“She’s not eating….” Alzheimer’s Disease and Eating

It’s a concern I hear often. “She’s not eating…” From daughters, sons, husbands and wives.  When someone has Alzheimer’s dementia or another memory disorder, we may become concerned about many things.  And food has so many meanings – both as the fuel we need to function and a more personal, often spiritual, connection.  In times of sickness and celebration, we gather around food.  Concerns over eating are therefore understandable.

My first approach is to find out if the “not eating” is causing problems.

Is there weight loss? It may be that the loss of appetite is due to decrease energy output.  When we don’t move as much, we don’t need to eat as much.  What seems like too little to live on may be an adequate amount for that individual.  If there is no weight loss, it may be fine to monitor for safe, nutritious food choices and allow the amount of food consumed be enough.

My mom went through a phase of eating less and some weight loss after an acute illness during her middle stages of Alzheimer’s dementia.  She, along with her family for support, implemented several strategies to increase her caloric and nutritional intake so that she could regain the weight.  But, in her late stages, when she had stopped walking as much as she had (we often felt she was the famous Bunny in the battery commercial– never sitting still for a second), her need for food was less.  While it was a bit hard not to nudge her to have a bite or two more at meals, she was listening to her body and didn’t need those bites.  When I forgot and nudged, she would either feel sick the rest of the night or get angry at me without really understanding why.  I only understand now in retrospect that her anger was a signal that I shouldn’t be pushing the food.

Is there muscle loss? Is the individual becoming weaker? Are there falls?  If not, again, the food intake most likely is adequate for the physical needs of the individual.

What if there is weight loss or weakness?

I would recommend several ‘check-ups’

Is food available? Have the tasks of food planning, food purchase, food preparation become overwhelming? If yes, can this be assisted in some way?   Can you accompany your loved one on weekly trips to the store, brainstorm new approaches to meals that don’t require complex preparation, or provide meals?

One devoted son would take his mother, who lived with dementia, out for a weekly grocery shopping trip.  The time together served many purposes: it provided respite for her husband; bonding of the mother and son over meal planning, meal memories from his childhood; allowed him to partner in the modification of her meal preparation burden.  He commented often to me how rewarding the time together was and how he could observe and adjust to her changing needs.

• Has eating become lonely? Eating is enhanced when done with others; studies show that more food is eaten when you sit with someone.¹  Many senior centers have noon-time meals where the social environment may help with appetite.  Consider having someone available at mealtimes for a loved one that lives alone.
• Has eating become difficult? Think about the entire eating process. Can utensils be used or do they need modification due to arthritis or memory loss? Do dentures fit? Are there sores in the mouth or teeth that need a dentist’s attention? Any difficulty with swallowing or choking? Many conditions accompany aging and dementia that may make eating difficult.    If you notice anything, a check-up with the physician or dentist with your observations and direct questions is in order.

My mother had a short period where nothing tasted good to her.  She couldn’t quite tell us why nothing tasted good, but she shied away from many foods.  It took me several days, but I realized her ability to perform mouth care was suboptimal, that food was stuck in her posterior teeth; a yeast infection had developed and altered her taste for food.  We treated the infection, began assisting with mouth care and her eating bounced right back.

• Have medications or supplements been assessed lately? At times, medications or supplements that were once needed are no longer required. Or side effects have developed with advancing age or state of health.   If medications are causing difficulty, such as a dry mouth, are there options for an alternative or trial off the medication?  Consult your health care provider to ask.
• Is there a new medical condition that needs attention? Is it time to make a visit to the doctor to check for medical conditions that may be affecting appetite?  Conditions as simple as constipation may have cropped up that could respond to a diet change.  Thyroid abnormalities increase with advancing age and are not as “classic” as when they present at younger ages.   Mood changes such as depression often present with loss of appetite.   Make an appointment to assess or uncover an issue.

There are a host of reasons someone may change their eating.  Before making too many modifications in someone’s life, explore the why behind the change. Understanding the cause will guide a successful approach.   We will discuss other strategies for modifying eating in future posts, but first we must perform a few checks to understand what the underlying issues may be.

Consider this

• Eating less is not always a problem – it may just signify less overall activity and less need for food.
• Explore the reason behind the decreased food intake – the right reason will focus the approach for improvement and ensure a reversible cause is not overlooked

Wright L, Hickson M, and Frost G. Eating together is important: using a dining room in an acute elderly medical ward increases energy intake.  J Hum Nutr Diet 2006;19:23-26.