How to help mom eat?

Fad marie

My mom was dx with Alz 4 years ago.  She's in the moderate stage now.  She is 76 and lives at home with my dad who is 89.  She is in relatively good health otherwise, but her weight has continued to decrease as she loses her ability to not only remember to eat but also how to prepare food or even find something to eat in the refrigerator.  We have a caregiver who comes M-F 10am - 1pm to help her go on walks, to get out of the house once in a while, to help run errands, and to help her eat.  The caregiver tries to make sure she has at least one meal when she's there, but my mom sometimes refuses to eat saying she's not hungry.  We do get her to intermittently drink Ensure, but I'm not sure she does when the caregiver isn't there.  

I feel pretty comfortable with her eating when the caregiver is there, but in the evening and on weekends, my dad says that she rarely eats.  She's lost about 25 lbs over the last few years.  There is often leftover food in the fridge (from what the caregiver prepared or what they brought home from a lunch out), but my mom doesn't seem to remember it's there or is too daunted by the prospect of how to eat it that she doesn't.  My mom cannot use the microwave or stove anymore.  My dad is near zero help.  It is highly unlikely to get my dad to regularly prepare her dinner.  I've asked and encouraged, and all he seems to do when I come over is complain about how much leftover food she has in the fridge and how annoyed he is that it goes to waste if he doesn't eat it.  I've reminded him repeatedly that he could remind her or offer her food from the fridge, but I don't think he does.  

My mom subsists on cookies and candy in her bedroom in the hours when the caregiver is not there.  Any suggestions on how to help my mom eat when no one else is around to help (and my dad won't)?  She'll eat food when it's delivered to the house (like if I call for pizza delivery), but that just leads to the same problem of leftovers piling up in the fridge.  Is it possible that she's not getting signals of hunger as often and she genuinely isn't hungry?  Or does she just not know what to do when she feels hunger besides eating the cookies in her room?  I'm also okay with her subsisting on cookies and candy if that's what's easiest for her, but if there's a relatively easy "solution" that one of you can suggest, I'm up for that, too.  

loveskitties

I have noticed with my father that he takes "cues" from others at meal time.  

Are the care giver or your father actually sitting down and eating with her, or are they just putting it in front of her?  It is difficult to know when LO is hungry or full, which is why a schedule for eating is important.

It sounds like you are past the stage when she can actively initiate things like meals, and given their ages perhaps need more than a few hours a day to have help come in.

Fad marie

Yes, my mom does take cues when I am there to eat with her or when the caregiver is there, but when the caregiver leaves, she does not seem to take cues from when my dad is eating.  She largely spends time in her bedroom watching TV, and she may not even know when he's eating dinner.  And, like I said, he doesn't say anything to her.  

We have thought about more caregiver hours, but it really does not seem she is at that point yet (other than the eating).  She still does relatively well getting dressed, brushing teeth, not wandering from the house, etc.  It's just hard to justify caregiver cost for that many more hours each day if it's mainly just for mealtime.  

harshedbuzz

Fad Marie-

A certain amount of weight loss seems pretty common as the disease progresses. Her preference for sweets is an almost universal behavior among those with dementia.

That said, it's quite possible your dad isn't up to the task of caregiving either because he's not hardwired for nurturing behavior or he's just worn out or maybe even starting his own cognitive shift. Executive function is often the first loss- not appreciating the consequences of not feeding his wife might come under that umbrella. I mean, would you hire an 89 year old off the street to care for someone who can't care for themselves?

My question is this- what is dad doing for himself vis a vis mealtime? It sounds like the caregiver is encouraging a meal 5 times a week- what's happening the rest of the time? Does dad go out? Does he fix something and eat alone? Perhaps he doesn't care to eat with her or isn't up to the amount of cajoling needed to get her to eat. 

Some ideas. You can fix sweet smoothies with protein powder or use fortified puddings to get calories and nutrition into her. You could make sure the caregiver treats lunch as the primary meal of the day. Perhaps she could prepare a plated meal of finger foods that your dad could just hand to her at dinner time. But maybe the fix is a family member or additional HHA at dinnertime.

HB

Jo C.

Hello Fad marie, this is certainly a challenge and I know you care; but there seems to be more than just not eating that is happening.  Unfortunately, there is no "easy" solution to this; there are not going to  be any shortcuts.  Life is not going to go on as usual; things have changed and the approach to care seems to need adjusting to meet those changes even though your mother seems to be high functioning in other ways.   She is now in mid dementia; things have evolved..

Your father is 89 heading on to 90; he by this time has his own changes whether subtle or overt, with strength, stamina, endurance, logic, reasoning and judgment and in all probability as well, some memory or recall glitches.  He too needs support and cannot be expected to be the main care provider for your mother with dementia, especially as her condition has progressed and problems have ramped up. 

It appears that both of your parents are at a point at which they are not in an adequate level of care on a consistent basis, 24/7. This is a complex hands-on consistent problem.  A five day a week, three hour a day helper is not at all sufficient; especially if this person has not had in-depth education regarding care of a person with dementia.

Such a weight loss for your mother is significantly pointing that something is amiss. When was she last taken to her physician for an in-depth physical exam includng a full menu of labs? That needs to be done if it has not been, and she should also be checked for a "silent" urinary tract infection that has no physical symptoms but that can cause behavioral and other issues until treated.

The most important factors for a person with dementia is to be in a setting with adequate, consistent care that has both routine and structure on a daily basis, 24/7; your parents do not have this.  Lack of routine and structure is actually the "enemy" of  person with dementia and may be contributing to some of the outcomes being seen.

Your father is 89 years old - it is not reasonable for him to be responsible for your mother in her dementia; this is beyond him by this point and probably has been for a long time.  Insisting and reminding that he do this and that and etc., is likely not to bring results; it really is not appropriate to put this on him with "repeatedly reminding.".  He too needs relief and it is going to be up to the adult children to get this situation in much better circumstances.

My guess is, that if one of the adult children stayed in the parent's  home with them on a 24 hour basis for at least a week, it would soon be seen that there is a lot more lacking and that this setup as it is, is no longer working and in fact may well be a threat.

Everything has changed except the extended family has not yet realized they need to change the care approaches with it.  It is hard; it took me some time for my eyes to open and see my parents for what was actually happening to the degree it was.  When we suddenly realize, then it is all hands on deck.

It means that your mother needs that doctor's appt., it also means that the living situation needs to be assessed very closely especially in regard to expectations that cannot realistically be fulfilled.  Is your mother really being best served being at home ?  If she were in care, would she flourish by having 24/7 care with its routine and structure as well as activities and increased socialization with nurse oversight?  Would trying such an alternative be possible and would your father join her or stay in the house IF he is competent to care for himself 24/7?  He is going on 90; mother's dementia is advancing; things have changed.

Your mother's nutrition is lacking; she is not getting what she needs to be healthy; she has no structure, no routine.  It may even be that some of the left over stuff in the refrigerator is tainted and likely to cause illness.  How long was it before the left overs were put in the regrigerator, and how long has each item been there?  One would wonder.

If staying at home, your mother may be best served with someone in the house daily, at least full days and even better on a 24 hour basis.  If she has structure and routine with a capable caregiver, a nutrition plan could be set up.

 One would try small multiple snack/meals a day with decent nutrition.  Sometimes finger foods are better accepted.  What are her favorites - would soft foods be better than hard foods?  Does she need food cut into sizes that are more easily seen and handled?  Would she benefit from colored plates with side that turn up so food stays on the plate?  Is she adequately hydrated?  How much fluids is she getting each day?  In order to pull off an improvement, it is going to take much more assessment and care than she presently has AND your father is not the one to be expected to do this.  It is now up to the adult children to realistically put it all together.  As I found out, it takes time to make the changes and put it together well; but once done, the results can be amazing.

Sometimes, as I eventually found out the hard way, we have to make difficult decisions we never wanted to make to get a LO the care they need; but it is part of the process when dementia enters the picture.  So sad, and yes; financial implications, but necessary all the same.

Also, the Alzheimer's Assn. has a 24 Hour Helpline that can be reached at (800) 272-3900.  If you call, ask to speak to a Care Consultant.  There are no fees for this service. Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very supportive, have much information and can often assist us with our problem solving.

As you move forward with these changes, I send you best wishes from one daughter to another,

J.

mommyandme (m&m)

My mother lived alone, but when we started in home care we started with 6 hours a day, split in two 3 hour shifts. The morning would help get her breakfast and morning meds and leave a lunch in the fridge for her. The afternoon/evening caregiver would cover dinner and evening meds and help her get ready for bed. Then later she was able to get to bed on her own. That worked well until it didn’t then we went to two 4 hour shifts until it came to 24/7.  

I’m sorry for the worries and tedious journey you and yours are on.  

Fad marie

HB, thanks for your suggestion of the home health aide making my mom a more robust meal if it's going to be her main meal of the day.  And the idea of prepped finger foods that my dad can just take out of the fridge is good as well.  I appreciate your comments on my post and on others posts I've read on here.  You have a lot of helpful and compassionate suggestions.  

As for my dad, yes, he's slowing down as he approaches 90 but more so physically than cognitively.  He does have some typical memory issues that one would expect at 90, but we are all thankful at how well he is doing cognitively.  He's still driving (although all within 15 minutes of their house), emails/internets, makes his own meals, does light grocery shopping for himself, runs other errands, always has a new book, does crossword and jigsaw puzzles, and plays bridge in two leagues every week (running one of the leagues!).  That said, he turns 90 later this year, and I wouldn't expect him to be able to take care of my mom on his own.  Our home health aide that comes M-F is there for him as well.  When she cooks breakfast for my mom, she cooks for my dad, too.  She also does laundry and other errands for him at times.  Even though my mom can still take care of most daily needs (dressing, brushing teeth, going to the bathroom), we have the health aide come M-F to just be there for my parents if necessary.  My mom hates it as she feels it infantilizes her (but she quietly tolerates it around our aide and then complains to me when she leaves), but my dad appreciates the help and just having someone there with my mom (especially when he goes to bridge).  

I think he doesn't help my mom with eating very often for two main reasons: 1) He's slowing down and it's all a bit much for him, and 2) he's NEVER been a warm and caretaking husband.  I get along with him very well and he *tries* to help my mom when I ask, but he is just not the caretaker type of person.  On the plus side, my brother and I golfed with our mom today (she loved it... hit the ball well, but my goodness does she get turned around and not understand what to do from one shot to the next!), and while we were on the course, my mom told us that my dad has been much nicer to her lately.  I know he's trying, but it's hard to change someone's personality at this age.  And she ate two soft tacos after golf!

Tklbmom

WOW my husband is 56 with EOA if I wasn't here to feed and cook for him he would not eat. He certainly couldn't live alone and my 76 year old dad can stay with him. I'm sorry but this seems like a very dangerous situation.

NicoleP

Fad Marie, may I ask how you convinced your parents to accept a home health aid. I too am beginning to realize that my mom who has alzheimers and my dad who is stubborn and is 84 needs a little help. Like your mom mine us able to get up, get dressed, brush teeth make the beds. But eating, taking medication is proving to be a challenge.

LovingAwareness

Our Dad's tastes and capabilities to deal with "complicated" foods are changing so fast it is hard to stay a step ahead. The one constant that always works (so far) are the Ensure shakes. That way if a meal is a complete bust (like last night's chicken pie, which I got from the local pie shop because it used to be one of his favorite treats, but last night he would only eat the top crust) - then we know at least he had his shake.