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Nutrition and dementia - Carers UK Forum

Nutrition and dementia

For issues specific to caring for someone with dementia.
Many people with dementia often refuse to eat properly, how can we get around this problem?

I'll kick off with a simple question: Milk is a great source of nutrients, but should we encourage them to consume skimmed, semi-skimmed, or whole milk?
Well, if you can get anyone to drink skimmed milk voluntarily you're a better man than I am Gunga Din!!! :)

Personally, I'm not sure that we should get too concerned about nutrition for the very elderly (assuming that's the same as those with dementia), because they've got that far in life on whatever they've been eating!

It's very common for the elderly to prefer 'nursery food' - ie, sweet starch and sugar etc (puddings, basically!)- so why not let them? Ditto, many of that generation do NOT like 'healthy foods' like brown bread etc (that was for POOR people in their generation!), and, again, why plague them with it now?

Same goes for greens! My MIL never liked greens in the first place, and as she aged I used to try and coax her, but simply gave up. I don't see why she should be plagued now with them.

That said, she's got a very hearty appetite, so her total calorie consumption is not an issue. She loves cream teas (sadly, so do I :( )

I can remember a while back suggesting to another member here who had to coax her mum to eat, to maybe try those 'mini-pots' that are targeted at children's lunchboxes, as they won't seem such a 'pile of food'.

Other tricks could be like the reverse of those that women dieters use - eg, instead of putting food on small plates to make it look more, put it on larger plates to make it look less!

As for your original kick off question, not sure if its a 'trick question' (!) as otherwise I'd assume the answer would be 'full fat milk' as it packs the most calories for the volume consumed. ?? (Maybe less digestible though for that reason??).

Presumably the whole question rests on issues such as underlying health conditions and levels of activity?
I previously posted about the problems with getting my husband who has had a stroke, to eat. I spoke to his Doctor about the fact that he was losing weight, and she prescribed Fortijuce. It comes in little plastic bottles and is packed full of all the vitamins and minerals that the body needs. It also comes in a milk shake style. Only drawback is that even though you can get it in loads of different flavours, it doesn't really taste very nice.
I have to water it down as it is like a thick syrup and the only ones I could get him to take are the orange and strawberry, even then the orange has a metallic smell.
The downside is that these little bottles cost about £2 each and the doc gave us 24, 12 of each variety. Thank goodness we get free prescriptions in Scotland. I wouldn't want to have to pay for that lot. As you say, I tried him on full fat milk but it didn't really make much difference. I now find that he will take puddings or ice cream and fruit. I am wondering if he is having difficulty swalling solid food. He obviously had great difficulty after his stroke and it was a few months before he could manage anything solid and even then it had to be cut up small for him, but it seems that he is again having bother chewing. He loved grilled cheese on toast for his lunch in the months leading up to Christmas, but now it has to be a sandwich with grated cheese and even then, he won't eat it all. Managed to get him to take some apple tart and ice cream last night, all chopped up very small. He just says he doesn't feel hungry at all.
Hi Seoc

I'm with Jenny Lucas regarding skimmed milk... vile stuff!
We tried to get mum to drink full fat milk, but after decades of drinking semi-skimmed she found the full fat too heavy. We stuck to the semi.

About 2 years ago CUK asked me to write about my efforts getting mum to eat. I've located it and copy/pasted it below for you. I hope it's of some use to you.

I’ve been asked by Carers UK to write about my experiences regarding getting mum to eat when she left hospital earlier this year. She’d had a mini-stroke and was in hospital for two weeks. In that time she lost her appetite completely and lost a lot of weight she could ill afford to lose, as she’s always been slim.

I left my job at Tesco’s to become mum’s full time carer; I’d previously been her part-time carer since Jan 11when my father was diagnosed with cancer. He needed someone to mumsit mum as he’d noticed that she was losing her memory, repeating herself, leaving the gas on, etc. I’d do so whilst he was attending his various out-patient clinics, and I got a job working in the evenings so that I could be free during the day for my mumsit duties.
These duties increased as mum’s dementia (I hate that word; I’m going to invent another one) as mum’s spirit wanderings increased, plus her arthritis also increased.

I was plunged right in the deep end regarding mum’s nutrition when she came out of hospital. Plus, I knew next to nothing about nutrition. My idea of a goumet meal was a Chicken & Mushroom Pot Noodle washed down with a can of fizzy Orangina, or tinned spaghetti hoops on toast (white bread of course) followed by a Tesco’s Value Crème caramel or four!
To make matters worse, she hated those Nutrisip/Ensure drinks, describing them as too heavy and slimy.
So I diluted them with semi-skimmed milk and added a few drops of vanilla essence. I’d give my milk/nutrisip/Ensure mix a quick blast in the liquidiser and pretend it was a home-made milkshake. She’d now drink them.
The strawberry and banana Nutrisip/Ensures tasted vile, according to mum. So I only ever used the vanilla ones, and would occasionally add strawberries or a banana to my ‘milkshake’ to ring the changes.
She never managed to drink 3 a day, but at least I was getting some nutrition into her. That was a start.
I learnt via trial and error. I didn’t join the Carers UK forum until mid-september, so really was on my own.

Here are my top six tips for dealing with someone who has a poor, or no, appetite.
Everybody’s different, so they might not apply to everyone.

1) It is only human to present a pile of food to someone who needs to put on weight but, counter intuitively, this was the first mistake I made. Mum would look in horror at the massive plate of piled high food I’d slaved over. Large portions are intimidating to someone with a low appetite.
Now I present all meals, even a Sunday roast, on side plates.
I think it’s important that mum doesn’t feel left out, or feels she’s being treated differently, so I serve everyone with the same meal as her on the same sized plate. If anyone wants more they can always have seconds.
Plus, because I have to chop mum’s meat up into bite-sized pieces, everyone’s meat is chopped up too. I’m big on food equality as I don’t want her to feel she’s being treated like a baby.

2) Mum’s always loved fruit, and I noticed that she’d eat a lot more of it when I’d forgotten to put her fruit in the fridge after a shopping trip.
Food, especially fruit and salad, tastes much better at room temperature than when chilled. If you don’t believe me, try this simple experiment.
Take a punnet of soft fruit, place half in the fridge, and the other half outside fridge. After a couple of hours or so eat one from the fridge, then eat one of the room temperature ones. The difference will astound you; it did me.
Such a simple thing, but mum’s consumption of fruit nearly doubled overnight when I served it up to her de-fridged.
The same with salads. I’d always make these a good couple of hours before we would eat them, and leave them on the kitchen worktop covered with glass lids.

3) I resorted to tricks to get her to eat. Whenever I asked if she wanted something to eat, she’d always say no, maybe later. Later, I’d ask the same question. It was ALWAYS later. I gave up asking her in the end.
Instead, I’d fry an onion, and leave the doors open so the smell of frying onions would waft through to the living room.
I’d then walk in with a plate of cheese toasties/whatever. I’d casually start munching away, without offering her any.
This would either annoy her, and she’d demand some of ‘my’ food. Or, if she didn’t ask for any, I’d pretend I was full, and ask her if she wanted the rest.
About 70% of the time my stratagem worked.
I also ended up piling on the pounds too, in my efforts to trick her into eating.

4) Although she was very frail and weak when she left the hospital, she wasn’t bed ridden. But she was chair bound though.
After about a month, when some of her strength began to return, I insisted that she joined dad and me at the kitchen table for meals.
This made a tremendous difference. Listening to dad and me squabbling/nattering away meant she picked away more at her food than previously. When she joined in, she’d still pick away, and would often finish nearly a whole meal.
With hindsight I wish dad and me had eaten our meals with mum in the living room, instead of leaving her alone until she could join us. Perhaps feeling abandoned at meal times made her appetite worse than it actually was?

5) Mum now eats much more slowly than before. So I found it important to serve up hot foods that taste just as nice when they’ve gone cold. Chips and roasties aren’t very nice when they’re stone cold, and taste even worse when they’ve been re-heated. But boiled and mashed potatoes taste just as good cold as when hot. Fried eggs taste, and look, awful when cold, so they’re out. But scrambled eggs and omelettes taste fine cold, which is just as well as mum can take up to half an hour to eat her morning eggs.

6) I’ve trained dad and me to eat at mum’s pace; again so she doesn’t feel ‘different’ or abandoned, as we all finish eating and leave the table at the same time. I’m sure the stimulation of our meal talk times is helping her in other ways too, and not just with her appetite.
Not everyone will have the time to spend an hour eating super, but if you can manage it, give it a whirl if you too have a slow eating caree.

Naively, I thought once mum got her appetite back, that would be that. It isn’t. She can go days eating quite well, then she’ll lose her appetite again, and the whole rigmarole of tricks etc will have to start up again.
I know as people get older they need less food, but mum’s lack of interest in food, unless actively encouraged, puzzles me.
Is it a symptom of dementia? I don’t know. It has occurred to me that if her brain is changing, then why would her appetite be unaffected? Perhaps some eat too much for the same reason?
Regardless, I’m convinced that if she were living alone she’d have starved herself to death by now.

Which is why all those stories I keep reading about 15 minute care visits disturbs me so much. How can a paid carer possibly prepare food, and encourage their caree to eat it in 15 minutes, or even half an hour; plus all the other stuff they do? It’s an impossible task UNLESS hours are spent on it; not minutes.

Mum’s lucky. She has a very loving, concerned, caring family to look out for her. Many elderly people don’t.
I want to protect them all, but I can’t. Society as a whole can. So, let’s be selfish and demand better care for the elderly. Let’s kick these private care companies in to touch who pay rubbish wages to carers but demand all sorts from them. After all, if you’re not struck by lightning or a bus or something, you too will live to be a ripe old age.
Do you REALLY want a rushed 15 minute visit, conducted by a harried carer? Do you want your needs exploited, without actually having them met? If you don’t, then neither does anyone else.
Thanks all, appreciated. When it comes to milk, it's only whole (or full fat) milk here. Calcium, for obvious osteo reasons, fluids, protein and fat, all of which are required by older people to help maintain, at the very least, their basic metabolic functions. Throw in some extra protein (whey protein powder - yep, the stuff body builders use), fruit (bananas get a good look in here) or veg, fibre, coconut water (naturally isotonic) and vitamins, and through a liquid meal alone, we can at least ensure they receive the essential nutrients and minerals they require.

PS, I'm not an advocate of, often prescribed, products like Fortisip, which although nutrient rich, also have a high glucose content, not good for Type 2 diabetes, as this can result in more, rather than less medication.
My mum too hated those Fortisip/ Nutrie sip things, she hated them,,. Too thick and slimy, despite all my diluting of them. I actually thought she was right. I added orange juice to a Fortysip in hospital and it turned to jelly…. Opps! That’s not supposed to happen… so I hid the blasted thing and fed her chips instead from the café. She liked the chips.

But despite all my attempts at nutrition, I failed in the end, she just died. Eggs are good.
Sajahar, I'm going to remind you of what I think it was Susie said here (or was it Crocus - apols anyway)....

(I paraphrase...)

"We always have to remember that they are not dying because they are not eating - they are not eating because they are dying"

No animal, including humans, live for ever. Each species has a natural life span. Your mum's life ran its course. Feeding her would not have kept her alive. She did not die from lack of food. She died from other causes, including old age.

Nothing you could have done would have kept her alive longer - just as nothing I could have done would have kept my husband alive longer. And death released them from the infirmity of their bodies. One day it will release us too.
Thanks Jenny for reminding me of that saying.

“We always have to remember that they are not dying because they are not eating - they are not eating because they are dying"

You’ve actually done more to help pull me from the doldrums than my bereavement councillor did last Thursday. If anything, I felt worse after that session. I’ve been having a lot of very vivid dreams about mum lately, which got me onto a ‘What did I do wrong, could I have better, what if, blah, blah, blah’ track of thinking. Which in turn means I’ve been horribly depressed the past couple of days, and keeping myself to myself.

So much so, I was going to ring SM and cancel going to a Valentine’s ball with him, as I just didn’t feel up to it.
But now I’ve changed my mind; I might even enjoy it. If not, then it’s got to be better than sitting alone in my room brooding about mum.

So Jenny, thanks to you I shall be going to the ball after all; have a cyber kiss of thanks :kiss:

P.S. Fancy a Valentine’s day do being held on the 13th????
Seoc an Aonaidh wrote:Thanks all, appreciated. When it comes to milk, it's only whole (or full fat) milk here. Calcium, for obvious osteo reasons...
Hi Seoc, I agree that full fat milk certainly has its uses for frail elderly people, but surprisingly the semi skimmed milk has a higher percentage of calcium apparently (seems odd, I know). Anyway, when dealing with severely underweight elderly people, I reckon you just have to tempt them with anything they can swallow/face eating, and hope they get some pleasure from their food, plus enough calories for their needs.
PS, I'm not an advocate of, often prescribed, products like Fortisip, which although nutrient rich, also have a high glucose content, not good for Type 2 diabetes, as this can result in more, rather than less medication.
Valid point for younger people, but for elderly folk who don't have diabetes and who are struggling to eat enough , I reckon diabetes is the least of their worries. My Mum had swallowing problems and lived on a diet consisting mainly of hot milky drinks, soup, chocolate and sweets for the last couple of years of her life. There were times when she went through 2 bags of sweets a day, as she loved the flavour and enjoyed them melting in her mouth. We asked the GP about the risk of diabetes developing, and were told that it would take more years to develop than Mum was likely to have left, so just to let her enjoy her sweets.

Sadly, despite all attempts to keep her nourished and fed, she gradually wasted away, until her poor frail body had absolutely no reserves of fat/energy left to keep her going. We were fighting a battle we could only lose, but had we restricted her sugar intake to "healthy" levels, the battle would have been over much earlier.

One other thing. Apparently, the last thing to survive, taste-wise, is the ability to taste sour/bitter food, which is why elderly people often crave sweeter foods as time goes on. They seem to need more sugar to get the "hit" that gives pleasure. My father has become this way in the last few years, and will eat all manner of sweet things that he wouldn't touch years ago.
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