Is there any hope that she will see heart surgery as a wakeup call?
July 31, 2014 4:47 PM   Subscribe

My spouse's mother, a senior citizen, just learned this year that she has heart failure. She survived multiple heart surgeries recently, a harrowing process during which she said she never wants to go through that again. Great! We assumed this meant that she was seeing this as a wakeup call to change her eating/exercise habits and stress levels so that she could get healthier. Several weeks later, it turns out that she is going back to all the old habits that helped contribute to heart disease in the first place. Is there any hope for her changing her deeply-ingrained habits? If so, what can my spouse do from afar to help support mom? If there isn't any hope for her adjusting her lifestyle, then how can we learn to accept her choices and still give her the support she needs?

We live far away from her, and my spouse has spent much time visiting, patiently trying to help her choose healthier foods, and cooking at home. MIL who lives alone, won't cook for herself, and has also rejected the idea of hiring a personal chef, or eating prepackaged meals. She prefers to continue eating at the same restaurants, and will order foods that are not considered heart-healthy at all, or very unbalanced in favor of sugar/salt. While she is certainly stubborn, she is also quite possibly confused because she has received many conflicting opinions on how to eat healthier, both from her doctors, and from society in general. The good news is that she was never a smoker, and only drinks rarely.

Specifically, I'm looking for A) examples of people who had major "wakeup calls" and drastically changed their habits at an advanced age. What is required from an emotional perspective to be able to reverse such deeply ingrained habits? And B) How can we better accept a person's choice to refuse to change their unhealthy habits?
posted by anonymous to Health & Fitness (22 answers total) 5 users marked this as a favorite
What happens when you talk to her about these things? Have you or your spouse ever said something to the effect of, "Mom, we love you so much, and your health is really scaring us. We're scared we're going to lose you too soon, and it scares us to see you suffer or be in pain when you end up in the hospital. We know you've lived your life your way. What scares you about making the necessary changes that could prevent you from having total heart failure? How can we help you move past those fears? We can't bear the thought of losing you. Won't you please think of us and the rest of the family?"
posted by Hermione Granger at 4:56 PM on July 31, 2014 [1 favorite]

My mother more or less did the same thing, and her rationale was that it was no great thing to live longer if she couldn't do what she enjoyed. She died at 77 in what was a mercifully massive heart attack that sent blood clots to both sides of her brain. There was no trying to rehabilitate her, so we weren't faced with truly difficult choices.

The thing is that I had had some practice with her on less troubling issues. I visited her regularly and I learned slowly that she really didn't care for her home to be meddled with. Sure I could do some dishes for her, but if I did anything more than that, she took it as criticism and felt bad about herself and her preferences, so I decided to view her from the lens that I wanted her to view me from: respect of my choices, even if she herself didn't understand or approve.

I made a few decisions she didn't like, and she would protest about them but not strongly, only in a "are you sure you know what you're doing" kind of way. She let me do my thing. So I tried to do that for her.

And I did check her into rehab for drinking when I was in my early 20s, but I did it by asking her what she wanted (not "do you want to go to rehab" but "do you think you would feel better if you weren't drinking so much"), as opposed to my sister who would stage these big emotional scenes that did nothing. Anyway, she wanted to make that change and she just needed loving support for it. For diet and exercise though? Wasn't going to happen.
posted by janey47 at 5:15 PM on July 31, 2014 [5 favorites]

We had the talk that Hermione Granger recommends with my father-in-law when he had to have heart surgery. For him, the issue was smoking and drinking. I think it helped some with the drinking (though he mostly drinks alone. The smoking didn't stop until he had to go back in with an aneurysm.

You should talk to her, so that you know you did. Whether it helps is up to her.
posted by freshwater at 5:16 PM on July 31, 2014

Some people just don't want to change for whatever reason. And, I think in most cases, the more they're badgered (even lovingly), the more they dig their heels in. If she wants to make these changes, she has to do it for herself for reasons that are deeply important to her.

That said, I think a lot of people only imagine death as a further consequence of bad lifestyle habits. But, in my mind, death is better than a lot of the scenarios like catastrophic stroke that eliminates any hope of living an independent life. Or, not only heart failure, but multiple organ failure that leaves her in need of prolonged, intensive medical care at the expense of most other things in her life. Poor diet and bad overall health is also a contributor to major neurological problems. Is she totally aware of the possible non-death consequences? The prospect of not dying, but, instead, losing all of my independence and freedom in favor of being in an endless loop of hospitals/clinics/assisted living facilities was the biggest catalyst for me making better choices for myself.

And, yes, it's entirely possible that she's confused about what path to take with dietary changes. Most doctors give bad advice because they either have very little nutritional training, or their training is wildly out of date and no longer in line with current research. However, if she's unwilling to cook for herself, employ a chef, or eat better quality meals that are delivered to her, it'll be a tough battle. Is it the social aspect of eating out that she craves? It's possible that being a beloved regular at a restaurant might be the highlight of her day, both socially and otherwise?
posted by quince at 5:20 PM on July 31, 2014 [4 favorites]

Is there any kind of post-care program where she is getting surgery? That would be the best bet to get some change going, I think.
posted by thelonius at 5:24 PM on July 31, 2014

Is weight loss an issue? If so, and she really refuses to eat anything other than restaurant food, maybe you could at least design a low-carb diet staying away from sugars and starches based on the available menus that would let her eat rich savory meals while possibly losing enough weight to jump-start progress on other health goals like exercise. That doesn't really help with dietary heart-healthiness, but restaurant-only as you note is pretty limiting.
posted by XMLicious at 5:27 PM on July 31, 2014 [1 favorite]

My father-in-law suffered from heart failure, and he lived alone, until we had him move in with us to care for him. At that point, I could regulate his diet, take him to the doctor, etc., yet still give him food that he enjoyed. We did limit salt, which is the big baddie in many elderly diseases (I cooked from scratch).

My own Dad, who had a heart valve replacement several years ago, stopped drinking and taking in salt and caffeine after that operation. He drank herbal tea, ate cereal with a banana, chopped up salad for lunch, maybe an egg at dinner (no salt). But he had others around him, my brothers and sister who came up on weekends to stock the fridge with organic chicken breasts and chopped fruit for him to eat as snacks, etc. My brother would cook an egg for him at night. So, no takeout and no frozen pizza and no canned goods, as he could not have salt, and he did okay on that for a while, until his liver failed, possibly from diabetes, or medication complications, we will never know.

I have been through nutritional classes for pre-diabetes, and such, and there were older people there who just didn't care. They were only there because they had been told to go. Some didn't show up for the second class.

In short, no, I don't think she will change if living by herself. My Dad did stop some bad habits after his heart valve surgery, but he didn't stop eating salt until it was really too late (and that was packaged goods, not the salt shaker, none of them knew). And he had someone living with him who kept an eye on it when it became necessary. And the low salt diet that my sister and brother put him on really did make him more comfortable.

It sounds like you are judging her. Maybe she wants to have a quality of life that includes eating what she wants. I know that just because someone gets older, it doesn't mean they don't have any agency in their life. You can show your concern, but unless you are willing to go there and care for her or have her into your own home, there is very little you can do about what she eats. And in the end, with my father-in-law, my home cooking only saved him a month or two, really. But he appreciated it and told me many stories of his childhood during that time. It's super stressful, and I'm not judging you, as caring for the elderly is difficult, but someone has to do it, whether it's the adult children or a nursing home. In the end, the doctor just said he could eat or drink what he wanted.
posted by Marie Mon Dieu at 5:36 PM on July 31, 2014 [4 favorites]

I like the idea of working within the parameters of eating better within the framework of still eating out. Since it is often pointless for the child to discuss these types of changes I am wondering if nutritionists or dietitians ever make "house calls." I am envisioning a medical professional, that she might respect, going with her to dinner and helping her evaluate better choices. That might be a long shot though, so it would probably be more sensible to meet with a nutritionist-type and bring the menus of the places she goes and set up some ideas of healthier options within the context of eating out at her favorite places. Will there be any real change? Honestly I think it's a long shot. I would just ask her (one time) if she would like to meet with someone and really listen to her. It's okay to have an honest conversation, but continuing to nag will be counter-productive.

For my anecdotal evidence I submit my father-in-law. He has had a heart attack and manages his diabetes through medication. The heart attack convinced him to quit smoking cold turkey, but eating out (he also lives alone) is his social activity. Also, he never really learned to cook and he has been upfront about the fact that life isn't worth living if he can't go and do what he likes. Having a conversation about non-death outcomes has not been productive due to the above factors and a healthy dose of denial. We let him live his life and make his own choices. It is true that those choices will likely have a direct impact on our lives, but he is an adult.
posted by dawg-proud at 5:56 PM on July 31, 2014 [1 favorite]

It occurs to me that you should probably explicitly ask whether the multiple heart surgeries being something "she never wants to go through... again" is actually a do-not-resuscitate preference, like she's genuinely saying she would rather die.
posted by XMLicious at 6:22 PM on July 31, 2014 [10 favorites]

I agree with XMLicious, I was going to suggest you have conversations about end of life decisions with her and make sure that she has a power of attorney/healthcare proxy/will etc or whatever she needs from that perspective set up.

Also, as far as the behavior change issues, if I were you I would not pressure her about specific things you want her to do, but rather ask her with genuine curiosity why she is making the changes she is - first making clear that you understand that she is an independent adult who can make any decision she wants about her life and how to live it, and you respect that - so that you come off as being real and not disingenuous.

If she feels that you are not going to judge her or guilt trip her, she might open up to you about fears or misconceptions that she has that would give you other ideas about how to be supportive to her.
posted by treehorn+bunny at 7:18 PM on July 31, 2014

I'm going to respond to B). Her choice is a rational one. She is a person who has been told she has a diagnosis of "heart failure." She has survived multiple awful heart surgeries. Google or don't. A rational person in that situation (age, surgery experiences, medical scary) might conclude that, really, given everything, massive lifestyle change is not going to tip the balance. If you could see that side, maybe that would help somehow. Or not. Senior / health / parents -- it's all really hard.
posted by ClaudiaCenter at 7:20 PM on July 31, 2014 [2 favorites]

What's her social life like? "Eating at restaurants because she doesn't want to cook for herself" can dovetail with "eating at restaurants because that's where she meets up with her friends/has her social interaction for the day," and would warrant a different approach.

Anecdotal: my father had been a heavy smoker for decades when treatment for an unrelated illness revealed lung cancer. He never smoked again, as far as I know. However, before the initial Stage IV diagnosis was downgraded to Stage II (liver involvement turned out to be a separate infection) he said he was flat-out terrified, and willing to do an awful lot "in hopes of a miracle." Twenty years before that episode, he'd put down a nearly life-long alcohol addiction, also cold turkey, also due to health complications; the man is probably in arrears to St. Jude for eternity.
posted by Iris Gambol at 7:38 PM on July 31, 2014

I transcribed reports for a cardiologist clinic in Tennessee for years. I almost never saw any wake-up call changing. Once they've reached a certain age, they sometimes stop taking medications because they hate them and they figure they're nearly done anyway, so why should they give up all the stuff they love the most?

People changing was not common, but it happened when it was made easy - like a spouse was inspired to take over the cooking, insist on daily walks, etc.

It is easier to do what you always have done. If she is not open to premade meals, can you set up deliveries for her (with her permission - let her pick the ones she would be willing to try?) so she can try it out? It's not familiar, so it's not comfortable for her to do it. If you do the work (ordering) for a bit, she may find she likes them.

If an exercise habit is desired, pay for a senior exercise class for her and a friend or two, so she has inspiration to go ("My daughter-in-law insists I go! This is crazy! You come, too!").

In my experience of typing the reports about people with heart issues, the easier it was (and the less they had to do themselves) the more likely people are to change, especially anyone over 65. This is why almost no one made any changes; they were usually alone and had family and doctors who said "you must change" - and not "this is how to do it."
posted by AllieTessKipp at 9:01 PM on July 31, 2014 [5 favorites]

Seconding what Iris Gambol said about eating as a social activity - if that is what she is doing, it will never be fun to have a personal chef or to eat premade meals.
posted by AllieTessKipp at 9:02 PM on July 31, 2014

My heart issues were much less drastic and I wasn't dealing with stopping smoking or similar challenges, but the hospital where I had cardiac stents placed has a rehab program for people coming off of heart attacks, by-passes, stents and things like congestive heart problems. I have benefited greatly and see similar results in people who had much more serious episodes. The program I've been in is low key and highly encouraging. Being around others in similar situations helps. She should check and see if her cardiologist can direct her to a program such as this. Medicare is very supportive. Private insurance, also. It takes a lot of days of rehab work to cost as much as one day in a cardiac care unit as an inpatient.
posted by uncaken at 10:06 PM on July 31, 2014 [2 favorites]

I'm sorry, but maybe because I'm in the same age group and have some pretty advanced medical problems of my own, I have to stand with your mother-in-law. Her heart is pretty well worn out after multiple heart surgeries and now heart failure, which pretty much just means her heart is having to work harder than it's really able to do to pump the blood adequately throughout her body - her heart is tired out. You will not get her heart back into good shape with a heart-healthy diet and exercise - that was maybe fifteen years ago, not now. She knows that with her heart in the condition it's in she doesn't have another fifteen or twenty years to go regardless of how she changes her lifestyle, so she's just going to enjoy what life she has left. It's a point many of us come to if we live through the preliminary stuff to get there.

When I worked in a hospital years ago I very clearly recall a few patients in particular: One was a PE teacher, a fitness and nutrition and health and exercise fanatic, who came in with terminal colon cancer and she was absolutely heartbreakingly devastated, angry and in denial and - really, she felt betrayed by all she thought she had done right. Another lady was much older, but again lived organically, raised her own food, drank milk from her own goats, used herbs and vitamins and was obsessive about controlling her health; she had a major stroke that paralyzed one side of her body and took her speech, and again she was so, so angry and sad and shocked. It was harder on these two women - and another man I remember, a man who hunted bear in Alaska and had trophy animal heads mounted in his huge "cabin" - a man who had to have a colostomy bag and flat refused it until he was nearly dead. Other patients had been eating salt, sugar, fat, and other "wrong" foods, smoking, drinking, sometimes hard workers but not following any exercise regimen prescribed by their doctor, etc. - when they came in with some terminal illness, their attitude was more like, "Well damn - it figures." Now I'm not saying they were better off or more deserving of their illness, but acceptance came easier to them, for good or for bad.

One wonderful elderly gentleman had had a bad heart attack seven years earlier and his lovely wife put him on a heart-healthy diet to the max, got the excess weight off him and exercised him nearly to a marathon level and - crap - he came in with terminal colon cancer. His wife was devastated and so was he, of course, but when he went home he told me, "You know what I'm going to do when I get home? I'm going to have sausage and saurkraut! It might kill me, but I've wanted it so bad for so many years I'm eating it for supper tonight!" And his sweet wife smiled and nodded - she'd fix it for him.

When you get old and you get hit by the train, you might be of a mind to try to get back on your feet, give it everything you've got, or you might think about it and decide that you're already too far gone and you might as well just enjoy what time you have left; the food we eat is very much a part of the enjoyment of life and that counts for a lot when you're old.

I'd just hug her and eat healthy yourselves and encourage her - gently - to do what she can, but please don't push her too hard. It's hard enough to deal with without your kids trying to parent you when you don't want that.

I hope she has a whole bunch of happy days left.
posted by aryma at 1:35 AM on August 1, 2014 [18 favorites]

Probably not an anecdote you care to hear OP, but for what it's worth.

My father died last year, at 68, of heart failure, after a predominantly healthy life with no weight issues. This did not come out of the blue, he had several smaller heart attacks up to nine months before his poor tired heart just gave up. His heart had many problems and it would have got him eventually. But.

But he simply could not, after a lifetime of hard work and exerting himself, stop exerting himself and working hard. He only retired from teaching full time 6 months after the first heart attack. He did not stop exercising, swimming, llifting things, bike riding etc. even though he knew it was dangerous and could literally kill him and did in fact put him in hospital via the ambulance more than once.

How much longer would he have lived, if he had listened to our begging, our pleading, our anger, sadness, guilt trips, bribery, cajolery, persuasion and impassioned requests? We, and he, will never know.

I say this to illustrate how hard the - largely non-addictive compared to smoking, drinking, eating junk food - habits of a lifetime are. You may have better luck than us. We tried everything and he knew it was killing him and did it anyway.

You can't change a person unless they want to change, I'm sad to say - and with regards to stuff like this, I think you'll find most doctors would agree that voluntary lifestyle changes for medical reasons happen very slowly, if at all.
posted by smoke at 4:23 AM on August 1, 2014 [1 favorite]

You might find this post interesting - it discusses the reasons why some people are unable, even under threat of death, to make certain changes. There's also some info about how to shift things, though I don't know how successful you (or anyone) can be in making that shift happen for someone else.
posted by VioletU at 4:57 AM on August 1, 2014

My Mom was a smoker who got throat cancer in her 80s. She came home from the hospital, after the surgery to remove the tumor, and lit a cigarette. She smoked even though she was having radiation, and her throat was raw and vulnerable. She smoked while on oxygen, seriously, with the oxygen tubing around her neck. She only really quit when she could no longer go out and buy cigarettes. Same with drinking, which caused many problems, though the problems were less obvious. We all asked her to stop smoking, because we loved her, and wanted her to live.

Your Mom has a lifestyle that includes eating out, which is social, and which she enjoys. Go to the websites for the restaurants, or otherwise check the nutrition values of menu choices. Ask her to make a few changes, maybe adding a green salad with light dressing, having the fish more often, etc. What does she do for breakfast? Maybe she'd consider having a reduced-fat blueberry bran muffin, or raisin bran, and OJ or fruit. You can hire someone to shop for her and keep a few easy healthy items available.

If she can't/won't change her eating habits, and she probably can't exercise, what other health options might be possible? Does she get adequate sleep, or does she fall asleep in front of the tv? Don't ask her to change, put the tv in her bedroom, or make the couch conducive to good sleep. Does she drink enough water, take her meds, etc.? There may be incremental changes you can help her make. Old people have a lot of younger people telling them what to do. Sometimes, they hate that a lot. Focus on helping whatever time she has left, which may be more or less than you expect, as happy and enriching as possible.
posted by theora55 at 6:56 AM on August 1, 2014

An anecdote that points to people being stuck in their ways, or not seeing how certain (possibly difficult) lifestyle changes could really make their lives better: a relative of mine is a doctor, and when he was doing his rotations, he met a woman who didn't want to be diagnosed with diabetes. From her experience, that was a sure path to getting her legs to be amputated, because that is what happened to her relatives who were diagnosed with diabetes.

It's hard to help someone to change their behavior, and much more so from a distance. Everyone has different triggers that will be their "wake up calls," if they have such triggers at all. And everyone responds differently to different kinds of support and raising of concerns. Whatever your spouse and you decide to do, pay attention to how your spouse's mother responds and reacts, and adjust your strategies accordingly.

Why doesn't she prepare her own meals? And why does she always eat the same things? Maybe you can share some easy recipes you found that you like, catering to her tastes and preferences. Here are 53 three-ingredient recipes, and there are books with the same sort of recipes with limited ingredients and simple instructions. Try some pre-packaged meals, because some of them can be pretty tasty, and share what you find with her. And see what those restaurants offer besides her meals of choice.
posted by filthy light thief at 11:25 AM on August 1, 2014 [1 favorite]

Around So Cal, there are healthy meal delivery services. Very cool - food is delivered at the door, so when you get up, all you do is pop them in the fridge. I do not have this service. But, if someone bought it for me, I would definitely not be eating like I am now.
posted by crw at 1:20 PM on August 1, 2014

Another thought: perhaps given that nutrition in general is such a complicated topic, and she's unlikely to suddenly adopt a completely different diet, you could just focus on a single rule?

CHF can get exacerbated by a salty meal, throwing a person quickly into an episode where their lungs fill up with fluid and they feel very short of breath. It is no fun to go through although generally quite treatable with diuretics and breathing/oxygen support. If she focuses on just a low sodium diet (even though a low sodium diet is in itself challenging, especially eating restaurant food) it might be easier to get her mind around, especially since the results of "dietary indiscretions" as we call them in medicine can be so quick and miserable.

Final thing you could encourage - people with CHF can often follow the status of their CHF closely by monitoring their weight daily. It's easy to do and very helpful for medical providers to judge how the treatment is working and whether an exacerbation might be imminent or incoming. Maybe get her a nice, easy to read scale and journal to record the weight numbers in, and encourage her to use it?
posted by treehorn+bunny at 7:05 PM on August 1, 2014

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