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.