Suggestions on How to Get my Mother to Eat?

[mom2rtk]

We do still see it a bit. It's mainly given at night, probably because of the drowsiness issue. It could be why they stopped it in OP's Mom, if she was sleepy during the day. I'd guess they'd be reluctant to increase the dose, but it's worth suggesting it, anyway.

Cimbalta can be another drug to try which seems to have reported good results in the elderly.

Maybe the sales force finally gave up trying to get doctors to believe they needed to increase the dosage to decrease the side effect. 20 years ago I was on the front lines of trying to get that message out. It really does fix the issue. The tendency was to start them at a low dose and want to titrate up, but it's hard to get them to increase the dose at all when the side effects already seem too great. It's a shame too. It's a great drug for some patients when prescribed properly.

It was always fun though to tell the doctors that to decrease the side effect, they needed to increase the dose. That's when the ones who were paying attention always stopped and said "Wait.... what?".

 

[Shanti]

Yes, I know. She is already on medication for depression. She had always said she "wasn't depressed" but when they put her on the medication she got her appetite back and started enjoying things again. I have no idea why they took her off it, since it was doing what it was supposed to, and when she started going back downhill they put her back on it but it doesn't seem to be doing anything for her this time.

It is alarming that they took her off a successful medicaton, & seems to indicate a lack of competance on the part of her care team. Was it an economic reason why they took her off it? Are you sure they put her on the same anti-depressant the second time? All antidepressants are not created equal. Often a different brand/amount/formulation doesn't work as well as another. This is what you need to focus on first, making she sure she is on the exact brand/type/dosage of medication as she was when she was improving. You'll need to talk to her doctor about this specifically, & asap. Since the lack of interest in eating is linked to depression, that issue can't be resolved until her depression is under control.

 

[low-key]

one word "pizza"

 

[mom2rtk]

one word "pizza"

I recommend starting with a high dose.

 

[mnrose]

My father was the same way at the end of his life. There's nothing you can do to "make" them eat. I do think you should continue to explore the medication route because it sounds like depression. And, sometimes, you have to play with dosages, etc with those, so don't be afraid to continue to push the care team on that front.

It's very hard, but in the end, my father was a grown man who was entitled to make his own decisions, even if I vehemently disagreed with them. He was, however, of perfectly sound mind. In your mother's case, the mild dementia combined with depression could be affecting her choices.

And, being honest, I would NOT want to live in a nursing home situation. Assisted living, fine. Nursing home? No. Even the so called "good" ones are very depressing to me. So, I sort of understood his thought process.

 

[Pea-n-Me]

It is alarming that they took her off a successful medicaton, & seems to indicate a lack of competance on the part of her care team. Was it an economic reason why they took her off it? Are you sure they put her on the same anti-depressant the second time? All antidepressants are not created equal. Often a different brand/amount/formulation doesn't work as well as another. This is what you need to focus on first, making she sure she is on the exact brand/type/dosage of medication as she was when she was improving. You'll need to talk to her doctor about this specifically, & asap. Since the lack of interest in eating is linked to depression, that issue can't be resolved until her depression is under control.

What?? What do you suppose would happen if she fell as a result of drowsiness? Or if she choked on her food because she wasn't awake enough to swallow properly? Or she was displaying confusion because of her drowsiness? I can tell you what - the doctor and care team would be accused of "overmedicating" her. And by rights, if you were the doctor ordering that medication and report after report said she was having all these unwanted side effects, would you continue to order it? Probably not. They will need to find a medication that works better for her. I believe that what mom2rtk says is probably true, but this isn't the patient on which to test out the theory, if you kwim. This is why I suggested ether a psychiatrist or gerentologist gets involved - they are most familiar with these issues and how to resolve them.

 

[Pea-n-Me]

And while I'm sure depression can be a part of the picture, there can be a lot of other factors at play, as well, and those shouldn't be overlooked. Here are some examples.

https://www.agingcare.com/articles/...perly-and-what-you-can-do-about-it-133239.htm

http://www.aplaceformom.com/blog/01-23-2013-loss-of-appetite-in-elderly/

http://dailycaring.com/6-ways-to-get-seniors-with-no-appetite-to-eat/

http://graymattertherapy.com/why-wont-my-parent-eat/

 

[tasha99]

First, though it's probably been done, a speech pathologist should evaluate her. Is she in pain? Is she swallowing okay? Know that with dementia, patients often develop difficulty swallowing as the dementia progresses (feeding tubes generally not recommended in this case). There can also be cognitive issues that cause patients to not attend to their meals. Or it could be depression (it sounds like maybe a different medication is in order, but that's a doctor discussion). Things the speech therapist might try include: smaller portions (the serving sizes in nursing homes are enormous--often overwhelmingly), serving one item at a time, colorful plates to make the food more visible, putting sugar or maple syrup on the food, providing foods with contrasting textures and/or temperatures to provide more stimulation, serving finger foods, serving her meals in a quiet area, etc. Also, if there is some type of food you can bring in that she loves, that might help--try small amounts so she can feel successful. I used to buy Arby's for a resident because that was the one thing she would eat. Hope you find a solution, but I have to say, getting patients to eat with advancing dementia is a real challenge. Hugs to you.

 

[AquamarineSteph]

I know you're hearing lots of advice here, and I know you feel overwhelmed and sad. So first things first - a big hug. Make sure you take care of yourself first.

Second - ask the staff if they have specifically ruled out sepsis. It presents differently in the elderly, and it can kill if not treated. (Not trying to scare you there. Just talking from personal experience with my father. ASK that question specifically - have they ruled out sepsis.)

Next - antidepressants tend to do poorly when stopped and started again, especially with the elderly who generally cannot tolerate the same doses as younger people because their bodies just can't process that much in the stomach/liver. Ask about switching to a different drug.

Last - a previous poster suggested Marinol. It's basically marijuana in pill form and should be available in all 50 states as a CIII drug. It HELPS with appetite, but many doctors are afraid to prescribe it because they think it will somehow trigger a DEA audit. The only time it does is when it's prescribed inappropriately.

I wish you the best, and I hope your mother regains some strength and interest in the world.

 

[rastahomie]

Last - a previous poster suggested Marinol. It's basically marijuana in pill form and should be available in all 50 states as a CIII drug. It HELPS with appetite, but many doctors are afraid to prescribe it because they think it will somehow trigger a DEA audit. The only time it does is when it's prescribed inappropriately.

For the sake of specificity, I suggested actual cannabis, in edible form. I mentioned Marinol as an example simply because it's been used in my family, but it is def not "marijuana in pill form." It's some derivatives of MJ, but not all of them. Long story short, the user won't get high. With a 5mg dose of pot edibles, the user (a first-timer, anyway), will get totes high and have the mad munchies.

 

[DopeyDame]

Big hugs. My grandmother did that and my poor mom was beside herself trying to help. In the end, they actually put my grandmother on a feeding tube because she was literally starting herself. I don't have any advice to add to what's already been said, but I just want to send my good wishes. It is so incredibly difficult to see a loved one deteriorate and the helpless feelings can be overwhelming. Remember to take care of yourself in addition for caring for your mom.

 

[Wishing on a star]

OP, I am sending hugs... Looks like you are getting some really great input and ideas here!

That is SO interesting about the dosage thing.
Even if they could be 'persuaded' to increase the dose for just a certain number of days, on a trial basis, I wonder if there would be good results that might change their Rx.

I also love the idea of the Medical Marijuana.
My husband wishes I could try that for some of my issues!

I just wanted to add... The issue of swallowing is also very interesting. And, an elderly person might not be really quick to verbalize this kind of thing.
I have experience with that with my MIL.
She had a very rare disease/condition, that could have been treated to some degree, if she had been forthcoming about her symptoms. (or if a doctor had been competent enough to make a diagnosis)
Swallowing is one of the first signs.
By the time this was recognized, and one of the Hospital staff realized that she just was not eating/drinking, at all...
They ordered the Swallow Test, and the condition had progressed so far that they could not even successfully complete the test.
Wow...
So, that might be something else to be aware of.

 

[Firsttimer15]

I would take her back to the neurologist to try another medication and she should get the walker back. Physical exercise is good when depressed. She could also fall out of the wheelchair it is mean to take away her freedom.
Also the nurses should watch that she does not sleep too much during the day it is bad with the depression.
If they are scared she falls too much maybe aquajogging would be good exercise for her

To some extend it is normal for old people to eat less bc they feel less hungry and thirsty. It is the normal course of life.
If it was my mother or any other loved one I would never agree to a feeding tube. It is her free will not wanting to have it.
I see the drama at work every day of old people wanting to die and the relatives not letting them. Some are kept alive for soo many years and what for if they don't want it?

 

[Wishing on a star]

Yes, a feeding tube is considered to be artificial life support, and can only be done with the patients express request.
My MIL firmly declined.

 

[cabanafrau]

What?? What do you suppose would happen if she fell as a result of drowsiness? Or if she choked on her food because she wasn't awake enough to swallow properly? Or she was displaying confusion because of her drowsiness? I can tell you what - the doctor and care team would be accused of "overmedicating" her. And by rights, if you were the doctor ordering that medication and report after report said she was having all these unwanted side effects, would you continue to order it? Probably not. They will need to find a medication that works better for her. I believe that what mom2rtk says is probably true, but this isn't the patient on which to test out the theory, if you kwim. This is why I suggested ether a psychiatrist or gerentologist gets involved - they are most familiar with these issues and how to resolve them.

Ideally the medical staff at a nursing home would have a really good understanding of these types of issues common among the elderly nursing home population, but of course it's not a perfect world. Best wishes to OP that you are able to have an eval done by the right providers and it's possible for your mother to have a much better quality of life soon.