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Adam
Reply with quote  #1 
This is a sideline of the story about my grandparents in another thread.

Went to see Grandma and Grandpa today and there has been an ongoing and pestering problem that is not improving.

They don't eat enough (or barely eat enough) food to adequately sustain life.  Grandpa is nearing 91 years old and cannot walk.  Grandma is 89 and is quite functional.  They both complain quite a bit, and they don't like to eat enough food.

This makes my mother panic because they keep losing weight.  They have a full-time nurse in the home where they live who is an excellent cook and will gladly prepare ANYTHING they ask for, whenever they ask for it.  My family and the nurse purchase groceries based on Grandma and Grandpa's requests.  There is lots of food in the home, two refrigerators full, and all is clean and appetizing and ready.

Well, that all sounds just perfect, right?  We should all be so lucky...Well...

They say they like to eat something, so we buy it, then the next day they don't.  The list of 'don't likes' has grown so incredibly long that there is little left on the 'do likes' list.  Basically, they eat a half piece of toast here, a mini-waffle there, or a bit off a grilled cheese sandwich or a cookie.  That's it.  They liked fruit - no more.  They liked yogurt - no more.  Meat - not a chance.  Eggs, a great source of protein - forget it.  Grandma thinks she only needs to drink a dietary supplement everyday instead of eating food.  No way - she has to eat.

Now I know that as people age they often do not need to eat as much as younger folks because they are not as active, etc.  Also, my grandparents have bad teeth (not unusual at age 90), so chewing is difficult, but we try hard to accommodate all of this.  We do small portions, soft foods, nothing too hot, cut small, whatever they want.  Still, though, it seems they are wasting away by their own decision and it is quite concerning.  Worse, Grandma has always been the main purchaser/cook of food in their home during their married years, so if she does not want to eat something, Grandpa will not eat either, even if he is clearly hungry.  He thinks if he eats and she doesn't, it will upset her for some reason.  It bothers me to watch them grow thinner while good food goes to waste.  Not to mention how costly and frustrating it is when you go grocery shopping and buy and cook what someone says they want, then they say they hate everything and won't touch it...

They tell me they are sick of everyone telling them they need to eat.  You can't force-feed someone, but does anybody have any advice on:

1.  Why they may choose to not eat, despite being hungry and healthy enough to eat?
2.  Why foods they liked yesterday are not liked today, and the list grows and grows?
3.  Advice on what they could/should eat, how often, and how to motivate interest in eating?

Worst of all, the nurse from Medicare arrived about a week ago to take Grandpa's vitals.  She said that he should be eating more, and then looked at us and said she would be sending a social worker to evaluate - inferring that WE are the problem.  The house is clean and fully-stocked with food they SAID they liked.  We are ready to do anything to keep them eating.  What more can we do?  Mom was upset at the insinuation we are to blame, but I said bring the social worker on, I hope they have the answer.  I am all ears.  Social worker never showed up, so can anyone please offer advice?

Thanks...
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CJ
Reply with quote  #2 
Adam,

I definately understand what you and your mom are going through.  Before I start babbling about everything else, give your mom a hug.  People who work for these agencies have never been in these situations and only see if from the outside. They think by spending two hours with your grandparents, they have it all figured out.  Well they don't!  You all are doing the best you can, which is the best!  You are not doing anything wrong!  And you have no reason to feel guilty.  Next time "Medicaid" or the "Social Worker" come, tell them you hear what they are saying, ask them for five different solutions.  Patiently listen and then tell them, well those all sound reasonable and that's why you already tried them all.  Then ask them when was the last time they called their mother, father or grandparent?  I am willing to bet, they only call once a week at the most. 

Everything I am going to say in relation to food is based on my grandma, and you may not have as much luck...but you are right eating is critical...beyond just the weight loss...it's the loss of nutrients they desperately need.  In my situation, I can tell when she has skipped a meal or two - it makes her mood swings crazy, she has extremely low levels of energy and actually makes her memory problem a little worse. 

1.  Why they may choose to not eat, despite being hungry and healthy enough to eat?
  • They may not actually be very hungry -or at least how we experience hungry. From the way my grandmother's doctor explained it to me - they don't use enough energy, so they really don't get hungry like we do.  She said besides the scary weight loss - the nutrient issue I mentioned above was even worse.  She recommended that we buy the Boosts and when she refused to eat try to have her drink one of those.  This works for us, because she loves the chocolate ones.  When she won't drink it, I don't argue or push though, I just ask if I can have it.   I sit there and quietly enjoy it and shamelessly play the grandchild card.  She can't help but ask if I am enjoying it - she wants to make sure I am happy.  Then I offer her a sip.
2.  Why foods they liked yesterday are not liked today, and the list grows and grows?
  • I am a super finicky eater myself, however, I suspect this may be more about independence.  They probably don't want to be told when to do it, how to  it and why they should do it.  So they revolt.  I know I don't feel like I am doing that.  I feel like I am trying to help and really am trying to be encouraging.  There are some days, no matter what I say or how I say it, I get the speech. "I am not a child and can take care of myself.  I used to be able to do what I want, when I want, how I want."  While the nurse is willing to cook whatever, whenever...they still have to be dependent upon her for it. 
3.  Advice on what they could/should eat, how often, and how to motivate interest in eating?
  • I am not sure what type of health issues you are looking at, but I would definitely talk to the myriad of doctors they have...cardiologist, physician, optometrist, etc to determine what they shouldn't be eating .  Sometimes things you think are good for them (like fruit) can be bad for them.  Fruit has a lot of potassium - which is great at the right levels...it can negatively effect kidneys though if they already have renal issues. 
  • The Boosts are a god send!
  • Non-perishable snacks are good to have out around the house to at least get their calories up.  For example, pringles have these new honey sticks out that come in packets or individual serving size of almonds, etc.  We have decorative bowls and baskets strategically placed (for example on a table near the chair where she spends alot of time), full of snacks.  She will just grab it and eat it throughout the day.  She doesn't have to depend upon anyone, gets chooses when she wants to eat and what she is going to eat. 
I hope something here helps you.


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MaggieMay
Reply with quote  #3 

Adam    I am going through the same thing with my mother.   She has lost alot of weight.  She has been in a nursing home and last night had to put her in the hospital because of dehydration.   She is stuborn and strong willed  She hates being told what to do etc.    I wish I had advice for you but as you know there are no easy solutions.  Hang in there    Maybe others will be along with advice

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rosie
Reply with quote  #4 
My dad has been eating less and less over the last 4 years, he was quite vigorous up till 89 then he started to fall away - he is one of these people who has "tummy trouble"  - I think mainly due to anxiety; he would not eat any evening meal as he was afraid it would cause him discomfort during the night.
I have gradually got him onto a better nutritional path; I buy packs of mini cereals and he gets to pick which one he wants every day for breakfast. Mid morning he has tea or coffee and a piece of toast with his choice of spread. Lunch was a problem before as he would only eat half and leave the rest, but I found a brand of tinned meal that he likes and I add extra steamed or frozen veg, and he eats the lot, then he has some small dessert such as a yogurt or rice pudding. Around 3-4pm I give him a snack, maybe toast and hommus or other spread, or mini pikelets with honey, and a cup of tea or coffee.He can also snack on fruit or dried fruit. His diet has improved considerably.
What I have noticed is that he likes highly flavored food, especially sweet flavors, and it has to be easy to chew. I also bought Sustagen from the chemist - I don't know if you have it there, but it's a food supplement drink high in nutrients, carbs, and comes in vanilla or chocolate - basically it's like a milkshake, and it helps invalids put on weight.
I don't expect miracles but he seems amenable to the changes I've made and is eating a lot better now.
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'daughter'
Reply with quote  #5 
Hi Adam, my mom lost her appetite about 4 weeks after surgery. It turns out it was due to the onset of a UTI (urinary tract infection), and also - c.diff !!!! Anyways once they got that all cleared up, she starting eating normally again. BUT -- she is 74 - not in her 90's!

Barring any type of medical issue with your grandparents, it does sound like more of a pyschological/age thing. Shame on that Medicare nurse! Almost insinuating that you guys are doing something wrong. How many elderly people have these expert nurses been around?!!! Apparently - not many! The elderly have a TON of issues going on -- physical, mental, etc. ANYTHING could be a reason for them not wanting to eat, or eat much. And the nurse should be trying to help, not judge or insinuate. As CJ said, ask the nurse what SHE would do to get your grandparents to eat, and after she mentions everything you have already tried, then ask her "okay, so now what??" Okay never mind me!! That one got me riled.

On the flip side, yes they are old, and no one should be forcing them to try to eat, or nagging at them constantly. You can only encourage, and make suggestions, and make sure they have things around. It really could be a declining issue. Even though your grandmother may appear quite functional and 'fit', she may not be feeling it! And she may not be telling you or your mother how she really feels, same with your grandfather as well.

The thing where they like something one day, hate it the next - I think that might be kind of common at that age. I don't know why that happens. Gives them some kind of control over something, since everything else is out of their control, almost. Almost like a small child, trying to feel in control of something.

I like to entice my Mom with fast food stuff Yeah, I know, not real nutritional, but hey, she's getting something at least. Mom takes a multi-vitamin every day. Do your grandparents take a vitamin? My mom loves the fried chicken, or a Big Mac from Mcdonalds!! Not every day, just when I go to visit her, about once every 6 weeks. In between, she eats the same thing every day, like she has for the past 10 years or so. And I will get her different stuff to try from the grocery. As you say, you can only stock up their fridge and freezer with so much stuff. If none of it appeals to them, what else can you do??

Hang in there Adam, you're doing a great job, you can only do so much, you know?? You are not neglecting them, you are trying to help them. Also, maybe back off a little, give them a sense of more control in their lives, it sounds like they have lots of people swarming around them giving them 'advice' - you, your mom, the resident nurse, the visiting nurse, the doctors, blah blah blah!!!

'daughter'(beth)
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'daughter'
Reply with quote  #6 
Adam - p.s. -- could any of their medications be affecting their appetite?? Are they on any medications even?

'daughter'(beth)
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billie jo
Reply with quote  #7 

adam, i know how frustrated you are. it's like tryng to get a two year old to eat brussel sprouts! it seems to be a common complaint of caregivers to deal with meal time. it seems the older they get the more they lose their appetites and foods they love are unedible cr*p [to quote daisy!] she nearly lived on sweets and cookies when i met her and now she hides them. she is always saying she's not hungry and i do think they lose their sense of hunger. dasiy raised her kids on a lot of casserole kinds of foods and now she can't eat any of those becasue she says they are 'messy cr*p, meaning that they are not recognizable as a division of meat, potatoes and veggies. it's enough to drive a caregiver nuts. i do know that she now likes waffles with fruit and a bit of cool whip with a soft cooked egg on the side for breakfast, lunch. they are high in calories and i make the whole grain ones from scratch. she also love bananas with a light sprinkling of cinnamin sugar. a peanut butter and jelly sandwich with a bowl of applesauce or peaches, dark meat chicken and mashed potatoes with baby carrots. a lot of things like you said that are a little softer but pack in some nutrition where ever you can. if their teeth give them trouble it is hard to chew or sometimes are painful, but sometimes it comes down to loss of appetite due to age. i now you have racked your brain and tried everything and are so worried and frustrated so at this point let them call in social services and let them give all the advice they want. i do suggest if this happens you keep a journal on hand of what you have been trying just to show them that you are not neglectful. also, let them kkow that there have been complaints that you are not doing a good job feeding them better. ask the social worker or docor what food restrictions they might have and work from there. keep a log of what they are fixed and what the results are. there is an article in the news that came out in the last couple of days of a man and his daughter in law who are facing the same problem and are charged with neglect. cover your butts. i know how much you care,and how frustrated you are but sometimes the appetite is just gone. do your best and act on any advice they give you and log the results. most doctors will advise ensure or boost but many just do not like them. hang in there and if possible either share a meal with them or ask someone else if they can. sometimes they are more likely to eat if it's social rather that just meal time. with daisy i have to plan to make every bite count in nutrition and high calories. good luck and hang in there. i know what a headache feeding can be. it is the most stressful part of my day.

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gracenotes
Reply with quote  #8 
I think before making any assumptions about their psychological health and how this affects eating, it is first important to consider their physical health and if there are any problems that are affecting the appetite.  As mentioned here by others, maybe the problem is a UTI, or stomach problems, or medications.  Could be a number of things. 

And, I would not take the stand that old people are supossed to have bad teeth.  Bad teeth hurt, and/or are sensitive to heat or cold.  I do not see any reason why a dental problem could not be fixed regardless of anyone's age.  I really would also start there and see if they would agree to a dental appointment.  Find out if something is hurting.   I know, for myself, if my teeth were bothering me I would not want to eat much.  I would try to get them interested, if there is an identified problem, in seeing a dentist. 

And, sure, bring the social worker in.  I think that would be a good thing.   
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Mary E.
Reply with quote  #9 
Hi Adam,

First of all may I say you are a wonderful son and grandson to be so caring and helpful.  I'm sure it helps your mother tremendously to be there for everyone. 

My mother (who is 90) was going through a downward spiral weight-wise last winter.  She would say that she had no appetite and all of her skirts were literally falling down. She was having me take in all of her waistbands.   All of the foods she had previously enjoyed, suddenly didn't appeal to her at all. 

Her doctor was concerned and recommended Ensure, the drink similar to Boost and the one Rosie uses for her father.  He actually prescibed that she drink three a day.  She wanted to get better so she began using it and started to feel better - and gradually  got some of her appetite back and began to have small meals again.  Now, she drinks only one a day and has actually began gaining weight. (Soon there will be more sewing for me.)

The other thing that helped along with the Ensure was that she started to take Zoloft.  At the begining, she kept saying that it wasn't working - that she didn't feel any differently ( I think she was expecting to feel a "high" of happiness.) But I noticed when I weighed her at home that she was gradually beginning to gain weight again. These days she eats regularly and is more content. 

I think that at a certain age - whether from depression, boredom, pain, or just the realization that one is elderly (and hating it as my mother does) - that they begin to lose their appetite.  If they actually WANT to get better, they'll try anything as my mother did - and they'll break the pattern and begin to get strong again.  But sometimes, if they refuse to help themselves or won't agree to try the things that others say will help, they'll begin the downward slide and it is rather hard to stop that - they have to want to help themselves.  All we can do is offer to help them, but we can't make them get better if they don't want to. 

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Adam
Reply with quote  #10 
Thanks to all who posted and offered advice.  This site is really awesome - I wish I had found out about it sooner.  I feel better just reading what everybody writes!

Yes, hit the nail right on the head, there is a power struggle going on.  Even though they SAID they wanted to live in the home where they are living now, with the full time nurse, they still wish they could be independent in their own home and driving and such.  This is completely understandable.  Now the full time nurse does all of the food prep and they feel the only thing they can control is their food intake.

On the other hand, though, is that they were slowly and quietly starving themselves when they were still in their own home.  We did not know until they started acting really REALLY strange.  Doctor said Grandma was dangerously deficient in potassium and Grandpa had lost considerable weight.  They had no energy.  So we got 24-hour nursing care in their home, one thing led to another, and they are where they are now.  Grandma is also capable and welcome to prepare whatever she wants, even where she lives now, for herself and/or Grandpa.  Well, she copped the attitude that she should be "waited on," so full time nurse must prepare the food.  Stubborn, huh?  Grandpa also tried the power thing about getting up on his own during the night.  I'll post that in another thread - it is an interesting story.

You're right - there is no reason why someone in their 90s must have bad teeth, but it is not uncommon for teeth problems to occur as we age, and in the case of my grandparents, they refuse to go to the dentist.  We have tried, begged, whatever, and they said that dentitsts are for younger people.  Go figure...

We have told various family members about the refusals of food, and they have in turn said they will go out there and yell at and threaten my grandmother into eating.  I told them not to do this, as I really don't think this is the answer.  I keep saying, "did you ever want to do anything just because somebody got in your face and yelled at you to do it?"  I am afraid this will cause them to stop eating what little they are already eating.  I can't help but make mention of eating when I go to see them, and my mother had the idea to make incentives to eat.  Grandma likes to go to the mall, and mom says she will take her, if and only if she eats a little more...  This seems to work for a while, at least.  Isn't it weird when the parent becomes the child and the child becomes the parent?

I think the social worker (who never showed up) might have been a threat, but it really worried the full-time nurse, who has a license to worry about.  My mom was just angry that somebody comes in and sees my grandfather once a month and sees he's losing weight and immediately assumes we are neglecting him.  The first time this same Medicare nurse showed up, she said she wouldn't even look at my grandfather until he had a hospital bed.  So after ordering and receiving this bed (which Medicare still won't pay for because they say he doesn't need it), she looks us in the eye as if we're neglecting him.  WHERE do these people get their licenses from??  I am ready for whoever might have suggestions and will try what is recommended.

I am feeling that we must continue what we are doing, but at last, it might just be that they have to want to eat and all we can do is keep offering.  We cannot push it any more than we already have, painful as it may be, it is all we can do...

Thank you for your help and advice and may God bless you all.
ADAM
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Adam
Reply with quote  #11 

PS - Grandma and Grandpa have been drinking the Boost for some time which is very good for them at this point.  Mom drinks this as well.

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DV
Reply with quote  #12 

My Mom will not tolerate any of the ensure/boost stuff.  all have artificial sweeteners...  upsets her stomach...I have contacted the companies of both.   No response..    

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DV
Reply with quote  #13 

Many thing come into play...    Teeth(dentures),   remakes of special recipes...   changes in taste!!!..  Good luck,,, think about the favorites, how can you remake them to suit current abilities to chew...  Crucial,  Dad would never tolerate "baby food".   Still he would drink a "milk shake".    Freeze up a Boost with fiber, and add banana or other fruit.  Good luck.

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Janice W
Reply with quote  #14 

My Father in law was never hungry at meal time. I found he did better with frequent "snacks" than a big meal. While he was watching television I would sit a small plate of chicken salad on crackers next to his chair and nonchalantly say "here, have a snack" like it was a special treat. A few cheese sticks, some peanut butter and crackers, couple of deviled eggs, any type of nutritious food that was a finger food. Without realizing it, he was eating meals, just spread throughout the day. You can also add a little ice cream  and fruit to the boost and make a milk shake. You sometimes just have to trick them like you do a child who is a picky eater. Hope some of these suggestions help!

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billie jo
Reply with quote  #15 

janice w, you are so right about the snacking throughout the day for those who are never hungry for a real meal.i hadn't thought of the deviled eggs! and string cheese or cheese sticks, although they can be very constipating so make sure it is balanced out with fiber!  i just found protein pudding cups and they are not bad, especially with a dollop of cool whip. also, carnation instant breakfast is good, they now have a liquid, prebottled one, i think it is called carnation instant breakfast 2X. wow! that one is really good. prepackaged sliced peaches and applesauce any of those little things we stick in kids lunch bags work with daisy. it does tae a lot of patience and imagination. daisy has been steadily losing weight and it is so stressful. her health is great, no problems but the alz. makes her thinks she just ate. it is all worth a try. and that is all we can do is try. good luck. 

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