Coping With Changing Eating Habits
It can be helpful to:
- ensure everyone involved in the persons care is aware of this behaviour
- where possible, remove non-food items which could be mistaken for food, and lock away any harmful substances like cleaning products
- be vigilant and remove small items that may be easily placed in the mouth
- ensure food is available and easily accessible throughout the day
- during mealtimes, remove all non-food items from the dinner table, such as napkins and flowers;
- season meals in the kitchen, so that the salt and pepper shakers and spice containers are not on the table.
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How To Test For Dementia
There is no single test that can determine a person is suffering from dementia. The doctor can diagnose different types of dementia such as Alzheimers based on their medical history.
This has to be done very carefully. In addition, the doctor may conduct laboratory tests, physical examinations, and changes in the way the patient thinks.
When all things are considered carefully, a doctor can be able to determine that a person is actually suffering from dementia with certainty. Determining the type of dementia can be hard, especially due to the fact that brain changes and symptoms that are associated with the different types of dementias sometimes overlap.
It is normal for the doctor to give a diagnosis of dementia without really specifying the type. In such a case, it is important for the patient to visit a specialist in this area like a psychologist or neurologist for a more specific diagnosis.
Tips For Managing Dementia End
Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.
If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.
Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.
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Use Smaller Utensils And Different Drinkware
It may not seem like a big difference, but smaller utensils can be easier to manipulate with the hands than regular-sized utensils. It also encourages your loved one to take smaller bites, reducing the risk of choking on too big a bite of food.
Also, consider getting some specially designed drinkware to make drinking a little bit easier.
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When People With Dementia Refuse Help
When a person with dementia is unwilling to do something that we want them to do, this may be described as refusal or resistance.
As with other areas of a persons behaviour that we may find challenging or distressing, we need to try to find out what the person is telling us through their refusal in other words, the reason why they are refusing. And rather than expecting the person with dementia to follow our wishes, we should be focusing on how we can co-operate with their wishes.
Being forced into things makes us upset or aggressive, even fearful.
Why Do Older Adults With Dementia Quit Eating & Drinking
When seniors enter the later stages of dementia, they may have difficulty eating and drinking. There are several reasons seniors start to refuse food as the disease progresses, ranging from loss of appetite to physiological changes. Here are a few reasons seniors with dementia may refuse to eat and drink.
Additional Resources For Dementia And Eating Issues
Read and download the NHS helpful;Dementia Care Guide Support with eating and drinking . This guide talks about the common problems those living with dementia can have at meal time, and offers some tips to resolve them.
Another great tool that carers can use is;The DMAT;. The DMAT enables carers to;assess,;select interventions;and generate a;person centred care plan;to support;mealtime eating abilities and meal behaviours;in people with advancing dementia. You can learn more about the DMAT and its benefits;on their website.
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Arrange The Food On The Plate
You may need to experiment with different sizes, textures and flavours of food to see which the person responds to the best. Here are some tips to help you change things up:
- Add variety in the colour of food different colour vegetables help to really brighten up the plate.
- Try less quantities of food and fewer individual items on the plate.
- Think about what types of food they have always enjoyed in the past.; Put it on the plate with another food right next to it.
- Cut up the food into small pieces.
- Change the texture of the food potatoes could be mashed, boiled, baked for example.;
What To Do When Your Dying Loved One Stops Eating Or Drinking
Though outside of hospice care it may be unusual for patients to decline food or drinks, it is not uncommon for hospice patients to cease eating or drinking as they approach death. While it is unsettling for you to see your loved one refuse to eat or drink, rest assured that this can be part of the natural dying process.There are many reasons patients stop eating or drinking including:
- Medications that upset the stomach, alter their appetite, or make food taste odd.
- Lack of hunger due to constipation or other medical issues.
- Difficulty chewing food from dental problems.
- Loss of appetite as they are approaching death.
Regardless of the reason, hospice care professionals work to determine the cause by asking the patient questions when possible, and evaluating medications as well as eating capabilities. If your loved one has stopped eating or drinking while in hospice for dementia or other conditions, you may not even notice. There may be no visible signs other than weight loss and discomfort. Since the body is no longer in survival mode, its natural reaction while shutting down is to deprive itself of nourishment and water.
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Individual Preferences And Routines
Each one of us tends to live our life according to a set of routines. Some are imposed by necessity, but many reflect preferences and choices when we go to bed, when we get up, whether we get dressed before we have breakfast or vice versa, and so on.
A person with dementia may refuse to fit in with a routine that does not match their own. This is a positive sign! It shows us that the person still has a sense of their own identity and autonomy. Care services need to be flexible enough to fit in with the individuals routines. For example, if someone has always worked nights, it might be most natural for them to be up and about at night and this should not be seen as a problem. In this situation, the main challenge will be to find ways of engaging the person and providing company when there arent many other people around. In accepting a care service or moving into a care home a person hasnt given up their right to live according to their own standards and routines.
How Can Dementia Affect A Person’s Appetite
A person with dementia may lose interest in food. They may refuse to eat it or may spit it out. The person may become angry or agitated, or behave in a challenging way during mealtimes.;
If a person isnt eating enough, it can lead to weight loss and less muscle strength. They may also feel tired and weak. This can make them frailer and less able to recover from infections or viruses.;
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Encouraging A Person With Dementia To Drink
A person with dementia may not always be able to recognise when they are thirsty, or they might not be able to communicate their thirst. But nevertheless, it is recommended to aim for about eight to ten glasses or mugs of fluid per day. You could try:
- having a drink beside the person at all times
- adding a little flavoured squash if the person is not keen on water
- offering a choice of hot and cold drinks
- helping the person if they are struggling to pick up or hold a cup
- offering the person different shapes and sizes of cup
- finding out if they have a favourite mug they like to drink from
Lack Of Physical Activity
If your loved one isn’t very active physically during the day, they may simply not be hungry. Encouraging them to participate in appropriate physical activities can help increase their appetite as well as improve their overall wellbeing. The Long Island Alzheimer’s and Dementia Center offers stage-specific day programs that includes appropriate physical activities on a daily-basis.;
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Adapt To The Individuals Personal Hygiene Rituals
The best method of keeping your parent hygienic is to understand their preferences. When your parent with dementia refuses help, ask specific questions such as whether or not they prefer a shower to a bath. Perhaps the water is too warm or too cold. It may not seem like a big deal, but adapting some of your parents personal preferences can help them follow a hygiene routine.
How To Help A Dementia Patient Eat
If a dementia patient refuses to eat, its important to ensure theyre well hydrated. Dehydration is a cause of appetite loss. Its also possible for elderly patients not to be sufficiently hydrated.
Because of this, they become dehydrated quicker and easier because of their age, body changes, or medication theyre taking.
Drinking water might be too plain and met with resistance. Its useful to offer patients a soft, liquid meal such as cereal or soup instead.
Taking a look at the patients mouth will also reveal any redness or swelling that could cause a lack of interest in eating. A dental appointment could help to address any such concerns.
Some ways to encourage a dementia patients appetite include:
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Encouraging A Person With Dementia To Eat
Involve the person by asking them what they would like to eat. If they struggle to decide,; you could give them two options of simple things you know they like and can manage. If appropriate, you could involve them in the food preparation. You could try:
- offering something easy to eat, that you know the person likes
- giving the person small, regular portions rather than large meals
- being flexible: a person with a sweet tooth might like to eat their dessert first. You could add sweet condiments like ketchup or apple sauce to savoury food
- offering a small snack before a meal to see if that helps the person realise they are hungry
- using different tastes, smells and colours to stimulate the appetite
If someone with dementia is having difficulty swallowing, please seek the advice of a speech and language therapist before considering a diet of pureed or soft food, as this can lack nutrients. You should be able to request a referral from your GP. Your GP may be able to advise you on food to offer while you wait for a referral, but its a good idea to keep offering food you know the person likes and can manage.
Eat Small All Day Long
Contrary to what we believe, we do not need 3 main meals a day. Research shows that there is no major differences between 3 regular meals a day, 2 large meals a day or 5 little ones. In fact 5 little meals can help to regulate steady blood pressure which is an added bonus.
If you can only get your parent to eat small amounts, thats not a problem as long as this is at regular periods throughout the day. Its all about finding what works best for you.
Eating smaller portions can also benefit people living with dementia who have difficulty swallowing. Difficulty swallowing is a symptom of some types of dementia, including Alzheimers and Lewy Body Dementia.
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New Instructions Could Let Dementia Patients Refuse Spoon
People who abhor the thought of being kept alive with feeding tubes or other types of artificial nutrition and hydration have, for years, had a way out.
They could document their wishes to halt such interventions and have them honored using advance directives.
That includes patients diagnosed with progressive dementia who are able to record crucial end-of-life decisions before the disease robs them of their mental capacity.
But the practice has rarely almost never included provisions to refuse food and fluids offered by hand. Until now.
A Washington state agency that advocates for medical aid-in-dying has created guidelines for dementia patients who dont want to be spoon-fed at the end of life.
The group End of Life Washington, or EOLWA, which assists people using the states 2009 Death with Dignity Act, recently posted new Instructions for Oral Feeding and Drinking on its website.
Aimed at people with Alzheimers disease and other progressive dementias, the document provides a two-page template for patients to instruct caregivers not to provide oral food or fluids under certain circumstances. Theres another document explaining the dos and donts of using it.
The instructions are ground-breaking for patients who fear losing control not only of their faculties but of their free will to live and die on their terms, said Sally McLaughlin, executive director of EOLWA.
And the guidelines tell caregivers to respect those actions.
When Seniors With Dementia Wont Eat
What can you do when your older adult loses interest in eating? For seniors with Alzheimers or dementia, this could be caused by a variety of factors, including loss of taste or smell, distractions, too many food choices, or having trouble with utensils.
Of course, youre trying to make sure they eat enough to maintain their health. This can make mealtime frustrating or unpleasant for both your older adult and you.
Weight Gain In People With Dementia
In contrast and less common some people with dementia experience weight gain due to decreased mobility due to lack of exercise or an increased appetite. Frontotemporal dementia patients may be particularly attracted to sweet and starchy foods.
If you are concerned that the person is overeating or gaining weight, you should implement portion control when serving food or provide four or five small meals throughout the day rather than three large ones. If they feel the need to snack, replace high-calorie food items with low-calorie items such as fruit or crudites and dips. Keeping foods locked away or out of sight, so they are not encouraged to eat is also a good idea.
Increased activity will also help; depending on their mobility, they should be encouraged to go for walks, but exercises in a chair can also help if they cannot walk.
Are They Starving Or Dehydrating To Death
It may seem that the person is being starved or dehydrated to death, but they are not. In the end stages of dementia , the persons food and fluid intake tends to decrease slowly over time. The body adjusts to this slowing down process and the reduced intake. It is thought that by this stage the hunger and thirst part of the brain has now stopped functioning for most people.
The person may be immobile and so does not need the same amount of calories to sustain their energy levels. Having reduced food and fluid intake and decreased interest in this can be thought of as a natural part of end of life and dying.
Giving increased food and fluids artificially can be helpful for some other health conditions, but it is usually not considered to be helpful at the end of life in dementia as a way of managing reduced oral intake.
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The Downward Spiral Of The Stubborn Patient
Over the years that Ive worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient . I know that its not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were attracted to their profession because they possessed the right temperament for it. Either way, when they arrive in the rehab unit after some type of acute illness or traumatic event, it is very challenging to cajole them into health. I suspect that I am failing quite miserably at it, frankly.
Nothing is more depressing for a rehab physician than to see a patient decline because they refuse to participate in activities that are bound to improve their condition. Prolonged immobility is a recipe for disaster, especially in the frail elderly. Refusal to eat and get out of bed regularly can make the difference between life and death within a matter of days as leg clots begin to form, and infectious diseases take hold of a body in a weakened state. The downward spiral of illness and debility is familiar to all physicians, but is particularly disappointing when the underlying cause appears to be patient stubbornness.
2. I let them know that Im on their side. I understand that they dont want to be here, and that I will work with them to get them home as soon as possible, but that I cant in good conscience send them home until its safe to do so.