Alzheimer’s Disease and Loss of Appetite

Even the Cold Minnesota Winters Don’t Help Stimulate an Interest in Food for Some Dementia Patients

You’ve just come in from shopping on a cold day and can hardly wait for a bowl of that chili you had cooking in the crock pot while you were gone. Or, you walk by a bakery and the smell of what’s being sold inside, leads you right on in to buying a loaf of bread and some cookies.

It’s common for people with dementias like Alzheimer’s disease to have greatly reduced appetites and very little interest in food. At the very late stages of the disease, it is believed that the part of the brain that directs muscles used for swallowing has been damaged, so that the patient doesn’t know what to do to swallow. Sometimes in care centers you will see a staff person actually feeding a patient like this with very small bites, verbal direction to swallow and long pauses between bites.

My mom probably died of starvation secondary to Alzheimer’s disease in a care center at age 94. She was under Hospice Care, became unable to swallow her pain medication and was being given mild doses of morphine for comfort.   She became unresponsive and lived for several days taking nothing by mouth.   It’s a very difficult time.   Even before she became a Hospice patient, the care center asked if I wanted a feeding tube inserted.   Although I had worked in a care center and talked with many families about the pros and cons of tube feedings,   making the decision not to have one for my own mother was one of the most difficult parts of my care for her.

My mom hadn’t had much of an appetite during the six years she lived with me. It seemed like no matter how small the serving was, she would always say, “Oh, that’s too much.”

So, what are some strategies to work with loved ones who aren’t very interested in eating?

Some suggestions:

  • Very small portions may help. Sometimes a whole plate of a variety of dishes is overwhelming to a person with dementia. It’s as if their damaged brain simply can’t deal with the choices before them, and so they can’t deal with any of it.
  • Serving the meal one course at a time may be helpful. My recommendation is to start with a small serving of what is most important for them to eat–probably the protein.
  • Simplifying the table-setting; use one plate, one utensil and one drinking vessel as opposed to a dinner plate, a salad plate, knife, fork, salad fork, spoon, water glass, milk glass.
  • Make use of contrasts–a white plate with mashed potatoes on a white table cloth may be hard to see. Try a colored plate on a white placemate.
  • Make use of tangy foods. In general, as we age, we lose taste receptors. My mom seemed to enjoy things like barbequed ribs or chicken.
  • Be creative; you never know what might be appealing until you try it. One resident in an assisted living where I worked ate everything with a sprinkling of sugar on it. And I do mean everything–even mashed potatoes and gravy. There is some thought that of the four tastes–sweet, salt, bitter, sour–sweet is the taste that remains with us the longest.  So I guess is what you’re eating has no taste at all, a little sweet helps.
  • For extra nourishment, many families supplement meals with products like Ensure. One excellent way to provide it is mixed with ice cream (almost malt consistency) and offered before bedtime. If you give it mid-morning or mid-afternoon, it may affect appetitie for lunch or dinner.
  • Consider enriching food, so that the small portions that are acceptible are super nutritious–add wheat germ to meat loaf, make pudding with whole milk and/or part half and half, enrich cream soups and mashed potatoes with rich milk or cream.
  • Certain essential oils are believed to stimulate the appetite. In one assisted living, we used a mixture of 8 oz. water, 1 drop of dish detergent (like ivory) and 10 drops of the essential oil of lemon in an aeresol bottle, and sprayed it around the dining table just before the resident sat down for a meal. (Staff who were watching their weight were not in favor of this.) Essential oils are the very concentrated oils of plants, leave, flowers, roots, tree bark etc., said to have therapeutic properties. You can purchase them at a food coop or health food store. (I use the essential oils from a company call Young Living, because they grow their own plants organically (no herbicides or pesticides,) the processing is done with minimal heat to preserve the properties of the oils, and no petroleum products are used inconjunction with the oils.) Sprays that you buy at discount or drug stores may smell good, but are probably not therapeutic.
  • People who have eating problems related to dementia often need to spend more time at the table. They are often very slow eaters.
  • Most of us enjoy our food more if we have a pleasant companion and enjoyable conversation.
  • Some studies have shown that if you play 30 to 45 minutes of very pleasing music 45 minutes to an hour before dinner, people will eat more, will eat more independently and will sleep better, because music raises the level of the brain chemical Seritonin.
  • There are some medications that increase appetite as a side effect. My mother’s doctor prescribed Reminyl (sp?) for her. Frankly, we didn’t notice any effect as far as her eating was concerned, but it did appear to lift her mood. Of course, this is something you would want to discuss with your physician.

Loss of appetite is such a difficult problem for care givers to manage. Please know that there are times when nothing helps. Always speak with your physician about your concerns. Remember that a good goal in caring for a dementia patient is comfort.

When you are continually worried about what your loved one is not eating and urging him/her to eat more, that can be stressful for you and the patient. It’s difficult to keep this in mind, but Alzheimer’s disease is a terminal disease–right now there is no cure. With my mom, there came a time when it seemed most loving to allow the disease to take its course and to try whatever we could think of to keep her comfortable.

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9 Responses to “Alzheimer’s Disease and Loss of Appetite”


  1. 1 Francis Matthews May 20, 2010 at 10:24 am

    Hello

    Thanks for the posting about Alzheimers and loss of appetite. Very useful – if only to know that other people have this problem. My mother is 92 and suffers from partial dementia, has next to no mobility and incontinence problems! She had a healthy appetite until poleaxed by gastric flu about three months ago. Since then she’s had a bout of C Difficile too. Her appetite has gone almost completely. She’s been in hospital for the last six weeks, and has been rehydrated 4 or 5 times during that period. But the Consultant says he can’t do this any more. She goes back to the nursing home tomorrow. Any further tips for stimulating her appetite gratefully received. She seems to still like orange juice and yoghurt (in tiny doses) but anything solid seems to cause her discomfort. We’re in London (UK).

    Thanks again for the posting – Francis

    • 2 seniorliving May 26, 2010 at 6:43 pm

      Dear Francis,

      I’m glad you found the information about Alzheimer’s and loss of appetite somewhat helpful. It’s such a difficult situation and all too common. If your mother is still enjoying orange juice and yogurt, stick with that and don’t worry about solids. Think in terms of her comfort at this time. If she likes the texture of yogurt, she might light custards and puddings which have some good nutrition because of the eggs and milk. You also might try mixing a nutritional supplement like Super Ensure (whatever flavor she likes) with vanilla ice cream.

      MC
      Seniors’ Choice at home.

  2. 3 Manuela Campbell July 8, 2010 at 9:48 pm

    Thank you so much for this article. My father is 81 and has both Alzheimers and Parkinsons. For the past six weeks his appetite has really dropped off. He has lost a lot of weight since he went into respite care in the hospital. They are writing down everything he eats and its not very much. I have heard that Alzheimers can affect the taste buds, damage to the brain causing a disconnect with the taste buds. This certainly seems to be what is happening with him. He had a good appetite and although he took a long time eating did gain weight in the Seniors Home he was at until recently. He does not have depression, but has difficulty with saliva collecting in his throat due to the Parkinsons. The doctor says the Parkinsons also causes difficulty with the muscles used for swallowing. Your article has encouraged me to experiment with different foods and keep things really simple. We will try to music too and see how it goes. . .

  3. 4 Isreba Wheeler December 15, 2010 at 5:30 am

    I want to thank you for this information. I found it more than useful. It feels so alone…this care-giving role, thrust upon us. I hate it. I hate seeing mommie like this…it kills me inside every time i am with her.

    I have power of Attorney for mommie, and my sister {Nikki}, life partner {Peaches}, and i are the only three who care for her. My mommie has eight children seven of whom are alive to this day…but only two from her loins who care for her….go figure.Mommie is 84 yrs old now…and i pray she gets to 90–anything. but i sincerely doubt it.

    I had to mentally say goodbye to mommie in order to not mentally shut down my self. She begged us to never put her in a home when she was old, and we promised her we wouldn’t and have thus far, kept our word.

    We have an excellent HHA, who is just 21 yrs old, but wonderful, mold-able, honest, dependable, trustworthy, and professional.

    Mommie is constantly in pain from her legs stiffening in the morning, and no amount of range of motion exercise eases her pain. We have devised ways of making her comfortable by alternating ice/heat, and Bio Freeze ointment on her joints.

    She is bed bound, and sitting up in a chore for her as she has had a seizure and it has compromised her neck to being to one side. At times she can move it to and fro, but mostly it stays in a certain fixed position.

    We love her so much, and now seeing her not able to eat is killing us even more. She eats..{in my denied mind}, but i had to come to the realization that a feeding tube may be the only course of action for her. She is so thin now, and eats like a sick bird. A swallow here and there, a slurp of juice or ensure here and there during the day…nothing of any real substance goes in, for her pocketing it all day long, if we let her.

    I would seriously like to try these steps you have so graciously shared, before considering the feeding tube. It sometimes makes me feel selfish, wanting to give her a feeding tube, only to prolong the suffering, simply because i cant stand to see her go. But then i remember reading…’they aren’t suffering…the care giver is’. So….am i doing it for her…or for me?

    I apologize for bending your eyes, reading this long missive. I guess i needed to vent a little.

    I will definitely text this information to my sister and my partner, so they can see what wonderful advice you have given us.

    Once Again…I Thank You sweetheart.

    Isreba W
    Bx, NY

  4. 5 Barbara September 20, 2011 at 4:22 pm

    Thanks for the tips on making mealtime more interesting. I am serving the meal “in sequence” instead of all at once, however I have not served the meat, potatoes and vegetables separately. I understand that loss of appetite is another step along the way as the body prepares itself for death. I accept this process and will continue to keep my mom happy and peaceful, in her own home, until she returns to her Heavenly Father.

  5. 6 Connie January 4, 2012 at 7:30 pm

    I find cutting up the meat in small pieces keeps my mom from pushing it around on the plate. It’s funny though, she counts how many pieces of meat she has to eat. Also be aware if your patient is on Warafin (blood thinner) that ensure has 25% of daily vitamin K in it – which Warafin patients need toavoid.

  6. 7 Carmen March 13, 2012 at 1:44 pm

    Thanks for the useful information. My mom has Alzheimer’s disease and was never a big eater but her appetitie has decreased considerably and she has lost quite a bit of weight. I bought ensure (strawberry is her favorite flavor) and mixed it with plain yogurt and vanilla ice cream and she was able to drink her “milkshake”. Eating food upsets her stomach and liquids seem to be the answer at this point. I understand that this is a progression of the disease and it helps to know how others have dealt or are dealing with the difficulties it presents.

  7. 8 BEA SPIEGEL August 14, 2012 at 5:26 pm

    Thank you so much for the information on eating habits diminishing–We are not alone in this dreadful disease for which there is no solution—I have pleaded and threatened and begged to no avail–and now I understand that there is a reason and it is –sad to say-a progression—at 85 I am the care giver and my kids give advice but they are not here to face this challenge daily—I shall try the methods you suggested–small portions do not work but perhaps the classical music–and colourful presentation will stir something–I appreciate your walk- through ,and feel comfort in knowing I am not alone.

    G-D Bless all the patients and care gbivers who are faced with the situation.

  8. 9 Eda Street September 13, 2012 at 12:36 am

    My husband was recently diagnosed with mild-to-moderate alzheimers disease and he recently has loss his appetite. I don’t know if it is the aricept which has a “loss of appetite” side effect or if it is the progression of the disease. Thanks for the suggestions on getting smaller portions and ensure-I have to be careful in giving him things high in Vitamin K because of his blood thinner. Its good to know i’m not alone as a caregiver.


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