to think my elderly dad needs to eat less?

[LouuLou]

I know this sounds harsh. 72 year old DF has already had a heart bypass and is now very immobile. He’s steadily getting bigger and bigger, and it’s reached the point where it’s affecting his care.

We can’t even weigh him anymore because we can’t get him onto scales. The carers are struggling to move him, bathe him and change him. When he fell recently, even two paramedics had difficulty getting him up and into a w
wheelchair.

I do understand that food is one of the few comforts he has left. I’m not blind to that, and I’m not trying to take away the only thing he enjoys. But at the same time, this is starting to feel unsafe and unsustainable for everyone involved, including him.

My brother does the online food shop and just buys whatever DF asks for, including things like fried chicken. I’ve tried to say maybe we should rein that in a bit, but he thinks DF should just have what he wants. The carers also tend to give him whatever he asks for.

So I feel like I’m the only one thinking long-term about his health and practical care and I end up sounding like the bad one.

AIBU to think we need to put some limits in place, even if he won’t like it?

You acknowledge that food is one of his few remaining pleasures. Could you could work with him to change that ie find other things he can still enjoy as a starting point. Is anything be done to help him remobilise? Because from how you describe his life I can certainly see the attraction of eating oneself to death.

He tries to get up himself sometimes and ends up falling.

Yes he is on medication. Yes he has an alarm.

He is only interested in watching TV. The social worker offered to organise someone to come and sit with him to chat but he said no.

What meds is he on, is he on blood thinners. Has he been reviewed by the falls team and therapists.

Blood pressure, statins.

The falls team say he shouldn't get up without assistance but he does anyway.

I would suspect he’s probably heavier. I’m 5ft 10 and 18 stone (don’t need judgement thanks) and flexible, able to exercise regularly, do yoga etc and hospital staff had no issues helping mobilise me after an op

It doesn't sound like he wants your help, he has capacity and the GP has no concerns, has any health professionals ever mentioned his weight or eating habits. Without poa there's nothing you can do, except perhaps report the care agency to the cqc and adult social services and speak to his district nurse or GP to ask if he needs a new care needs assessment and risk assessments, preferably with his knowledge and agreement. I'd also stop buying clothes or speaking to him about his eating.

Then I suggest you concentrate on the quality of his life rather than the quantity.

15 stone shoyld not make him immobile. I did a 10k today and tbere were people substantially heavier than that finishing in under an hour

Op, I mentioned earlier about depression, do you think tbis could be the case?
What were his interests when he was younger?

OP said 'over 15 stone' and went on to say she doesn't really know how heavy he is, only that he is obese and growing. He has been assessed as requiring a hoist, presumably due a combination of his weight and strength. I'm not sure what's to be gained from quibbling over his exact weight.

It is not just his weight. He leg became very weak after his heart bypass surgery. He became sedentary and has sarcopenia.

He seems quote happy in himself watching TV all day long. When he was younger, he liked to travel around the UK, loved going to the pub and meeting friends, collected model trains. He says he is happy at home now.

You are enabling his ill health by not intervening and talking to him about his diet. He clearly needs help and it sounds like you are the ideal person to implement this. Changing his lifestyle will save his life. Good luck.

Everyone else is saying it is his choice as he has capacity.

I didn’t. And I agree with that poster. DB is enabling addiction behaviour.

If DF was in a care home they wouldn’t let him overeat like this as they have a duty of care. Do you imagine a caring wife would enable this? You can’t stop someone from overeating but you can provide decent quality food in reasonable portions. Why is this different from procuring any alcohol he asks for?

The problem that is affecting other people seems to be inadequate or inappropriate equipment to help him move. That is fixable by OT / wheelchair services. Also worth giving the ambulance service an estimate of his weight so they can send an adapted ambulance/ extra people if you need to call for an emergency ambulance.

Nobody over about 15kg should be being lifted by care staff / family carers. Everybody should be hoisted to protect carers' backs. That's not a bigger body problem.

Beyond that I would start by being curious about what in his life he has control of - frequent visits from care staff, not being able(?) to do your own shopping or cooking or showering/ bathing sounds difficult. How can you help him regain some independence? What does he want to be able to do for himself?

Would he want to move to a care home? Are there adaptions he could have made to his home to improve his independence?

Weight loss in elderly people isn't a good thing. There aren't any good ways to make fat people straight sized and the problems with attempting intentional weight loss are going to be magnified in elderly people. One of the biggest risks is regaining more weight than is lost. Look up 'weight cycling' or yo-yo ing. GLP1s cause lots of muscle loss - I doubt anybody would prescribe them in his circumstances where he can't do exercise to maintain his muscle mass.

A more nutrient dense diet with plenty of protein and fibre (if his bowels tolerate that) would probably be a good thing but that can only be his choice. It's still a better place to focus than on weight loss.

Physiotherapy and/or hydrotherapy are worth looking at - physio may be able to help him with skills to develop his independence. Movement in water might feel good.

@LouuLou

This must be so hard to watch, OP! Very frustrating!

I’m a carer for my elderly parents, different circumstances, but can certainly relate to the consequences of their unwise decisions impacting on others.

The care and services will do what they can as best they can at the time. His care quality will reduce as a result over time, yes. Sadly he has capacity to make the unwise decisions.

He is of an older generation, and male, this normally means stubborn too.

He isn’t going to change.

Yes, he’ll need to wait for hours for an ambulance to get him back up off the floor when he falls.

My only advice is to learn from it for yourself, and to look after yourself. Also look after yourself emotionally too. That may mean stepping back a bit, you’ll have to judge that for yourself. Try to limit the negative impact his choices have on you personally… 🤷‍♀️

Good luck!!

I have been where you are op and it is so difficult. My parent ate reasinably well but as they aged and became less mobile, health detoriated and rich foods had more impact. Eventually they had a stroke leaving them bed bound and passed away a few years later after complications mainly due to being bed bound.
It sounds like your dad has a similar mindset my parent was very down and just lost all motivation. Apart from contacting GP about mood etc sadly there is probably not much you can do. I would try to make subtle diet changes where you can but its such a challenge I wish you well x

Thank you to @independentfriend @ItsOkItsDarkChocolate @TheLemonLemur for your advice and kindness x

Does that make it right?

Thank you to all the posters who pointed out that a proper OT assessment needs to be done. If he has a hoist then and carers and paramedics are struggling to lift him and being injured then the hoist is either broken, unsuitable or you've encountered a lot of people not using it properly. Portable transfer hoists are usually able to lift in excess of 22 stone or so and are electric so nobody should be physically lifting him. As @independentfriend points our nobody should be manually lifting/moving anyone over a very low weight due to the cumulative damage it causes to carers/paramedics/nurses etc. I was a young carer for my grandmother along with my mum and Grandma was tiny but still was moved by hoist because it was safer for everyone

It's a difficult situation, and you have my sympathy, OP. It's very difficult to see someone you love making choices that are bad for them - but I think you have to allow them agency in this situation. My own Dad was confined to a bed (in his late 80s, so significantly older than your father) and chair (transferred by hoist 4 times a day by carers) when he had a leg amputated after a fall. I was able to move in with him and fill in the caring gaps. The thing was, Dad loved a drink. He would easily get through a bottle of wine a day, but much preferred vodka - preferably with a cigar. I talked to his doctor - we decided that at his age he may as well enjoy himself, and so I ordered the cigars, wine and vodka for him - I even poured the drinks and lit the smokes. I also did all the cooking/feeding - but he had the opposite problem to your Dad - his appetite vanished as he aged. I don't regret it - it made his very restricted life tolerable. He eventually died at 91.

I would have created hell if any of his carers couldn't read or write - the written log they filled in at every visit was essential. 72 is no age at all - but realistically, your Dad's not going to go on a strict diet and shed the weight, is he? Let him have the things he enjoys - and if the carers aren't strong enough, or don't have the correct techniques to manage his transfers competently, find new carers. I'm so sorry you're struggling with the situation - it's not easy.