My sister and I recently took mum to a spa for the evening, and whilst it was possibly not the relaxing experience that the spa ethos suggests, there were at least no major incidents and we returned home in one piece. However, a very real issue had presented itself as soon as mum set foot on the heated but still damp and slippery floor of the spa centre – if she had fallen how on earth would we have got her back on her feet? The realisation dawned on both of us as mum took her first few tentative steps. There was a significant chance of slipping (as demonstrated by a perfectly able-bodied woman behind us who shrieked as she lost her footing but self corrected without incident). Mum did not have the advantage of being light on her feet or that of being able to correct her posture to avoid a fall, if she had lost her balance she simply did not have the reflexes to regain her centre of gravity without hitting the deck. The bigger issue was that if she had gone down she would have stayed down. It is unlikely that even the most robust of spa attendants could have shifted her without structural equipment along the lines of winch and crane – partly because of her inability to assist in such a procedure but mainly because of her now portly form.
Mum has gone from a size twelve to a size 22 since the dementia diagnosis. What is most shocking about this is the clear force of will required for anyone to stay slim. Mum must have spent her whole adult life watching her diet if all it took was a few years with her eye off the ball to put on seven stone. It doesn’t bode well for an already hefty society if people with dementia, freed of concerns about their weight from an aesthetic point of view, are able to eat whatever they like whenever the mood takes them. The combination of dubious meal etiquette (mum has been known to reach over at the meal table to take food off one of the kid’s plates more than once), poor decision-making (saying yes to everything that is offered whether hungry or not) and an increasingly sedentary lifestyle leads to a perfect obesity storm. And whilst this was once merely an extension of the deterioration in mum’s appearance, it is now a care issue. We cope with the fact that she now resembles a ghastly inflated version of her previous self. We managed the expanding waistline by purchasing increasing sized elasticated garments, ginormous knickers and tent-like tunic tops. Whilst she changed from a slim attractive woman to a doughy lump in front of our eyes it was distressing certainly but now we have practical challenges to contend with – the luxury of fretting about how she looks has been superseded by worrying about how to keep increasingly deep skin folds and crevices clean, taking care of basic hygiene and staying mobile. We’ve already had one incident where mum got stuck in my sister’s bath and needed two people to haul her out, this was a couple of years ago and she is, if anything, bigger and less able to physically assist in any similar extraction process now. I’ve worked in the health service long enough to know that carers and nursing staff knacker their backs on a daily basis by lifting even the frailest and most featherlight of people. Somebody mum’s size is going to present a real health and safety risk in a formal care setting and before we get to that stage my dad’s back is likely to have been put through its paces. The scenario whereby mum falls at home would currently have the following potential outcomes:
- Dad is home and manages to get her back on her feet – despite this being the best option it is still likely to be painful and traumatic to both parties’ shoulders, backs and knees
- Dad is home but cannot lift mum. Paramedics have to be called to assist. This would in no way constitute a medical emergency and could therefore result in a long stay on the floor.
- Alison or one of the carers is at home but rightly predicts that to attempt to lift mum would be too great a risk to themselves. Lengthy delay waiting for dad or paramedics (or both, in a manner similar to long line of people pulling out The Enormous Turnip).
- Mum is at home alone and sits tight on the floor for an unspecified period.
None of these are ideal and things are only going to get worse as her mobility decreases and her instability and subsequent risk of falling increases. Clearly we need to get her weight down somehow without it being too traumatic or obvious a process. We have tried reducing portion sizes but she tends to want whatever is out on the table and there is a natural reluctance to stop her enjoying what is essentially one of her only pleasures in life. Similarly, if she asks for a glass of wine with a meal she will neck it like a tequilla slammer and we let her, anxious not to deny her a ‘treat’. I feel similar to the parents I sometimes see in surgery who continue to overfeed their morbidly obese children. There is a desire to indulge those you care for, to let them trough on smilingly, filling their faces way past the point of chubbiness and into the dangerous realm of actual physical harm. It is interesting that we would never encourage loved ones to overdose on drugs or smoke more cigarettes or drink alcohol to the point of liver failure but where food is concerned there is a deeply rooted need to nourish and feed that probably stems from a time when resources were scarce. Anyway, I digress and fear not! I have a plan…
One of the advantages of the advancing dementia (and I say that advisedly, knowing that there are very, very limited advantages here) is the fact that normal biological triggers no longer seem to have the same effect. Where once mum would have felt hungry and therefore made herself a snack or a meal now she will only feel the need to eat if someone is eating in front of her or if food is prepared and placed before her. She has neither the skills nor the inclination to seek out her own sustenance. This can be used to our advantage by simply omitting weekday lunch. Currently dad leaves a meal out for mum to eat at some unspecified point during the day (lets say lunchtime for convention’s sake but in all honesty the meal is probably consumed whenever mum finds it, irrespective of time of day). I cannot see that mum would be any worse off for not having this meal. I genuinely do not think she would feel hungry – her level of activity during the day is at best comparable with an elderly sloth so her calorie expenditure is minimal. The social aspects of eating the majority of her meals with dad and big family meals with us can all continue and hopefully her weight will slowly start to reduce. And hoorah – the dementia diet is born!
Please note, any nutritionists out there, that I am not advocating this as an ideal solution. I will not be bringing out a range of books and menu ideas based on my novel concept of ‘missing out meals you’ve forgotten you needed’ but it is a start.