When your loved one won’t eat. 

     There will come a time in the course of dementia that your LO will stop eating or eat very little. Sometimes this is temporary but often it becomes a major concern.  

The following suggestions may help: 

Look for a physical reason. There are many physical problems that would bring about refusal to eat.   Check for: 

Dental problems.   Loose teeth, tooth ache, sores from dentures, canker sores, or other oral issues.            

Physical issues. Pain from arthritis or other physical condition. Headache. Urinary tract infection, etc. Constipation may also be an issue. A visit to the doctor to rule out physical problems may help. 

Depression.  Most people with dementia will have some level of depression. Even if the person is on an antidepressant, it may need to be adjusted. Be aware, however, that some antidepressants decrease appetite and some will increase it. Ask the physician. 

Visual Problems.  Can the person see the food? If they wear glasses and don’t have them on, this could be a problem. The person could also have agnosia, a term used to explain what happens when the person’s brain can no longer process what the eye sees. 

Older people lose more than half their taste buds by the time they are 65.  Food may taste bland. Try enhancing the taste with products such as No Salt, a seasoning alternative to salt. 

Check for swallowing problems or pocketing of food.   At some point in later stage dementia, the person will no longer be able to swallow normally. Coughing and choking may be a problem. 

Look for possible side effects of medication . Check the side effects of any new medications, but even if someone has been on a medication for a long period of time, this is still a possibility.  Some medications can reduce appetite and others may cause digestive problems.  

What can caregivers do to help? 

Check to see if the person needs more help eating? Are they confused by what they see on the table? Here are some steps you can take. 

Use help aids.  There are many help aids for people who have problems eating. They include such things as plates with rims to help keep food on the plate, utensils that are easier to use and sippy cups for adults. It may also help to reduce clutter on the table, serve the food in a solid colored plate on a contrasting mat and avoid patterns in table cloths. 

Try serving one food at a time. Do not place everything on the table at once. For instance: serve a small salad or something like applesauce. Remove it. Serve the main plate of food, remove it. Serve a slice of buttered bread, remove it. Serve desert.  Keep a beverage handy for the person to sip between bites. 

For the person who is having difficulty with utensils and handling the food, there is a step between independent eating and being fed. Try breaking the task down. Encourage the person to do such things as: pick up the fork, put some meat on it, put it in your mouth.  You may have to Help the person get started.  Place your hand over the person’s hand. Help them to grasp the fork or spoon, put a small amount of food on it and guide it to their mouth.  Doing this several times can re-establish the physical pattern in the brain and the person may be able to finish on their own. 

You may have to demonstrate chewing.  It may also help to gently stroke the throat to encourage swallowing.   

Short attention span may be a problem. Feed the person in a quiet room and remove any distractions. 

Make sure the food is warm, not too hot or cold and flavored with mild spices. 

If the person is no longer able to handle utensils at all, try finger foods. People with dementia who are still able to self-feed seem to eat more. Use a bib or towel to protect the clothes. 

 Other things you can do:   

Avoid pressuring the person to eat.  Try not to increase anxiety at mealtimes. This will only make the situation worse. 

Try feeding 6 small meals instead of 3 large ones.  Make each bite count. Focus on protein, high calorie items and nutrition dense food. 

Consider comfort foods and don’t forget treats.  Try such things as peanut butter and jelly sandwiches, Nutella, macaroni and cheese, hearty soups (these can be pureed if needed), cheese and crackers, ice cream and pudding, anything the person liked to eat before they got sick. Try making their favorite recipes. 

Increase exercise if possible.   Taking the person for a short walk outside can do wonders to increase the appetite.  

The late stage dementia patient: 

The person in the last stages of dementia will eventually lose their appetite and then their sense of thirst. This is a signal that the body may be shutting down. At this point the body is no longer able to digest, metabolize or excrete nutrition normally. Forcing them to eat or drink will only cause distress and may put them at risk of aspiration.  At this point the person with dementia is usually bed-ridden, totally incontinent and very confused. Most families will use hospice for support at this time. 

Stephanie Z 

Good suggestion Nessa, Thanks,

Stephanie

I have been doing them all Stephanie; 

why does pocketing happen?

Ny neighbor as you referred to, has a side effect from anti depressant  of decreasing appetite.  She is so thin (she has been caretaking for 8 years and her husband just passed).

The doctor is switching her to a new anti depressant which has the side effect of weight gain.

One can always check with the pharmacy before they have a prescription filled to see if it is a med you want to use.

Hi Bella, Pocketing food is simply storing it in the cheeks (kind of like a chipmonk) rather than swallowing it. This may be a symptom of dysphagia (impaired swallowing) or simply because the person does not want to eat and feels pressured to put food in their mouth.

Stephanie

larkep, take a flashlight, tell her what you are doing, and try to look in her mouth to see if there is an infection or sore in there. I'm not in support of forcing her mouth open or pouring liquids in when she is gritting her teeth. Either something is irritating her mouth or she is just not wanting to eat or drink.

Having said that, it would not suprise me to find out that it might be related to brain activity. Perhaps you will never know, but at least please try to look inside her mouth.

Stephanie

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.

The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:

• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky
• Loss of consciousness

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:

• Give 5 back blows. First, deliver five back blows between the person's shoulder blades with the heel of your hand.
• Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich maneuver).
• Alternate between 5 blows and 5 thrusts until the blockage is dislodged.

The American Heart Association doesn't teach the back blow technique, only the abdominal thrust procedures. It's OK not to use back blows, if you haven't learned the technique. Both approaches are acceptable.

To perform abdominal thrusts (Heimlich maneuver) on someone else:

• Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
• Make a fist with one hand. Position it slightly above the person's navel.

• Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
• Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid.

If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths.

Demonstrations can be found on youtube at: https://www.youtube.com/watch?v=7CgtIgSyAiU