Sunday, February 20, 2011

Anorexia in Old Age and Isolation at the Relative's House

The historic Hamburg Inn. 
A few weeks ago the Relative was in the hospital. It was an hour's trek to the hospital through an unplowed foot of blizzard snow.  The days were both full and depressing.  I tracked the Relative's vital signs in a notebook, watched her favorite TV shows with her, recorded conversations with nurses, and pushed her IV during walks. 

The dietitian was direct.  She told her,  "You've lost a lot of weight this year and eating is the main thing standing between you and going home."

The Relative has developed a contempt for food. She went from a size large to a petite-petite in a year.  Anorexia in old age?  She didn't bother to talk to the dietitian.

According to a 2001 article in the Guardian:  "Though anorexia nervosa is most commonly associated with teenage girls and young women, the latest research shows that it is as likely to occur in the elderly - and that eating disorders in the elderly are more deadly, accounting for 78% of all anorexia deaths."

It may be anorexia.  I fleetingly thought of it at the time, yet no one suggested it. This may be because of widespread ignorance of psychiatric problems, the general lack of psychiatric training among physicians (an average of two weeks in a four-year residency) and nurses, and separation between the hospital and its psychiatric ward. 

I was there mainly to make sure she ate a little.  I spoon-fed her some small bites of vanilla pudding until she defensively began to use utensils again. "Can't I just feed myself?"  The nurses were convinced she was mentally incompetent and had forgotten how to use a fork.   I tempted her with pie from the cafeteria--she ate the whole piece with a fork--and a hamburger from Hamburg Inn--she ate it with her hands.

At the end of the day I was eager to go home.  I collapsed on the couch.  I was eerily isolated from the world.  The newspaper had been stopped at her house, there was no mail, no internet access, the street was still unplowed, there were only 20 books in the house, and the TV dominated the living room. I had to bring in food from the outside world because she obviously had not been eating for some time.

It's odd to stay in a TV-oriented house.  What was happening in the world?  I had no information except from the TV.  The blizzard was the only local news.  I had investigated and experienced the weather personally and didn't need the "Road Warrior" reports.  How I missed print and the internet.

Yet there must have been 50 cable channels.  Change the channel and you get V, The Good Wife, old movies, reruns of The Sopranos, or the Lifetime channel.  Where's the news?  I didn't have the faintest idea.

I looked at the relative's books.  I was desperate for something to read and hoped to learn more about her.  Books are simply not her thing, though.  There were:

1. Barry Paris's biography of Audrey Hepburn.  I wouldn't have minded reading that.  But Audrey weighed 103 at tops and I'm afraid the Relative weighs less now.

2.  Two copies of Gone with the Wind.  Scarlett wore a corset!

3.    The Torch is Passed.  A book about John F. Kennedy published in 1964.  Did the Relative order this through an ad in the paper?  

4.  Several books by Danielle Steele.  Romances about thin people, I'm assuming.

5.  Gladys Taber's The Book of Stillmeadow.  She was a magazine writer who wrote several books and this is the story of a year at her country house.  I left this during a previous visit and forgot to bring it home again this time.   I haven't read Taber, so can't say if it's good or not.

I found some old photo albums and "read" those instead.  And of course I had brought some books from home.

Addendum:  Now the Relative is out of the hospital but eating is still a problem.  She is in a new place, found by another closer relative, and weasels out of going to the cafeteria for meals.   It may really be anorexia.  Apparently large numbers of people in assisted living refuse to eat. Some get very depressed.  Some die of starvation.  Doctors don't often diagnose anorexia in old age.  They consider the loss of appetite normal.

Loss of appetite is one thing; refusal to eat is another. 

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