime, only about 4'4" at 103, when we couldn't actually weigh as she couldn't stand unaided. I'm 65 and am getting shorter. But I'm sticking to my mantra of "five feet in thick woolly socks"

 

[Sterlingtimes]

@Sterlingtimes it can go lower I'm afraid. The last time I checked mum's Care Plan, it was recorded as 12.7. Sadly, it seems that this state of low weight can continue for a long time, which is pitiful and awful for us to witness. I get the impression that my mum is unaware of her malnourished state - I hope this is the case.

Thank you, luggy. This is most helpful because my Googling failed. Our mothers must be in similar positions. Similarly, my mother does not appear to be aware of her critical low weight. She has said, "I have lost my boobs: there's nothing left".

 

[Sterlingtimes]

Are you going by original height or have you accounted for any shrinkage caused by getting older? My mum was 5'1" in her petite prime, only about 4'4" at 103, when we couldn't actually weigh as she couldn't stand unaided. I'm 65 and am getting shorter. But I'm sticking to my mantra of "five feet in thick woolly socks"

Thank you. I did deduct a few centimetres to allow her lost height. She has been unable to leave bed for several months now. Even if she could stand, her spine is curved. She is weighed in a sling.

 

[Rayreadynow]

Today, my mother looks remarkably well and is lively, having regard for all of her circumstances, but her weight is now down to 37 kg (5 stone 11 pounds). How much lower could she reach on the BMI scale?

View attachment 71354

Kg on left Stones on the right, seems that for 5st 11 pounds all heights score 2 is high risk of malnutrition:

 

[millalm]

My 91 yr old Mum has been considered EOL for some months now. She is bedridden, has no intelligible speech and has been incontinent and immobile for the last 4 years. Recently her weight loss over a period of months was shocking. She is now on pureed food and since I feed her dinner most nights, which up until recently included Cadbury chocolate bar (s) which I mashed into small bits and put in her mouth, I know her weight is not reflecting her calorie intake. After using fortified puddings etc, in addition to 3 meals a day for months, I now realize that her poor old body is just not holding on to the processed foods and I have accepted that this is part of the long, slow march towards death that is Dementia. I know what I am seeing in terms of the weight loss when I lotion her from head to toe most days, so I have asked them to stop weighing her ( since she is bedridden there is yet another hoist involved).

I have spent the better part of 12 years fighting the system, advocating for my Mum and others and trying to make things as 'perfect' for her as I can. I can't remember a single day that I was not in person, by phone, by email or just in thought trying to fight this cruel disease. Recently, one of the lovely ladies who has looked after my Mum in her care home for 8 years found me crying in frustration, and sorrow, I was worried that Mum was about to die, in spite of my best efforts. She said to me 'It is not her time yet, but when it comes we will ACCEPT it' In that moment I felt like the weight of the world was lifted off my shoulders and her words have somehow given me peace.

I am no longer spending my energy on trying to change the system, or trying to force reason upon bureaucrats with their inane protocols and stupid rules. I am now focusing instead on time spent making sure my beloved Mum is well washed, (I often do a sponge bath and hair cap wash on nights she is sweaty and hot), and always lotioned and perfumed , hair dried and brushed to keep her in as close to the way she was used to. I feed her the sweet puddings she likes instead of forcing her to take the puddles of food that her body can swallow, listen to favourite music and talk to her of family and people and places she loved.

I can't make her life the way it was, but I can give her comfort in feeling cared for and loved, which in todays long term care facilities is something they just don't have the resources to provide.

I think what I am trying to tell you all, is looking back at the 12 years on this roller coaster hell, is that if you can make peace with the fact that Dementia is a fight you can't win, you can choose to devote your energy to making sure your PWD's days are filled with the care and love they deserve.

Wishing you all strength on your journey.

 

[Chizz]

There was a programme on the radio today called "Protein: Powerhouse or Piffle" at 15.30 on Radio 4. It was an investigation into the effectiveness of the modern trend for protein powders and shakes that apparently in fashion at the moment.

On the programme, a Professor from some college in Cambridge University said that (i) protein is required to keep the body functioning and (ii) protein cannot be effectively stored (unlike carbs and fat that can be stored), and, thus, a person needs to eat protein regularly and (iii) if a person's dietary intake is less protein than the body needs for the amount of energy being used, the body will search out and burn the protein already in itself, such as in muscle, and thus the person will lose weight and will be and become under-nourished.
Calories, interestingly, were not mentioned.

The programme can be listed to on BBC Sounds

 

[Sterlingtimes]

I think what I am trying to tell you all, is looking back at the 12 years on this roller coaster hell, is that if you can make peace with the fact that Dementia is a fight you can't win, you can choose to devote your energy to making sure your PWD's days are filled with the care and love they deserve.

I really feel for you, millalm. We took the decision three months ago to halt all interventions other than pain relief. That included avoiding any form of forced feeding. I was glancing at my mother's food diaries until a couple of weeks ago, but I no longer see those. I am struggling now to understand my mother's medical position, and the nurses are unable to help. I was looking at weight as a proxy for determining the extent of my mother's demise, but that appears not to be a satisfactory marker.

I agree with you that dementia, along with co-morbidities, is a battle that cannot be won.

 

[Sterlingtimes]

There was a programme on the radio today called "Protein: Powerhouse or Piffle" at 15.30 on Radio 4. It was an investigation into the effectiveness of the modern trend for protein powders and functioning and (ii) protein cannot be effectively stored (unlike carbs and fat that can be stored), and, thus, a person needs to eat protein regularly and (iii) if a person's dietary intake is less protein than the body needs for the amount of energy being used, the body will search out and burn the protein already in itself, such as in muscle,

Thank you, Chizz, for your interesting posting. My mother's protein intake must be very low; sources may be limited to ice cream and Fortisip. I can see the sense of focusing on protein weight rather than calorie intake. My mother has great strength in fighting all of these adversities.

 

[luggy]

I really feel for you, millalm. We took the decision three months ago to halt all interventions other than pain relief. That included avoiding any form of forced feeding. I was glancing at my mother's food diaries until a couple of weeks ago, but I no longer see those. I am struggling now to understand my mother's medical position, and the nurses are unable to help. I was looking at weight as a proxy for determining the extent of my mother's demise, but that appears not to be a satisfactory marker.

I agree with you that dementia, along with co-morbidities, is a battle that cannot be won.

@Sterlingtimes may I ask when you say that you took the decision to halt interventions other than pain relief, including forced feeding, do you mean the Oral Nutritional Supplements? I only ask, as I have requested these to be stopped, only to be over ruled by care home, dietetics & GP on 2 or 3 occasions during the last year. At one point, the GP at the time mum was resident in her previous care home, did agree that it was no longer in mum's interests to be given ONS, but when mum had to move to a different nursing home, they were reinstated and done so without my knowledge, and mum remains on them.

 

[Sterlingtimes]

@Sterlingtimes may I ask when you say that you took the decision to halt interventions other than pain relief, including forced feeding, do you mean the Oral Nutritional Supplements?

Hello bloggy. Our repetitive trials continue. This is an interesting question. The hospital consultant stopped a longish list of intervention medications, notably bisoprolol, edoxaban, and alendronic acid. Comfort medications remained: lansoprazole for acid reflux and her eyedrops.

The Oral Nutritional Supplement Fortisip was prescribed and endured. I would have preferred that Forsip be withdrawn, but it is provided, so it seems, almost as a matter of policy. I have seen Fortisip used alongside liquid morphine to make it easier to take, i.e. mixed in and spoon-fed. Mother is most disturbed in the early morning when it comes to washing her body, and morphine is used to settle her; otherwise, liquid paracetamol is used throughout the day.

I think that we need to experience this to understand the various ups and downs and twists and turns.

 

[Chizz]

Some think giving nutritional supplements as a form of intervention over what would happen naturally.

 

[Sterlingtimes]

Some think giving nutritional supplements as a form of intervention over what would happen naturally.

Thank you. I think it is a form of intervention. According to the best authority I can find, my mother would require 0.8 grams of protein for every kilogram of her body weight daily, i.e. 37 x 0.8 = 30 grams. One bottle of Fortisip provides 9.6 grams.

A bottle of Fortisip provides 240 kcal in energy. I used a calculator to find my mother's calorie requirement in her current state, 960 kcal.

 

[millalm]

@Sterlingtimes I agree with you wholeheartedly that what we here in Canada call’ fortified’ puddings, liquids etc are a form of intervention. Just as I can choose to halt medications now that Mum is considered EOL , I can choose to stop ‘fortified’ products. To me It just seems cruel to be fattening up my Mum, when her body is so clearly on a different course. I have the support of the care home doctor who , when consulted on this subject, said to me that there is a point with a PWD where we are no longer prolonging ‘life’ , we are prolonging death. The last thing I want to do to my poor Mum is prolong this horrendous ride.

I feel that we are all brothers and sisters in arms in this fight 🙂 I appreciate your thoughts

 

[Chizz]

Yes @millalm the whole of dementia is in my humble opinion a living death.
In early stages there is much living but gradually in declining quality as the brain deteriorates.
Then in late stages there is much, but v slow, dying, with some life clinging on and virtually no quality.

 

[Sterlingtimes]

@Sterlingtimes I agree with you wholeheartedly that what we here in Canada call’ fortified’ puddings, liquids etc are a form of intervention.

This is a rough situation for us all, isn't it? A week ago, the nurses stopped tracking my mother's food, liquid, and outtake intake. I inquired why and was told that it was pointless. I agreed. I will ask whether they will stop the Fortisip.

 

[Sterlingtimes]

Yes @millalm the whole of dementia is in my humble opinion a living death.

Good description.

 

[Collywobbles]

I believe also that with dementia effectively ‘shutting down’ areas of the brain, physical resources are diverted to concentrate on key survival functions - brain, heart and lungs. Limited energy is diverted away from the digestive system, which starts to shut down along with the desire and instinct to eat or drink. It no longer matters how much food is taken, nor its nutritional value, there will come a point when the digestive system will simply not process it. There is a school of thought which suggests that feeding a PWD at this stage, can even shorten their life.

Ultimately, it’s a battle against the PWD’s illness, that we can’t win. Counting calories and tracking protein intake might give us the appearance of being in some sort of control, which can be helpful.