Frustration with eating

dadoesApril 29, 2013

Having constant frustration dealing with getting the grandmother to eat, properly. Left to herself, she'd either sit all day and eat nothing, or nibble on crackers, maybe a Roma tomato, slice of bread, a sandwich half (the daily sitter keeps a few ready-made in the 'fridge). Last couple days she has been binging on Diet Rite Cola ... which is funny being as she constantly claims to dislike carbonated drinks. If I give her half a can with supper, she complains it's nasty but she drank three cans between evening and morning yesterday.

She doesn't recognize "food" in the refrigerator. Bowls of vegetables, meatloaf, chicken & pasta, rice & ground beef & gravy ... all sits untouched. I come in at the evening, heat a small portion. Call her to come from the living room to the table for supper. She typically goes to crying that I'm "fussing" at her, just at the simple suggestion to come eat supper. I can sit at the table with her, not saying a word, and she's sobbing and sniffling, picking at the meal, then pushes it away that it's too much.

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Instead of 3 regular meals have you tried mini snacks/meals instead? You don't mention how old she is, any health issues?

You might want to try some boost or ensure ( diluted with milk ) in small quantities throughout the day to get the proper nutrition or
maybe some smoothies instead?

    Bookmark   April 30, 2013 at 11:28AM
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My mother was the same way, an anti-depressant really helped and also, they do make a medication that is a appetite stimulant. I know someone that wasn't eating much at all and the appetite stimulant medication really helped. Of course, we could not tell my mother what the medication was really for, we just told her it was to help give her more energy, she was ok with that. I bet your grandmother's doctor would help you with either or both. Good luck....

    Bookmark   April 30, 2013 at 12:33PM
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My mother was the same. A normal serving of food was a complete turn-off for her. Sometimes even a child's serving in a restaurant would destroy her appetite. So when you fix her a meal, just put a few bites on the plate. It might not look right to you, but it may be fine for her. If she wants more, then add a couple more bites.

Good luck, this was a tough one for me.

    Bookmark   April 30, 2013 at 12:54PM
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Yes, it's tough. MIL has always been careful with her weight. Now it has turned obsessive with her dementia. Add in a naturally decreasing appetite as one ages, and it's a recipe for being eventually bedridden.

Talk to her doctor. Like dbfirewife said, there are a few prescriptive drugs that could help.

Assume you have proper legal and financial PoA docs done already?

    Bookmark   April 30, 2013 at 1:59PM
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Age 93. Dementia moving well along. Had a stroke 2001, vision & some memory affects, no paralysis. "Mildly" diabetic, on a daily pill. Thyroid supplement, BP, laxative. A previous doctor had her on an antidepressant for a couple years but she had a couple episodes of rage that stopped happening when the med was dropped several years ago.

She may peel/cut an apple, cut a tomato, open a bowl of crackers or fruit, bread/butter, unwrap a sandwich half ... but she won't get into a bowl of meat or vegetables by her own accord. Just. Will. Not. Or maybe can't is a better way to put it? So the only way she gets a "meal" is via the sitter (M-F bfast & lunch) or me (supper, S-S bfast). I usually present the supper as being something I brought, even though it's prepared food from her refrigerator.

    Bookmark   April 30, 2013 at 7:51PM
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93 with dementia and living alone (altho with some care)? I think that any problems you may have right now with eating are minor compared to the big picture. And no, probably nothing you do will make her change and feed herself. It will only get worse. So for your own sake, realize that fact.

Do you have a plan for the next step?

    Bookmark   April 30, 2013 at 8:31PM
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To clarify, she isn't served a full-size dinner plate by any means. I use a dessert-size/pie-slice plate or a 15 oz. Corning Grab-It bowl. One entree choice (beef spaghetti, chicken breast, etc.) and one vegetable or maybe smaller portions of two. Or something like mixed rice, ground beef, & gravy or a portion of one of those bag-type frozen meals such as chicken & pasta that the sitter has prepared in the fridge. Inevitably she protests immediately that it's too much. I may show her a full-size dinner plate for comparison but of course that doesn't register. Not unusual that one Grab-It bowl starting maybe 3/4 filled carries over for a 2nd day's supper. Today (Tue) there was a tiny portion still left from Sun evening that she wouldn't/couldn't finish yesterday (Mon) evening.

    Bookmark   April 30, 2013 at 8:35PM
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CA Kate

It is not at all unusual for elderly people to eat much less than what we would consider normal, their bodies simply don't need large quantities of food.

Then, there could time- of- day issues. She might be more hungry at noon than at 6 pm. Also, as ogoopogo mentioned, many tiny meals might work better than 3 bigger ones. If she likes sandwiches then give her sandwiches... In her comfy chair if she wishes.

Think of her as a small child, both in her food amounts AND her behavior.

    Bookmark   April 30, 2013 at 10:06PM
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In watching my MIL and from many stories about elderly who do NOT have dementia, I'm not so sure the major reason (for undereating) is the natural decline in appetite.

We also spend time with two still-active, sharp women who are 91 and 93 respectively, and a couple the same age as MIL. Although they eat less than they did a decade ago, it's not that much less, and they are happy to snack between meals.

Dementia means more than just memory loss. It also means that the "body signals" to the brain begin to short-circuit, too. I have had MIL say "I'm too full" as she sits down to dinner, before she's even had a bite - when we know she hasn't eaten anything for over six hours.

Left to herself, she will only take half-portions and as little protein as possible. Not only does she not eat properly, her calorie intake, even on minimal activity, dips dangerously low, into the rigorous dietetic range (which she so doesn't need, not being overweight).

So far we have been able to trick her a little into eating more:
- Cutting the crusts off sandwiches, and making the filling more substantial (extra cheese, extra meat). Without crusts she will often eat 1-1/2 sandwiches, sometimes even two of them, for lunch.
- Having more soup. She won't take much of it, no more than 8-oz., but even that little amount of a substantial soup, like split pea or a chicken-corn chowder, helps.
- Having shelf-stable desserts she likes. She loves custard, for example, and tapioca pudding. I don't care about the preservatives; I think she needs them just for calories.

Eventually she may end up like her SIL: so weak from gradual, continual starvation, she ends up permanently bedridden. Sometimes all you can is hold off the inevitable for just a little while longer, and then realize it's time to surrender gracefully.

Best of luck to you on this difficult journey.

    Bookmark   May 2, 2013 at 4:21PM
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Could be another problem also, my mom didn't say anything for longest time(my dad had same problem) their teeth needed to be checked out(dentist was on 2nd floor & neither could walk up the steps.)So got new dentist- Dad had a tooth pulled & he was still afraid to eat chewy meat as the stroke had left him slightly damaged & he would bite inside of mouth a little or ends of spoons occasionally, I can see where he bit them eating ice cream(it's soft but for some reason he bit down they are good quality stainless steel) Mom's problem when I questioned her was "seed from strawberry gets caught under denture on top to finally telling me they feel like they are falling out.(She gets new dentures in next week) They don't always make it "clear". So ask Mom, does your mouth hurt when you eat, top or bottom teeth?(They had regular dental care but dad didn't want to go as he wanted to clamp down & thought he would hurt dentist" Ask if they have sore mouth or sore, watch for cracked or bleeding lips(I get that when it's cold & I'm much younger) Look for cracks in corners of mouth, that can make eating painful. Dad would eat most food but didn't want veggies the last yr. too hard to chew. Mom wanted different food every day & didn't like leftovers but has switched to wanting salad of veggies(no lettuce) & baked potato every night. Morning used to be big meal of 3/4 to 1 cup strawberries, blueberries & raspberries, cup of cereal, hot or cold, piece of toast, orange juice & coffee. Now it's 1/3 oj, 1/2 cup coffee 1/8 cup cereal with 2 tbls, milk & the fruit. No toast, no egg scrambled. Occasional pancake that I've removed the salt & use Hain no salt baking powder, or orange cheese pancakes I changed so her legs don't swell up. But what a difference in 6 mos. Lunch is 1/2 what it was. They do change a lot as they age. Mom's 91.

    Bookmark   May 2, 2013 at 8:03PM
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She ate pretty good this evening. :-)

No dentures! She doesn't have any ongoing dental issues. Went for checkups every 6 months (fussed all the way there and back) until about a year ago when her long-time dentist retired and moved away. I didn't switch her to a new provider due to all the ruckus always involved with the appointments.

    Bookmark   May 2, 2013 at 9:10PM
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CA Kate

Ahhh. But could she have tooth pain? You say she hasn't been checked in a year, something painful could have popped-up in that time.

We get DH in 3 times a year for a cleaning and checkup... because our insurance pays for that many times AND because I can't really see what I'm doing when I brush his teeth. So far so good.

    Bookmark   May 3, 2013 at 2:17PM
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Well, my mother also developed this; she had had a few tiny tiny strokes before she had the one that left her so disoriented and unable to care for herself. Just as you describe it...too much food on the plate, she would push it away, "I don't want it". So, I just gave her a couple of bites of each item, then if she seemed to relish any one thing, as many bites more of that as she would take. and I fed her six of these little meals instead of 3 -- the extra 3 would be "treats" or "snacks" like a bit of cheese or several honey peanuts or ice cream. She hated Ensure-type drinks.
It seemed like she would be overwhelmed by the sight of a full, or even what would be for me a half serving. I do think that her strokes were the cause of this.

    Bookmark   May 7, 2013 at 11:04PM
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We prefer Boost to Ensure. Ensure tastes terrible and is much higher in sodium. Boost has both a high protein as well as a Plus variety (which has a higher calorie content. I'm tbinking of changing MIL to the Plus soon. The chocolate is yummy, in fact - makes a super mocha coffee!

    Bookmark   May 8, 2013 at 11:27PM
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I help an 89 year old friend with her shopping. and she is diabetic. She loves the Glucerna chocolate supplement, says it's really tasty, and it's okay for diabetics.

    Bookmark   May 9, 2013 at 12:10AM
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My Mom passed at age 87 from COPD/ emphysema. She had lost weight over the years, going from 130 to about 90 lbs at her death. At one point, she was hospitalized and refused to eat hospital food. They gave her canned protein shakes, she'd take a sip then set it on the window sill, saying I'll have it later but she never did. My hubby with MS is now bedridden. He sees fast food commercials on TV, insists he wants a certain burger, I'll drive and get it but then he eats only a little, our dog gets the rest. Just my experiences regarding appetite problems in sick/elderly. .

    Bookmark   May 17, 2013 at 11:33AM
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Fri evening I went by, checked the mail, picked up the sitter's time sheet, fetched some clothes to wash, crossed-off the day on the calendar. Refrigerator had: full casserole of HB Helper spaghetti; smaller bowl of bits of chicken breast with broccoli florets & macaroni & light cheese sauce; another dish of chicken breast & mixed veggies; 4 ham/cheese sandwiches cut in halves; 3 Roma tomatoes; small bowl of corn; small bowl of green beans; small bowl of carrot sticks; milk; tea, etc. I hid the sandwiches in back of crisper drawers with half loaf of bread. Took the lid off the chicken/broccoli, left the dish prominent in front. Asked if she wanted supper, she didn't respond so I left without pushing the issue.

Sat 7:15 AM went by for the first pill. She had eaten a tomato in the night, nothing else touched. Back at 9 AM for breakfast. Sugar-free instant oatmeal (she loves it), and small portion of the chicken/broccoli (she doesn't know the difference between breakfast, lunch, whatever ... often confused between morn & evening). I went by 6:15 PM for supper. Another tomato gone. I had her to take her desired portion of the chicken/broccoli, which was only three spoonfuls ... so I took a bit more and added green beans. She ate the whole thing.

Sun 7:15 AM, she had eaten a tomato again in the night. I did not go back for breakfast. 7:45 PM, she had opened and ate a full can (15 oz?) of no-sugar-added apricots. The can was left in the sink but she denied having ate them, said she had been saving the can but couldn't explain why, or how it got empty. She also had found the bread and sandwiches, and took a box of pasta from the cupboard (of course, didn't know what it was or what to do with it). I tried to get her to agree for some spaghetti, green beans, and tea for supper ... she refused. Ended in an argument with her complaining about being weak (no kidding), confused (yup), ranting/raving about wanting to be dead (common theme for years). So I left.

    Bookmark   May 26, 2013 at 11:02PM
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Dadoes, you're only frustrating yourself. You cannot reason with her. You cannot get through by using hints or putting things in special places. That's magical thinking.

And it is not going to get any better. Time for a reassessment of her entire living situation and the 'sitters' and you. Whatever you're doing now isn't working too well, is it?

I don't mean to be harsh, but what you wrote about the past three days is just an exercise of you beating up on yourself. You won't make any inroads in her behavior unless something else changes, I am sorry to say.

Good luck. Been there,,,, etc.

    Bookmark   May 27, 2013 at 5:54PM
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CA Kate

Without going back and retreading the whole thread....

She really needs to be in an assisted living situation. Is there some reason this isn't happening?

    Bookmark   May 27, 2013 at 6:18PM
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I concur.. It is time to go to the next level when they are harming themselves or others. She is harming herself with the eating or lack of it.. Confusion , not enough fluids I bet.

It's time to move onto the next level..

You have to REMEMBER you are the parent now & she is the child and you need to do what's BEST for her.

Keep us posted and lots of luck & ((hugs))

    Bookmark   May 28, 2013 at 10:07PM
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Finances are bottlenecked. The only income is SS of less than 1K/month. What's left of savings wouldn't last a year at nursing home rates.

Pulling her out of her home of 65 years would destroy whatever spirit remains in her psyche.

Best we can hope is she dies at home as she wants, within the time span supported by the remaining funds ... until/unless something more specific happens to force an alternate route.

    Bookmark   June 1, 2013 at 10:13AM
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If she has dementia, she could be in a nursing home, covered by Medicare/Medicaid. Talk to an attorney who specializes in elder law ASAP. She owns her own home? The value of that should go to her care. so you'll know how to handle her assets.

I'm serious about talking to an attorney, and fast, so you'll know how to handle her assets. The longer you wait the more she'll suffer ad the less control you will have of any assets that she has.

    Bookmark   June 1, 2013 at 12:41PM
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Just do not agree to pay for her care. Allow her house and savings fund her care. Talk to your counties Medicaid coordinator. Called different things in different areas of the country. She can keep her house but when she dies it must be sold but keeping her safe should be more important than any inheritance she would leave.

    Bookmark   June 1, 2013 at 11:06PM
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Yes, if you are dealing with dementia, I cannot emphasis too much advance planning. Even a couple of years out, it is important to do now. Talk to an elder care attorney before you do anything else!

    Bookmark   June 1, 2013 at 11:28PM
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In Kansas she would have to sell her home when she ran out of money to pay the bill. If she has her children's name on it she does not. The one I know about had two daughters so a third of the home went to medicaid when sold.

    Bookmark   June 3, 2013 at 3:16PM
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The "sitter" has been involved since Oct 2007, so it's not a new situation. I can't put a finger on precisely when the dementia started, of course.

Granny has only a 3rd-grade education. She worked as a "laborer" ... there is no pension / retirement other than SS and her savings, which she did amazingly well considering her stature in the economic chain but it's a pittance compared to what others may have. The house is 68 years old, needs substantial repair. Appraisal district valuation of the property is $30K. The value is to her as a home of comfort and familiarity.

It's too late for a plan to "protect" assets and even back in the day there weren't enough assets to be of note. Far as literal control, we have that. She was widowed in 1964. My mother is the only child. Mom and I both have direct access to the funds, I've been handling the bill paying for years before the dementia started so there has never been an issue of "getting control" from her. The savings *is* going to her care, as it should. Durable Statutory and Healthcare POAs are done. I live 2 miles away, can get there in 5 mins.

I'm not asking for advice here on how to handle the situation as a whole ... although insights are always welcome for reference and comparison ... as in "we've been there, this is what we had to do."

Mom has in fact been there, done that with her aunt & uncle (granny's sister), who had no children. They had more funds and his pension income.

I'm looking for experienced suggestions on working with and within her mental condition and behavior to facilitate her comfort, to the extent that it's even possible. It'd been better if she had died 13 years ago when the mild stroke occurred than to go through this mental hell-on-earth ... but that's now what happened. Modern medicine can be cruel in unreasonably extending life.

    Bookmark   June 4, 2013 at 2:30PM
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dadoos, I agree with modern medicine prolonging life. I have a "comfort care" document for myself. It is similar to a living will that stops the use of machines to prolong life, this one stops the use of meds. It is called by different names in other states.

My husband had it also. When he was in the hospital they called me to tell me the doctor ordered nutrients through the IV, I said he has a comfort care order. She told the doctor and they didn't proceed. This document covers any meds from being administered to prolong life. I won't even have tests anymore because I wouldn't take treatment for anything fatal.

    Bookmark   June 4, 2013 at 4:52PM
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We are not ignoring your original question by not giving solutions. What everyone is saying is that there are no solutions, and you are seeing the progression of dementia to the point where you need to consider your next step in caring for your grandmother.

All of us who have 'been there, done that' have come to that conclusion. There is no magic pill that will make her start eating properly and not driving you nuts.

Sorry, you have my deepest sympathies.

    Bookmark   June 5, 2013 at 11:34AM
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The sad thing is, my experience has been that neither assisted living or a nursing home (unless they are top-flight facilities, which I did NOT experience) will help with the eating. My mother went from 110# to 94# in the first 6 weeks that she was at the nursing home, while still getting OT/PT for her strokes and still able to walk with her walker. They simply didn't pay any attention to her intake, even though I discussed the problem thoroughly with their intake coordinator and repeatedly with the "nurses".
By the end of her first year there, she was down to 79#. (Yes, I tried to move her to another facility, but with her on Medicaid, no one ever had a bed "available")
I often see elderly admitted from nursing homes or assisted living with dehydration and /or malnutrition. The staff will put the food in front of them, but don't notice if they eat.

    Bookmark   June 17, 2013 at 6:37PM
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I read an article that said most seniors die of starvation and I thought that meant not eating at all. Now I realize that it can be caused by not eating enough to sustain life.

    Bookmark   June 17, 2013 at 8:59PM
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CA Kate

Wow! Emma. Just something else I'll need to start watching.

    Bookmark   June 17, 2013 at 9:54PM
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There's a point where someone is eating so little that you need to stop worrying about what they are eating and just worry about getting them to eat anything.

Yes, a balanced, nutritious diet is better. But if someone is not taking in enough calories, then anything you can get them to eat is better than nothing.

So if she likes tomatoes, always have tomatoes in the house. If she likes the canned fruit, always have canned fruit in the house. If she likes sandwiches, have sandwiches ready to go.

If she'd rather eat in front of the TV, let her eat in front of the TV. She's 93. She doesn't have to eat her vegetables if she doesn't want to.

And based on what you say she likes--oatmeal, tomatoes, canned fruit, sandwiches--these are all pretty soft foods that may not need a lot of chewing. So I'd try to get her to a dentist for a checkup. She could have broken a tooth or something else that's affecting her chewing.

    Bookmark   July 6, 2013 at 6:26PM
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CA Kate

Emma, I just discovered that DH hasn't been able to suck thru a straw and had gotten very dehydrated. I found a sports drink bottle with a long bent straw with a squeezable container. I now can squeeze liquids into his mouth. For the first day we couldn't give him liquids fast enough. He was one thirsty man!

    Bookmark   July 7, 2013 at 11:04PM
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CA Kate

Duplicate posting

This post was edited by westelle on Mon, Jul 8, 13 at 17:48

    Bookmark   July 7, 2013 at 11:05PM
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you might try sitting down and "eating" with her

    Bookmark   July 18, 2013 at 3:45PM
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Having a meal with her ... tried that, doesn't help the situation.

Resigned to the fact that there's nothing can be done. Best to let nature have its course. She won't take a "proper" meal but she'll roam the kitchen in the night and gorge on whatever she can find at any given time. Half a loaf of bread. An entire container of margarine. Five cheese slices. Three cans of diet ginger ale, which is funny being that she claims to not like carbonated drinks when I give her some as a "treat." She ignores the bowls of green beans, peas, broccoli, Hamburger Helper, baked chicken wings with potatoes & carrots. If I give her a serving of such, she picks at it, maybe eats 1/3, refuses to finish even if I cajole her along the lines of please finish your supper so I can wash the dishes. Wants to "save it" for later ... but the later rarely happens. Yesterday evening I gave her a bowl of Hamburger Helper & peas left from two days prior (one of those "save it" situations). Quantity of about 1/2" depth in a Corning Grab-It bowl. She ate 1/3, refused the rest so I threw it to the trash. Lots of waste. There's no way I can find to "spin" eating scenarios to get cooperation. Just. Doesn't. Work. She does at least usually eat ham/cheese sandwiches, the morn/afternoon sitter keeps several halves on-hand. And she'll eat tomatoes, canned fruit, or apples (multiples at a time) which I've advised the sitter not to have more than one available. Unfortunately she also gets into things and doesn't know what to do with them. I'm sure she has eaten raw bacon in a few instances. I've found eggs cracked in a bowl in the refrigerator. Packaged items out of the freezer or refrigerator.

    Bookmark   August 8, 2013 at 9:08AM
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Well, can you edit the contents of the kitchen to contain only the things than she will and can safely eat, that don't require preparation? Don't worry about her eating randomly in the night, just have things there that she will eat. Give up on the casseroles if she so consistently doesn't want them (or, just serve her the small quantity that she typically eats and no more until she asks for it--and don't prepare 8 servings unless it is for your family too!), get rid of the boxes of pasta. and bowls of vegetables and raw eggs. If she eats eggs, have them cooked in the frig.

Maybe keep some of those lunch packs with cheese, crackers, lunch meat? (yeah, I know, preservatives, salt, fatty etc & I wouldn't feed them much to a child but at this point does it matter?) And why worry about sugar-free with so little intake? she may be diabetic? but better to give her the calories and manage the blood sugar later.

I wonder if her taste buds are so impaired and maybe her eyesight, that most things don't have enough taste and look unappealing. She seems to like certain foods like tomatoes, maybe because she can taste them? Or because they are cold and juicy?

Mom got to where things had to be salty (like bacon, soy sauce, bottled marinades and dressings) or sweet, at the end really only wanted sweet things (and she had NEVER had a sweet tooth or salted her food). So I put sugar in her milk, found a protein enriched sweet milk drink at the grocery store that she loved, brought her that or ice cream or creamy pie slices every visit, put syrup on everything else!

Another thing-- if she is on Aricept, that is known to reduce appetite. So are some of the other drugs that confused elderly are given. Take a look at her other meds and ask her doctor about possible effect on appetite or taste/sensation/dry mouth (although, sadly, MDs sometimes aren't well versed in the possible or less common side effects of even commonly used meds).

And remember, you are NOT FAILING if you can't solve this. We just do the best we can.

    Bookmark   August 12, 2013 at 3:42PM
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Sometimes it is helpful to step back and look at what your goal is in getting something done. So for your grandmother, are you trying to get enough calories in her every day? A well-balanced diet? Control diabetes?

If the main goal is to get enough food into her, I'd focus on that. Not on what she's eating or where she eats it.

If she likes to eat in front of the TV, fine. If she likes to eat walking around the house, fine.

If she doesn't like certain foods, just don't have them in the house. Focus on what she does like and will eat.

At one point, my dad was very ill from an infection and was in the hospital. He was eating about 300 calories a day. The hospital dietitician came and spoke with me about getting him to eat more.

She focused on what his favorite foods were. Since he liked fried eggs on toast, she told me to call the kitchen whenever he was hungry and order two fried eggs on toast, at any time. Since he liked strawberries and strawberry ice cream, he got strawberry flavored Ensure. He liked fish, so she had some fish prepared specially for him.

She told me that the goal was to get the calories into him. That at this point, his calorie intake was so low, that a healthy diet was not the goal, just getting enough food into him was. For example, although he was diabetic, she ordered the Ensure with sugar in it, because he needed those few extra calories. They controlled the diabetes by constant, careful monitoring. The eggs might not have been good for his cholesterol, but they were necessary for his overall health and recovery.

    Bookmark   August 25, 2013 at 8:20PM
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>>at this point, his calorie intake was so low, that a healthy diet was not the goal, just getting enough food into him was.>>

Good point, camlan. We've seen this with my 85-yr old MIL. She is always "not hungry" or "too full". Even at breakfast, LOL. We are getting her into a very good asst living facility, but we're pretty sure her weight, which we have actually increased, will begin to drop.

Why? Because altho the staff will try, they can't force a senior to eat. Now, it may be that in a social situation, MIL will eat a bit more (sometimes it happens, sometimes not), but we really can't depend on it.

But we have come to terms with this. We have done what we could, taken care of her as best we can, and going forward will do whatever activities with her that she can still enjoy. She does not want to stay alive forever, and if weakness and death happen....then it happens.

But (smile) as long as she's still living with us, it's now two bottles of Boost Plus a day! After that, I don't care if she stuffs her face with cookies and potato chips. Whatever she wants, she can have.

All of this is just marking time, really. It's a long slow slide to the end, prolonging it does no one any good.

    Bookmark   August 28, 2013 at 8:43PM
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