Monday, September 24, 2007

...Her cupboard was bare

Old Mother Hubbard went to the cupboard,
To fetch her poor dog a bone.
But when she got there, her cupboard was bare,
so then the poor dog had none.

I have had a hard time adjusting to a reduced number of people in our household over the past year. Our refrigerator is often over full, and I still get carried away purchasing fruits and vegetables. Our freezer is crammed with leftovers.

About a month ago I assessed an elderly lady in her apartment after she had a bad fall. She had tripped over her beloved little poodle who slept in the doorway of her bedroom at night. She still was limping from the bruises and sprains she experienced. She told me she had been off balance for a few weeks and hadn't been able to go out or drive her car. I ordered a walker for her and arranged a visit the next week to check her again.

The next week she was limping even more and I took off her shoes and socks to look at her feet. She had a very inflamed ingrown toe nail that had been bleeding. I asked if she had something to soak her foot in and she sent me off to the kitchen to find a basin. I opened her cupboards and was surprised at the disarray and lack of food. I peeked in her refrigerator and found a package of opened stale pastries, a bottle of Bourbon and a couple of chocolate bars in the vegetable tray. Her freezer contained a number of boxed frozen dinners that were covered with frost and past their expiry date. Her microwave oven tray was covered with burnt food. I did find a large bowl and filled it with warm water to soak her foot.

She told me about her move from Vancouver BC four years ago to be near her only son in Ontario. He was attentive and visited her once a week, except when he spent the winters in Florida. She is very independent and always told him she was doing fine. He never looked in her fridge or cupboards. They would go out for chicken at Swiss Chalet every week, and that was likely the only decent meal she ate until he came again.

The kitchen "assessment" gave me more information than my patient did. She was not eating well, her vision had deteriorated, she was not using the microwave correctly, and she lacked the stamina to prepare herself a proper meal. The Bourbon was not an issue as the bottle was full. I was concerned that she still had a drivers' licence.

Many of our patients who are admitted for rehabilitation have significant nutritional deficiencies with low B12, albumin and vitamin D levels as well as a recent weight loss. Families may miss the signs as the deterioration is gradual and the patient is often adept at hiding their struggles with food. They may be too proud to admit they need help, or unwilling to pay for the delivery of a hot daily meal from the volunteers at Meals on Wheels.

I visited this lady again last week. She had another fall and looked weaker than before. Her son had taken her dog as she could no longer look after it. The dog is 13 years old and needs a daily insulin injection and will be euthanized when her son goes to Florida in October.

What can I do? Not much without my patient's consent. All observations are dutifully reported to the home care case manager who is able to set up services to address her needs. I see the same group of patients in the hospital and in the community. Her next fall may be the one that breaks a hip and sends her to the geriatric rehab centre or nursing home. If you have a loved one who may be at risk, open their fridge and cupboard to see how they are really doing. I am challenged right now with too much food, but someone else may be challenged with too little.

8 comments:

  1. Oh my, what a heart-rending story, which is probably the case more than we can even imagine. I keep track of my Mom and look in her fridge and freezer every week.

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  2. While my mom was still living at home, I looked one day in her trash can. It was as empty as it had been when I'd emptied it 36 hours previously. As her meals all involved some packaging, I realized that she'd not eaten in those same 36 hours. Probably not the first time that had happened. Snooping in the kitchen of the elderly is most instructive.

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  3. Food never has been important to my guy so when he was home alone, didn't eat breakfast and I'd find his lunch in the micro. I retired shortly after a s realized (then) he couldn't be left alone. Lots of good points.

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  4. Boy, isn't that the truth Ruth. People really can't "see" the low albumin and protein levels readily. Sad story. And you are correct in knowing that an event will eventually occur which takes the choice out of her hands. Poor dear.

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  5. Poor lady... Her situation is a very common one, unfortunately. If it were left to my Mom a few years before she died, her food stock would have included canned soup, frozen dinners, coconut cake, candy, and ice cream. She didn't eat well and fractured her hip. I always checked the cabinets and frig. Luckily, during the past 7 years, a visiting nurse kept them well stocked with fruits and vegetables - good food. You are such a good person, Ruth.

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  6. I remember keeping an eye on Grandma T. She started living on Raisin Bran cereal and buying box after box. It was at this point we moved her into an apartment where meals were provided and meds monitered. The senior years can be sad. I'm thankful that to this point in life I've been blessed with good physical and mental health.

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  7. Do you have anything like Meals on Wheels where you are?

    Can you make a referral to an Adult or Elderly services unit at the social service office or is that up to the case manager to do?

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  8. Pam- Your mom is lucky to have an attentive daughter like you. Nothing against men, but they sometimes have more difficulty recognizing subtle kitchen clues than women.

    Femail doc- I hadn't thought of checking her trash can. That could be another interesting source of information.

    Jean- Weight loss and disinterest in food is part of dementia for sure. This lady is cognitively intact, which in some ways makes it more difficult to intervene.

    Jayne- I know you could tell skin/wound stories that go with malnutrition.

    Mary- Your mom had a pretty good variety of food on her list compared to some I have seen. The worst I saw was a man living alone who had one jar of jam and a loaf of white bread in his fridge. That is all he ate. He had to be placed in a nursing home.

    OmaLois- I guess cereal is easy to prepare, but too much raisin bran would be a problem. I didn't know that about Grandma T, being an oblivious and self-centred teenager at that time.

    Laura- We do have MOW, but for some reason, some people thing the $7 per day fee is too expensive for a delivered hot meal. I encourage people to sign up because the volunteers have a chance to see of the people are OK each day too. I work on a contract basis with home care, and all community referrals have to be done by the case manager. I can recommend, but I cannot refer to another agency.

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