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making excuses not to eat
Posted: Friday, November 8, 2019 10:19 AM
Joined: 11/8/2019
Posts: 1

Good morning to everyone! I'm new on here and I would appreciate some advice for helping my father-in-law. Dad moved in with us this September 26th. My husband brought Dad from a nursing home in their hometown of Hagerstown, MD. Dad was being neglected as only a facility can do it, not to mention his step-daughter's neglect/financial abuse of him, (and her mother). Dad's wife was my best friend, she passed away on Thanksgiving eve 2018. Dad has mild to moderate dementia, and so we are learning how to work with him for personal care. I was a CNA for five years, which training has really helped me, along with a goodly dose of plain old common sense.  

So here's the problem with Dad. He is six feet tall, and weighs only 126 pounds. Doctor thinks it's likely due to prostate cancer, (which hasn't yet been confirmed, although my husband has it), as well as long term neglect. Dad seems to think he has diarrhea all the time. But he certainly doesn't eat nearly enough to actually have that problem. Still, he spends a LOT of time in the bathroom, yet nothing significant happens there. There is a "large mass", an enlarged prostate until we know more, which is likely causing this urge to defecate constantly all day. 

Dad is now using the "I need the bathroom" excuse to not eat. Almost as soon as we serve him the small meals we fix, he's in his wheelchair bathroom bound. Of course, his food then gets cold, and he declares he "isn't hungry right now" when he's back in his room. Obviously, we can't deny him the bathroom, but considering there is no real diarrhea issue, he's using that to not eat meals. However, offer him some junk food, and he's all over that stuff.

We are at our wit's end trying to get Dad to stop with the bathroom excuse long enough to actually eat a small meal couple of times a day. He doesn't like any of the supplemental nutrition drinks, but will eat (for example),cheese, olives, and a half banana for a snack. Dad adores banana popsicles, peanut butter and banana sandwiches too. But getting a real meal into him has become a challenge. He'd rather be in the bathroom becausse of "diarrhea" than to sit and eat a small healthy meal.

Please, if any of you have some ideas or solutions to help us get Dad to stop fixating on the "diarrhea" issue and enjoy some healthy small meals, I would appreciate hearing from you.

Thank you and God Bless all of you!

Posted: Friday, November 8, 2019 11:01 AM
Joined: 10/9/2014
Posts: 1091

Caring for a PWD in your home is quite a challenge. I'm sure your training has been an asset.  Are you at home with him all the time?  I ask, because, it might be that you end up needing to restrict him entering the bathroom alone.  Can he be supervised in the bathroom each time?  I know it sounds odd, but, eventually, he will not be able to handle the visits on his own.  His judgment sounds like it's already suffering. 

I'd likely first try to figure out what is causing him to feel urgency or pressure. See if he can be treated for this.  At least get the options, if there is some problem in that area.  My dad had urgency and the urologist treated him with meds that worked great, but, I'd figure out what is going on with him medically and if it's affecting his appetite or weight loss. I'd inquire about something called Cachexia.  It can cause some of the symptoms you care describing. 

I'd discuss the diet with his doctor and get his input.  Is there any reason that your dad can't just eat all the foods he loves and not struggle with a certain diet?  When my LO got dementia, my goal was to keep her as content and comfortable as possible. And, we focused on quality of her time, not quantity, though, I realize not everyone subscribes to that approach. 

I hope you can get the answers you are seeking and that your dad can get some relief. 

Posted: Friday, November 8, 2019 11:42 AM
Joined: 10/24/2018
Posts: 1078

Welcome! You are a loving DIL for sure. 

The medical issues should be addressed, certainly. If he feels he has to go, that is real to him. 

If you look at what he will eat, rather than what he won't, your list includes all the basic nutrition a vegetarian could ask for. Peanut butter and banana sandwich with cheese and olives is a very good meal indeed! One of my boys grew to six foot plus, 165 lbs, on PB&J sandwiches, bananas, and coffee yogurt. I kid you not. 

Or perhaps being at the table is somehow connected to this. 

Posted: Friday, November 8, 2019 3:33 PM
Joined: 2/6/2018
Posts: 290

Give him the food he wants to eat, as much as he wants. He is severely underweight, has suffered neglect, likely has cancer, is physically uncomfortable, and is old and has dementia. IMO, the priority at this point is allowing him to eat whatever he wants to eat, when he wants and as much as he wants, and to make him as comfortable and happy as possible. It sounds like a sad situation. I’m glad you got him out of the bad facility and I hope he can spend his remaining days with as much love, gentleness, and comfort as possible. P.S. Peanut butter and banana sandwiches would be good nutrition for him.
Eric L
Posted: Friday, November 8, 2019 9:56 PM
Joined: 12/5/2014
Posts: 1288

Is FIL being treated for anxiety? It was explained to us when MIL started the whole "I need to go pee every 3 minutes thing" is that it is often anxiety related. It might be worth looking into. In our case, when her meds were adjusted and we found a sweet spot, she didn't have to visit the bathroom as often as she did before they were adjusted.

As far as meals go, this is one of those times that caregivers need to adjust our expectations. The reality is that dementia is terminal. Healthier eating or regular meals won't make them better. As the disease progresses, they will eat less and less. We watched my MIL go from eating 3 solid meals a day last fall to being lucky on some days if we could get a packet of instant oatmeal in her, a couple of ensures, and a yogurt in her. My philosophy is that when they are still willing to eat, essentially let them eat whatever the heck they like. Get as many calories as you can in them, even if they aren't "good" calories.
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