Q: We are trying to find foods that our mother will eat. She is 85 years old and has Alzheimer's. She's not eating like she used to … do you have any suggestions?
A: A person with dementia may forget to eat, forget how to eat, or get easily distracted at mealtimes. Thus, your mom's problem is common among those with Alzheimer's. I struggled similarly to help my dad as I was trying to keep him from losing weight or to at least help him keep his weight up between his bouts of pneumonia. Since I was primarily concerned about calorie intake, I changed my grocery shopping to include more of his favorite foods even if they were not considered the "healthiest." Look for the times in the day when your mother is the hungriest — likely in the morning — or whenever! Don't be tied to "breakfast foods" at breakfast, for example. Then offer her favorites. Easy-to-eat finger foods may help, too. Older adults eat more when they eat with others. So join her at the table, offer gentle reminders to continue eating and provide assistance if/when needed. Smaller, more frequent meals may help, too. Dietitians recommend as many as five mini-meals a day.
Q: My mother is in assisted living and goes to the dining room for meals but will not eat. She was recently in the hospital for dehydration. We've tried everything to get her to eat. Any ideas?
A: Often older adults "lose their appetite" just because they haven't been eating! Appetites perk up once eating resumes. If possible, visit at mealtimes to encourage your mother to eat. Ask for some of her favorite foods even if they aren't being served at that particular meal. The facility has snacks and the kitchen has options available. Don't hesitate to encourage your mother to eat dessert first (or even have two) when her appetite is at its lowest during the day.
Dehydration is a serious problem and one of the most common causes of hospitalization among older adults. While assisted living facility staff members may conscientiously replace ice water pitchers at bedsides, many residents cannot easily reach the pitchers or find them too heavy or difficult to pour into a cup. As you interact with staff, ask them to encourage and enable your mother to drink more. For example, ask nurses to offer a full glass of water when taking medications. In addition to water, request that your parent be provided with fruit juices (with added sugar, if weight loss is a problem), milkshakes, carbonated beverages or a therapeutic nutritional product, such as Ensure, Ensure Plus or Juven Ensure. Find out if your family member prefers beverages icy cold, room temperature or hot. Then let staff know.
Q: My 80-year-old mother is depressed, won't eat properly and doesn't do her exercises. She seems to be getting weaker, and I don't know what to do. Please help!
A: Most of us know that eating healthy foods is more than just a good idea. Today, experts know that nutrition is an essential part of managing many health problems, including depression and dementia. Not eating enough causes muscle loss, called sarcopenia in older adults; it often causes fatigue and discourages staying active.
Sometimes medication side effects, such as diarrhea, constipation, bloating or stomach pain, are the cause of appetite loss. Many of us prefer to avoid such gastrointestinal problems by eating less. Some medications may make food taste "off," metallic and/or bland. Check with your physician or dietitian about such side effects and ask about alternative drugs. Also describe your mother's depression to see if there are ways to lessen it. I was able to help my father remain in my home for several years once he was prescribed an antidepressant. He had to try several before we found one that returned him to his former lovable self.
Q: My mother's assisted living facility serves high-fat foods and lots of meats with nitrates. They seem to be clueless when it comes to good nutrition. Is there anything I can do?
A: While many assisted living facilities employ registered dietitians (RDs) as consultants, most states do not require them to do so. I always suggest that families considering residential facilities for a loved one ask to speak with the dietitian on staff. That's a guarantee that the facility is doing its best to protect the nutritional health of its residents. RDs monitor food and nutrient intake, weight loss (or gain), hydration status, etc. They, along with speech therapists, are concerned about chewing and swallowing problems. RDs participate as team members in resident care planning and intervention.
So if possible, regularly meet with your mother's care team; express your food and nutrition concerns. Ask for a consultation with an RD and follow-ups. You may ultimately have to consider moving your mother to a fuller-staffed facility. Then make food and nutrition a priority when choosing the new facility for your mother. Do realize that such a major change may be quite disruptive to your parent. So first try to resolve the problem in her current situation.
Nancy S. Wellman is a dietitian with firsthand caregiving experience. She is an adjunct professor at Tufts University's Friedman School of Nutrition Science and Policy.