Extreme weight loss in short-term rehab. Is this normal?

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Extreme weight loss in short-term rehab. Is this normal?

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My 85 year old mother had a stroke on 3/16. She went into the hospital that day, and thankfully there wasn't too much brain damage. She was kept there 4 days, released into short-term rehab on the 19th. When she was discharged from the hospital, she weighed 90 lbs. She's been extremely thin for years now, but at the doctor's the week earlier, she was 92 lbs. She's 5' 3" tall.

So she's been in rehab two weeks, and today I find out - not from the rehab itself, but from the RN at the assisted living community mom hopes to move into after rehab, who was there to evaluate her - that she is now 82 lbs.! She's unhappy there, doesn't like the food, and is supposedly a "choking risk," so is on a soft diet. There's no evidence that she's ever choked, either at rehab or at the hospital. The rehab's answer is to give her Ensure, which she hates and won't drink.

I'm in totally new territory with caring for my mother, the stroke, rehab. I'm 300 miles away. My father died on Feb. 16th; and after 54 years of marriage, my mother is in despair. That said, she tells me she's hungry all the time, but just doesn't like the food. But a 10% weight loss in two weeks sounds like starvation to me.

I'd appreciate any perspective more experienced caregivers can provide. Right now I'm so angry at the rehab I can't think straight, but don't know if I'm overreacting. I am going to call her regular doctor and tell her about the weight loss.

Diet & Nutrition

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Choking risk should be evaluated by a speech pathologist who will try different textures of foods and measure her swallow reflex. You might call and ask for this to be done with someone present who can gain your mom's trust and understanding of why this person is coming in to give her a bunch of food. If speech can't properly evaluate her ability to swallow they will keep her on a soft diet. Have her evaluated by a geriatric psychiatrist. Given her circumstances, she is almost certainly suffering from depression and perhaps from vascular dementia. Most antidepressant medications also increase appetite.

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I went thru a similar soft food only diet with my father in a rehab/LT care facility. It made me livid. He dropped alot of weight. I was told he couldn't form his food properly to swallow. They had him drugged out of his mind on risperdal. I guess it's to save their butts with law suits if anything happens to a patient. I live close to that rehab center so was able to go there daily after work. I started buying take out on the way over and he started eating again. They insisted even when I was bringing real food to cont. with that soft food nonsense. He's now home and eating normally. Good appetite.

Is there an issue after the stroke with her swallowing? It sounds like you need someone there to evaluate the situation and if your mom is capable of swallowing to make sure she gets regular food that they serve or have a service set up to deliver food to her there. Food and nutrition are important.

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1).Request a Care Plan meeting with the social service person to discuss your concerns and your options for having the diet changed. Request to speak to the dietitian and the speech therapist at the facility to discuss your concerns for the soft diet and your mom's weight loss and poor appetite. Many facilities will let you and your mom sign a diet wavier that allows her to have any foods she wants. Ask for a swallow study or FEE test to prove she isn't a choke risk and the facility will upgrade her diet.

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I spent 7 months with my mother in a rehab facility after a fal and subsequent chf. While there I noticed they seem to put everyone on restricted diets, soft, chopped or puréed foods. Initially my mom had a swallowing issue where she choked and threw everything up. Once this happens they restrict. Once they restrict, I believe nerves get in the way and the choking gets worse. Speech pathology should get involved and be working with your mom daily to give her help and confidence in swallowing. Talk to them to find out what they are doing to get her back to solid food. This therapy can vary greatly from on facility to another. The first facility did almost nothing to help and showed effort. The second facility offered great therapy that got mom back to solid food and eating and swallowing normally without any invasive procedures. As background, when moms food was chopped she was furious and would not touch it. After talking to many other seniors they too would not want to eat if the food was altered. This must be an issue of loss of control and pride, so getting things back on track is a priority. So first things first. Talk to the dir of nursing or the administrator. Find out what their protocol is for this. I learned that you need to be the patient advocate and let them know what is acceptable. Being so far away is a challenge. We supplemented moms food with lots of ice cream and milk shakes. The "ensure" they offer in the facilities we have been to is not "ensure". It was called "resource" and mom would not drink it. Check to see what they are "really" giving her. The facilities mom was in also touted that the serve homemade milk shakes on request. They were good. However, the prob was getting mom to request one. Talk to the dietician and have standing orders for milkshakes to be delivered to her room between meals. You are right to be concerned about the weight loss. Any chance of having someone visit with ice cream? Good luck. Prayers for you

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My mom lost a ton of weight before her accident, and it later found to be a constriction of her esophagus. A "Swallow Test" will determine if there is a problem. There is a procedure where they open the restriction (out patient surgery). She went from 103 pounds to 170 : ( She's on a ground diet because of her teeth.

Another possibility is that food is making her nauseous, and she's just not communicating that. When my mom was sick once and wouldn't eat, her response was "I feel funny when I eat." I translated that to "nauseous," they gave her a med for it, and she started eating again.

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It might be a different situation, but when my grandma was in the hospital, we found out the hard way that no-one really makes sure the person eats, properly. Luckily, we lived closeby and my mother went every meal time to sit with grandma to feed her. Otherwise, she was kind of so out of it that she didn't even realize it was mealtime and just didn't eat.

Being far away, either you or another family member could travel there to be with her or could see if you could hire someone to be with her. It is hard to assume anything without having someone physically sit with your mom to see what exactly is going on.

Recently, and another totally different situation to yours, but my mom dropped a lot of weight. She was living alone and just didn't recognize it was time to eat and wasn't "with it" enough to figure out what to eat. She is now living with me and eats when she's supposed to and what she's supposed to because she realizes it's meal time in that the rest of us sit down to eat and fill our plates so she does, too.

My point is just that it could be a lot of things. She's in a strange place, maybe scared, maybe depressed, maybe not having her weight carefully watching by these strangers. It could be a lot of things, but you won't know without having someone go review her in-person and get back to you with a report.

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The others have given you excellent advice. One word of caution, based on my best friend's experience. Her mother choked to death in a very nice and expensive assisted living facility a few years ago. I wish the facility had identified her as a choking risk and had taken the necessary steps to keep her safe.

My own mother is currently in a short-term rehab center and her appetite is definitely "off." She doesn't like being there, is depressed, plus has been taken off a medication that used to cause her to have a voracious appetite - in fact, she had gained too much weight.

My heart goes out to you and your mom - it's very hard to navigate these waters and to know what's best.

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You're not overreacting, you are right to query this; but don't panic. The weight loss might not be as severe as 10 lbs in three weeks - allow for a margin of error in measurement, for one thing, different machines, different clothing. Add in possible dehydration - hot environment, possibly she's not drinking enough?

But all the same, if she's hungry but doesn't like the food (I don't blame her, Ensure is disgusting: I wish prescribers were made to drink it before they order it), would it be worth asking for her swallowing to be reassessed?

By all means speak to the rehab staff and question them closely about your mother's care plan; but don't go in all guns blazing, they probably are doing their best and acting correctly. It's early days in your mother's recovery, there's an awful lot going on for her (and for you too) - maybe take a deep breath and slow down.

I'm very sorry for your recent loss of your father, too. You're under terrible strain all round. Is anyone looking after you?

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My dad loves to eat, candy, cookies, ice cream, cake...if you get the picture you can see there is a problem. I got him Slimfast Strawberry which he loves, it tastes like ice cream, protein bars (cookies to him), he loves fresh fruit, cut up small, and there are puddings, shakes, etc that your mom might find taste. Some of the official meal replacement drinks taste like yuck. He has gummie vitamins also. Go visit, find a drinkable supplement she likes already mixed, and keep it in her room so she can feed at will. Dad uses a bendy type straw (flexable).

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ThereseC...my mother also quickly lost a lot of weight after being placed in what was suppose to be "short term rehab", 2 weeks according to the doc's orders. She lost twenty pounds in that two weeks. Had been eating less with gradual weight loss for months prior to rehab. All doctors and nurses responded with was suggesting Ensure drinks and cups. My mother sometimes drank/ate a little of the Ensure, and sometimes not any. Would eat very little solid, or then purried food. She said it didn't taste good. After further pressing the point with docs/nurses that she's losing a lot of weight and not eating hardly anything, they then recommended a pill that was for anorexic patients, and were optimistic about it improving her appetite, based on experience with other patients. But, it took 7-10 days for the full effect of the pill to kick-in. My mother didn't last that long. It was too little, too late. She died three days after they began giving her the appetite pill, which was a week-and-a-half after she first entered "rehab". IMO my mother actually died of starvation.

I agree with others, you need to be with your mother and find out more about what's going on with her weight loss (how long?), eating (how much, if anything?), treatment (how are they responding to the weight loss/eating issues, if they are?), and future plans (doc's thoughts, evaluations?) She may be suffering from dimentia or other medical issues. She could be purposely not eating (she's ready to go.). Or, dimentia or her despair from your father's death could cause her thinking and logic to be foggy.

Keep in mind...it is not uncommon today that doctors place patients, especially seniors, in rehab centers/programs for palliative care, not for actual "rehab". And it is also not uncommon that the doc won't tell you that.

Only after you observe your mother's status and her treatment process can you evaluate the situation and make decisions. The lack of eating issue can be heartbreaking, with many twists and turns. I would visit her and see what's going on ASAP.

Extreme weight loss in short-term rehab. Is this normal?

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