Mum in hospital and not eating

[nonevernotever]

Mum was admitted to hospital a week ago with inflammation on her bowel. She had also fallen at home when she was feeling ill so had been having CT scans in her head every day. We have been told that the scans show nothing acute. (She has had at least two strokes in the past so we know there is some damage there.) We've been told that her bloods have improved, she's medically stable but a bit wobbly on her feet so they are doing some work with the physio and plan to send her home early this week. However she's very tired, much more wobbly than she was and doesn't seem to be eating or drinking anything much. Maybe a couple of spoonfuls of a meal and that's it. Hospital haven't mentioned any concerns, but we have to push to be told anything at all so I'm not sure they would tell us proactively . What else can we do? (We've tried taking in things she normally likes, but not with any success.)

Ask for a dietitian to review her.

That hadn't even occurred to me @headstone thanks. Is that possible?

yes it should be possible. I work as a nurse and I refer my patients if they stop eating or loose weight. Usually a dietitian will come and check the patient. Usually it means fortified milk shakes.

Just came on to say the same thing as headstone. Get the nurses or the doctors to refer.

She may need actual assistance with eating and drinking - have you tried feeding her and seeing how she responds? If it helps, talk to the nurses about help for her when you're not there. She may be so tired that the effort of lifting a spoon or cup repeatedly is too much for her. Cut things into small bites for her and maximise calories in everything- will she drink hot chocolate with cream, little squares of hot buttered toast, nut butters? Make sure she's having full fat milk (would she drink that too?)

Has she been encouraged or helped to eat/drink? Just asking because when I was in hospital food and drink was put out of my reach and when I did get food, it was a slab of concrete "pastry" that I couldn't even cut...I just went without because I felt too crap to make a fuss. Might be worth checking.

My OH was given special drinks when he could not face eating - can't remember what they are called but GP prescribed them.

The dietitian will usually prescribe something like Ensure or Fortisip. But they have specific characteristics so I'd leave that to them.

Some good ideas here thank you. We've tried encouraging her to eat and she'll try a little bit but not persist, so eg she'll nibble the corner of a porridge bar and leave 95% of it. My niece took hot chocolate in for her today, but she wouldn't really try it, whereas normally at home she'll have half a dozen mugs if hit chocolate. I took in a pot of ambrosia rice pudding and I think she may have had at least some of that, but even if we're sitting there trying to encourage her she just seems to lose interest . I'll try some fullfat drinking yoghurt tomorrow, and speak to the nurses about getting a dietitian to review her.

It feels like one of those catch 22 situations to be honest - she's not eating because she's in hospital/doesn't like hospital food/whatever but needs to be stronger before she can go home, and needs to be eating/drinking in order to get stronger

To add to this. Please keep an eye / start making noise with the team looking after. My dear father was admitted to hospital with a bowel obstruction and despite having an tube sucking out all stomach contents (otherwise he was just sicking it up) even the dietitian didn't piece together than fortified energy drinks weren't going to be sustaining him. Ffs. He lost 10kg in 12days. I thought he was going to die of starvation. I had even flagged to the dietitian that I was worried about him not being able to take on enough calories but silly interfering family members probably got completely dismissed.

To caveat this is one amongst a series of fucking awful errors just in his case in 'our wonderful' nhs.

My point being that if she needs additional calories and nutrients, ask them to explain in detail what the care plan is for that specific point. Then hold them to account and ask why if things aren't moving in the right direction in the time frame expected.

I'm on the speech therapy side so just the mechanics not the nutrition, but from what you've said she may be finding the harder chewier stuff too tiring - the rice pudding was an excellent idea. What happens if you actually spoon feed her?

Can you buttonhole one of the clinical support workers/health care assistants, or best of all a student nurse, and ask them to really focus on her nutrition and drinking and giving her snacks in between meals? What is she ordering for meals? Would she fancy something hot and soft like porridge or Weetabix with hot milk first thing? The wards sometimes have nutrition soups (meritene is the brand we have) which can go down surprisingly well, and sometimes the puddings drowned in custard get eaten more than anything else.

(I really wouldn't recommend referring for speech therapy as it doesn't sound like a mechanical issue).

I agree with the other PPs suggestions
It' can be far too common for older people not to eat much and go lose weight when in hospital when they don't have someone sitting with them encouraging eating

Please kick up a fuss with ward that mum isn't eating and is moaning weight as they can refer to dietician on ward who will give advice

If mum has lost her appetite in a care home they would fortify her foods to make what she does eat high calorie and high nutrition
But as mum has inflammation of bowel she needs to see dietician to establish if certain food are involved in that 😱

If you can, ask to go in at meal times

When my mum and my sister were in hospital I travelled up 4 days a week and sat feeding them (separate times: years) because I wasn't happy to see them lose weight on top of all their health problems and that wasn't even bowel inflammation food intolerance issues but I'll health and fatigue

I badgered and raised nutrition every couple days
I also do that for my clients and suggest families go in as much as they can visit when someone is on a ward for more than 7 days

Nutrition is key to recovery often

So difficult during covid restrictions but hopefully easing up now

Anyway

Mum lost half a stone while she was in hospital having her knee rebuilt. She didn't like the food and had stopped eating because she thought she was going to be sick. No-one had noticed that every meal came back uneaten, she was there with the knee and that seemed to be the only consideration. I was That Family Member and suggested that she was discharged before she starved on the ward. They weighed her after which there was much scurrying around.

She was discharged to a rehab facility and they were fantastic, had the doctor prescribe something for the nausea and provided a range of appetising meals after asking her (and me) what her favourite foods were.

Hospitals use a malnutrition tool to identify those at risk and action early intervention.
im an elderly care nurse and the last ward I was on used the MUST tool every week for every patient.
First line intervention is to fortify diet (additional calories using high calorie milk powders to porridge etc).
the next level is fortified drinks, deserts etc. The dietician prescribed these after assessing patients who scored high with MUST assessment.
I would ask the staff how they assess malnutrition risk, and how much weight your mother has lost.
IME the small fortified deserts were more palatable than the drinks for many elderly patients.

There are plenty of "tools" in hospitals on every subject under the sun - usually involving a mass of form filling. What is missing are sufficient nurses to actually have time for the patients - to talk with them, to help them eat etc. I was with my OH all day every day when he was in hospital as the nurses simply did not have enough time to help him to eat, to put his tablets in spoons of yoghurt as he had trouble swallowing etc. My DDs and I did all this for him, as well as being alert to the fact that he had waited 45 minutes for the commode, and then was left stuck on it for an hour as there were not 2 nurses available to use the required standing aid. This is not a grumble at the nurses - they were as unhappy with the situation as were we.

Many thanks for all your help and support. It's appreciated! I took the afternoon off work yesterday and spent it with mum /talking to the nurses/ requesting a referral to the dietitian etc. They're going to monitor much more closely. Mum has now passed her physio assessment so I'm hoping she can come home soon. The previous ward said that it was just because she was wobbly on her feet that they were keeping her in. This ward said she couldn't come home while she was confused. I pointed out that she has problems with short term memory loss, but these have been ongoing since her strike two years ago and are no worse at present. She's been living independently albeit with carers/cleaners twice a week and us popping in every day (we're lucky to live so close - DH and I are ten minutes one way, sister and younger niece ten minutes the other, and elder niece 15 minutes away). So fingers crossed she'll be discharged soon. (I don't think it did her cause any harm to be doing the crossword when the staff nurse in charge of her care came in, ; he asked her if she remembered him and she promptly piped up yes you're the Dutch gentleman who lives in (local street). I got her to eat a tub of rice pudding and a chocolate biscuit while I was there and she drank a glass of fruit juice and a glass of water. One of her friends ( a former physio specialising in the elderly) is going to see her this afternoon, and my sister will take a small flask of hot chocolate in tonight. Thanks again for your support though.