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Since entering assisted living over two years ago, my mother has gained nearly 40 pounds. In truth, she was really underweight when she first arrived, due to not being able to cook for herself and being alone. However, she is now nearly 25 pounds heavier than she has ever been in her life. The problem is that she does very little activity (on a walker, hip change) and that the facility uses food for entertainment. Mother's doctor does not want to put her on a special diet, just wants to see her every three months to monitor her A1C numbers. We are concerned about this weight gain and our mother has no ability to control what she eats. It is not the best food, lots of carbs, high fat, meat at every meal. Anyone else ever deal with this?

my wife gained weight when she could no longing exercise due to back problems, went from 165 to 225. The memory care facility has no "diet" menus so the health care professional suggested saying she is "diabetic" and they have a special menu for that.
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To update on my original question and concern: I am working with the Food Administrator to make healthier "pre-choices" for Mother, and this has been discussed with Mother as well. She probably won't remember that, of course. What my sister and I are horrified by is the thought of having to put Mother on another medication (insulin), possibly injected, at the age of 94. That is what we a trying to avoid, not turn her into her formerly active, 135 lb, self. Although I must say, the body has its own intelligence. We have so many ways to keep us existing far past our actual ability to function, that perhaps this is the last ditch effort of the organism to get us out of here.

We aren't going to go to some unbelievable effort if this doesn't work. We are very accepting of where Mother is mentally and physically. Again, thank you for your answers.
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NeedHelpWithMom Feb 6, 2020
Very good reason to be concerned. It’s sad that you have to monitor so closely but you have to do what is needed to avoid insulin. A good dietician should be able to address this issue without your mom feeling deprived.
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Need: Yes. She loved the food. Funny story - she lived with her grandmom taking care of her, who had 2 dogs - short dash hound - Smoky #1 and Smoky #2. Those dogs' skin was so taut because grandmom fed them bagels with cream cheese and bologna. She was Polish and didn't know any better. Smoky #2 died behind the sofa & it was DH's job to get him out & be buried.
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NeedHelpWithMom: Where she lives, there are different restaurants to go to so that's why. It is an AL, but she is still mobile enough to get to these food eateries. She's only mid to late 60s, but prior to moving she was having a lot of health problems. She sees purely a Christian holostic doctor who advised her not to get a flu shot. Then she got the flu badly.
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NeedHelpWithMom Feb 5, 2020
Oh, I see. So, basically it’s all about the choices that are made.
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Since people use AL indiscriminately sometimes, it is hard to tell what to say. Regular AL, people should have enough sense to make proper choices and monitor themselves somewhat. MC is a different story.

Our mother gained 20# in the first year of MC. I don't think the food itself is the culprit, but rather the deserts offered. Usually the choices are not too bad and the portions small, but when Ice Cream Bars are offered (chocolate covered of course!) we snag that right away! She wasn't eating great before the move (frozen dinners and boxed crap - forgot how to cook really,) I consider the meals she is getting now an improvement (she had those ice cream bars at home too, but might run out between times I could take her shopping.)

Trying to restrict foods or provide other foods (if specific orders from doc, they should provide that), it might run into battles - they generally eat together and might resent getting lettuce for lunch when others have mac 'n cheese! Certainly we can try to have them provide other foods, but to achieve what? If they don't exercise in some way, the weight isn't going to go away.

Our mom was one to join exercise classes and then stop after a while prior to dementia, and walk around the condo complex, so of the TONS of clothes she had in the condo, they ranged in size from 8-12. Not too bad. But, with the weight gain at MC, I had to get more clothes. Not much local choice except WM, so I got some there, mostly from the clearance rack. I asked her to decide if she liked/would wear them and all she was interested in was the size tag. Oh, this is large, I usually wear a medium... Couldn't say it but thought 'Not anymore!' The last time I brought new items, I cut the size tags off (some are now printed on the item, so can't remove those!)

I'm fairly certain she has gained more since then (we've just started on year 4). The staff try to run simple exercise programs, but she refuses to participate - "Oh I did that years ago, I don't need it now," The first year or 2, most of the ladies walked the hall (circular), walkers or not. Not mom. She would sit and read paper, magazine, sale catalogs. She didn't even need a walker the first 2 years, but wouldn't walk with the others. :-( After some knee pain, she did have PT, but probably didn't do much between appts. The last time PT was ordered (she developed a fear of standing and walking because of a few non-injury tumbles, which are likely due to lack of moving and losing muscle mass/strength from sitting too much!) she refused to work with them. So, now we're in a wheelchair most of the time.

It's not likely "water weight" mom has gained, because in addition to her BP meds, they added a water pill. Salt generally isn't put on the tables, so that doesn't contribute. In her case, Ice Cream Bars. Plus any cookies, cake, candies, sweet stuff... Anything a 2 yo would want instead of dinner (although in her case it would be in addition to dinner!)

For our mother, at 96 with dementia, I'm not about to fight any battles over food and weight. It is what it is. Doc did order tests for diabetes and wanted the second one fasting (1st wasn't) - sure enough didn't she scarf down toast, jam and coffee with cream before the nurse could stop her!! The report posted indicates the blood work is "fine", so I guess that's okay. But, at 96 (going on 2) with dementia, let her eat what she wants, gain weight, whatever. Staff mostly likes her, she isn't too demanding, doesn't ask much and is generally pleasant enough there, so I let her be. It wouldn't be worth the battle.
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NeedHelpWithMom Feb 5, 2020
Yeah, at 96. Who cares if she gains a little weight? You’re right.
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Yes, my sister in law in Assisted Living facility gained 20 pounds from over eating.
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NeedHelpWithMom Feb 5, 2020
Do you think it’s the food? Is the food too fattening? Or eating out of boredom?

I think about mobility issues with overweight people. I am not a food police type but if it starts to effect mobility then it’s a real issue.
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People become sedentary early in life. They aren’t active anymore. I rode my bike, played outdoor games as a kid. Kids are sedentary now. It’s sad. I took my kids to the playground to run and play. We stayed active. Exercise should be taught from a child. We had physical education every single day in school. Today, they cut the budget for PE, art and music. Ridiculous!

Then in later years they really aren’t active. Their metabolism is so slow. Active people have a more productive metabolism. Most of the elderly aren’t able to be very active. It’s sad.

You can see where people have been active throughout their lives. When I toured facilities years ago I was shown a walking path. There was a lovely woman in her nineties without a cane or walker that was enjoying her walk. She was fortunate and was healthy. My mom has Parkinson’s disease. That’s tough. As people age and go down hill it’s hard for them all around.

I commented how wonderfully this woman got around and the person giving me the tour said she had been walking on those trails since the day she moved in. She had been a daily walker all of her life. It makes a difference. It’s a lifestyle. Non active people pile on the pounds. They don’t burn it off.
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People get used to eating what is placed in front of them even though they aren't really hungry. It's something to do. Since dr won't do a diet, then maybe you can get some kind of control of the meals. Do they offer menus for a week or month at a time? If so, you do the selections in advance for her. For the snacks being passed out, ask what they have and make a decision on what she will get when they pass things out and have it noted in her chart. Tell the dr the additional weight also determines her ability to walk and is slowing her down. Ask if he will order physical therapy to get her back to the level she was when she entered the facility - you might comment that her sedentary life style now is causing decline. If he won't order PT, ask if she allowed to go to the exercise room whenever she feels like it. If so, notify facility that you want her to go everyday and do some sort of exercise on any available machine or be monitored while she makes walking laps and increase laps every week or so.

You are right in having concern about the weight gain, the types of food she is receiving, and little to no exercise. She is going to end up in a bed and unable to walk when it could have been avoided for a longer period of time. Good luck.
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My mother has been in two places over three years and has gained about 40 lbs, going from size 16-18 to size 20-22 or 2x. When she was home with me she ate maybe 2x day with a snack in between. Now she eats 3x meals a day with several snacks. I've told facility to limit the snacks, but when they are serving the other residents snacks, she wants one too. I've talked to facility to at least make them healthy snacks and get rid of the white bread and get more fiber in her. Their solution is medication for constipation and two medications for her blood pressure and high chlosterol. Since she doesn't move much she's lost muscle and has fallen several times. I guess when her ALZ advances and she forgets to eat she will have plenty of weight to lose as long as she doesn't pass away from heart/circulation issues ahead of time. Staff everywhere seems short staffed and can't give each resident individual attention, I'm lucky if she gets shower/hair washed 1x week. Sad state of affairs for the elderly.
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my2cents Feb 4, 2020
pdfer5 - You have made a very good example of what happens when facilities fail to hire enough people to care for our elderly folks in an appropriate manner. The very place you put them for care is the very place that neglects. We're talking about people who have been educated/trained in medical issues and even basic classes should have taught them that the food they eat will create constipation issues. The medication is a short cut and makes the gut rely on meds.
You might want to review the monthly meal plans and make healthier selections for her AND send the menu selections along with a letter to the facility about why you have chosen these things. Perhaps her dr will order physical therapy to get her moving more -- walking also helps with constipation issues.
Showering is supposed to happen every other day in most facilities. I would be willing to bet when you put her there, they said bathing is every other day. If so, have a chat and review what was said when she entered and your expectation for it to happen. Follow up with a letter....as per our discussion on XX date, you will be following the menu/snack plan as well as ensuring she is bathed XX times a week. Written documents get attention.
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My LO with dementia has gained 20lbs of weight in 7 months, so the dietician at the nursing home has placed her on small portions. It’s kinda silly though because they still include the cake, or cookies etc., with every lunch & dinner.
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eventually she will stop eating so be thankful she can still eat and drink.
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I have spoken with the Wellness Director and Food Administrator, as well as my mother. They have agreed to let me choose the foods Mother will have. Again, thank you for your answers.
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NeedHelpWithMom Feb 3, 2020
Great!
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If I was 90+ and someone tried to step on my eating choices, I think I'd have a tough time with that. Absent diabetes (and I think the OP posted that her mom was NOT diabetic), she should be allowed to enjoy herself (within reason, assuming that she isn't trying to eat the whole cake). What's the point of living a long time if you can't enjoy yourself?
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You know where my bro is in assisted living he sometimes laughingly says that it is always time to eat. And portions are generous. His table mate always orders double portions. As far as exercise I think he gets MORE here, as he feels safer with his poor balance to move around where there is always help available. He is quite active. Yes, he has gained weight, but in all truth he NEEDED to do so. There are always snacks in the fridge, desserts with each meal. He says that he has noticed more weight round the middle and he is now having cereal and fruit for breakfast instead of bacon or sausage with eggs. So he is well enough to take some charge of this himself. I think this three meals for seniors who often only ate ONE at home is a big change. Good luck!
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I think this goes for ALs too, but the State regulates the portions of food a resident is to have. My daughter says there is a lot of waste, because most residents no longer eat that much. They can't be made to eat what is served but the law says it has to be served. My Moms NH did monitor her food. She had a low salt diet.
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AlvaDeer Feb 3, 2020
Where my brother is they really LISTEN about food. They will serve you the size you want, and the food you want. Often the seniors will say "no bun with my burger" and that's how it is served. They are asked about dessert. They get a menu and make it out, can substitute salads. If they change their mind before service they are able to do that. The place is well aware of and hates the waste when it happens. They will monitor diet according to MD instruction for weight loss and gain, special diets and so on. Really I can't say enough good about them.
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Can you speak to the dietician for your mom? Ask them to modify her diet with healthier food.
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The weight gain would be a big worry if this is water weight caused by high sodium diet. Things like canned soup and many prepackaged high carb meals are just too high in sodium. Often, high sugar content will cause inflammation and push A1C too high. It puts to great a strain on the heart.

I would look really hard at her diet. I would ask to talk with the dietitian at the facility.
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Thank you for all your answers. Mother is not yet diabetic, she is very mobile, but uses a walker after a hip replacement last year. She is, like one of you mentioned, a person who has dieted off and on her whole life but is now too cognitively challenged to make good food choices. She won't be able to make the better choice on her own. As the "off site" daughter, I am going to try to make those choices for her, but I need to meet with the wellness director and try to get everyone on board. Just yesterday, after a full lunch and ice cream, I purchased a small bag of popcorn at a movie we took her to see. She reached over and took two handfuls before I could stop her. I had to rudely tell my own mom that the popcorn was for me, and she couldn't have any! She just laughed. She has no ability to make the good choice, and she is as mobile as she has been in the last two years. I am comforted to know that others face this dilemma, however. Thank you for all your suggestions.
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My folks have been in two different ALFs over the past 6 years and neither one of them 'monitored' the residents food intake, nor do they accommodate special diets of any kind. A Memory Care or SNF would, but not most ALFs.

So, to answer your question, yup. My mother has been in an ALF since 2014 and went from 140 to 188 lbs. Complaining all the while about the 'horrible food' and the 'tiny portions', etc. Now she's in Memory Care and wheelchair bound, so she doesn't move at all, for the most part. GERD has become a huge issue lately, and still she refuses to change her eating habits. Her one concession is to eat oatmeal for breakfast 2 mornings so far, rather than her usual bacon & eggs. She's not diabetic, so the doctor has not ordered a special diet for her. Plus, if she were to do that, my mother would be beside herself and furious. Food is her only enjoyment in life and all she feels she has left. She spent her whole life dieting and has now decided to eat everything that isn't nailed down. She's paying the price for doing so, and so am I for all the added problems it's causing, but it's not going to change. At 93, she can do whatever she want, I guess, at whatever price.

I think these women have to make some concerted effort THEMSELVES to push the plate away. Or to refuse dessert, or ice cream, or the birthday cake being served after lunch. Self-discipline, in other words, but I don't believe it's likely.

Wishing you (and me) the best of luck trying to get our mother's to exercise some common sense.
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You need to talk to the RN. Your Mom is a diabetic this is a health problem. They should have a list in the kitchen of dietary restrictions. Yes, Moms AL held a birthday party every month. Parties for this and that and always a cake. I caught an aide giving Mom coffee. I said no no. The aides response was, she wants it. I told the aide u give it to her and you will pay for it.

Moms AL had a nutritionist off sight. Mom was weighted every so often. She had lost weight which was not good. She was seeing a Dr. for Graves desease (thyroid) and should have been gaining with the meds she was on. Was told she hadn't lost 5 lbs. Told the Medtech she is not suppose to be losing any weight. Losing weight meant her meds needed to be adjusted.
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I've reminded the kitchen people at my mom's assisted living many times that she is not to eat so many sweets. Doctor's orders. That was going well. They took her nuts, carrots, and celery instead of cookies. Then another person was hired who bakes and my mom can smell the cakes and cookies and wants some. Some is fine, but the staff does, as you say, use food as entertainment. Often I see they've given her a cookie AND a large slice of cake with a sugary drink and I have to remind them again. I think if you could just keep up with the reminders to the care givers it might help. Ask if it could be written down in some sort of daily calendar that your mom is not to have so many sweets. As for the other carbs, meat, and fats, maybe they could be instructed to give her less of that at mealtimes and more of the greens. My mom is at a very small assisted living home, so it's easier. If your mom is in a large facility it might be more difficult to keep their attention on this issue, but persist.
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Try speaking to someone in charge to see if they can help her with her choices. Since she can’t walk someone is making her food and bringing it to her correct? Perhaps you can have lunch with her a few times to see what she is being served and if you can find a likely advocate to help slim down her portions. Many elders will eat whatever is placed in front of them. If she has someone to visit with, she might slow down eating during the time she is at the table.
Has she been placed on any new medications? Check to see if a side effect is weight gain?
Can you ask her dr to order PT so she can become more mobile?
If I were you I would weigh her weekly to see if she is continuing to gain. The initial gain is probably to be expected. My aunt is not quiet 5’ and weighs 144. Which is heavy for her frame. She fluctuates over the year up to 156 down to high 130s.
Her taste seems to change and seasonal foods will pack the lbs on. She loves cake and chocolate. Her BS is a little high but she’s not diabetic. Her geriatric primary isn’t concerned. At 93 she eats as she pleases for the most part. Her weight moves slowly up and down.
Sitting too much and eating too much salt can cause the body to retain fluid. Some of your mom’s excess weight might be fluid. Discuss that with the doctor also. We can’t leave a salt shaker out for aunt or she will add too much. Let us know if you figure out a way to help her. We learn from one another.
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The problem is that in AL people are expected to be their own advocates in their daily lives. There are many people living in this facility and unless all of them are gaining unwanted weight some of the blame may have to do with your mother's choices, facilities here usually have two options at meals and one is usually more substantial than others. At lunch people can always opt for the soup of the day rather than the full meal, they can ask for their portions without sauces and gravy, they can forego dessert... so even though they aren't planning the monthly menu they do have some control, KWIM?
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