Dementia pts refusing to eat.

leslie :-D · Jul 17, 2008

r/o constipation, pain.

i've had aides that add sugar to their food.

and, pt needs to trust person feeding/caring for them.

if all else fails, give them food of choice.

i don't give a darn if they want to live out their life eating ice cream.

leslie

registerednutrn, BSN, RN · Jul 17, 2008

What I have tried in the past that has worked is to have finger goods that they can pick up and eat on the move and at will. If you try to force them to eat the just refuse even harder and like previous post find what they like even if it is icecream

nightmare, RN · Jul 17, 2008

Some Dementia patients literally forget how to eat.They are a big challenge.I have one just now,wasting away before our eyes.

We thicken all fluids with supplement so that when we do get something into her it counts.She clams up her mouth and fights you away because you are poking this metal thing at her mouth and she doesn't know why.If food does go in her mouth she doesn't always swallow.I have found food still in her mouth several hours after being fed and had to evacuate it for fear she chokes.We do not use IV's where I work so getting enough fluids in to keep hydration is a lot of work.Sometimes we us sub cut fluids ,depends on the wishes of the relatives and the doctor.Stroking the tip of the spoon on the bottom lip can sometimes provoke an opening mouth reflex but again there is no guarentee she will swallow.Stroking gently down the neck will sometimes get a swallow reflex as well.At this stage swallowing medication becomes impossible as well and we try and get the medication in liquid form as much as possible and discontinue those drugs that are not required any more.

leslie :-D · Jul 17, 2008

Some Dementia patients literally forget how to eat.They are a big challenge.I have one just now,wasting away before our eyes.
We thicken all fluids with supplement so that when we do get something into her it counts.She clams up her mouth and fights you away because you are poking this metal thing at her mouth and she doesn't know why.If food does go in her mouth she doesn't always swallow.I have found food still in her mouth several hours after being fed and had to evacuate it for fear she chokes.We do not use IV's where I work so getting enough fluids in to keep hydration is a lot of work.Sometimes we us sub cut fluids ,depends on the wishes of the relatives and the doctor.Stroking the tip of the spoon on the bottom lip can sometimes provoke an opening mouth reflex but again there is no guarentee she will swallow.Stroking gently down the neck will sometimes get a swallow reflex as well.At this stage swallowing medication becomes impossible as well and we try and get the medication in liquid form as much as possible and discontinue those drugs that are not required any more.

nightmare, you are referring to those w/very advanced staged dementia/alzheimer's.

when they reach this point (of forgetting how to eat), it is risky trying to even get them to swallow.

aspiration is a major cause of death in this population.

when it reaches this point, it's time for comfort care (if poa refuses fdg tube).

leslie

MisMatch, LPN · Jul 17, 2008

I have had some success finding food they like that they can suck through a straw. Ice cream was a popular choice - I just let it soften to the point where they could suck it through a straw. My theory is the sucking instinct present at birth stays intact until death.

nightmare, RN · Jul 17, 2008

nightmare, you are referring to those w/very advanced staged dementia/alzheimer's.
when they reach this point (of forgetting how to eat), it is risky trying to even get them to swallow.
aspiration is a major cause of death in this population.
when it reaches this point, it's time for comfort care (if poa refuses fdg tube).
leslie

That's the trouble though,we don't use tubes either!!In all the years I've been there I've seen one Ng tube and one PEG.They just don't like nursing homes using these at all.

SuesquatchRN, BSN, RN · Jul 17, 2008

Well, I'm not a fan of keeping people this sick alive. At the point at which they stop eating it's time - but under the law, you get cited if the patient loses too much weight.

Ice cream and pudding work well. I've seen pudding and food alternated.

katepmds · Jul 17, 2008

Some people are overwhelmed with the amount of food served at meals. Try putting a small amount of food of one type on a small plate and giving them the food that way. You will need a couple of plates and when they finish one, put another in front of them. Red plates and small red glasses also help as it is the last color they see. Keep distractions to a minimum, no tv, loud noises, music etc. It should be a quiet calm environment. Help them get started eating. You may have to give them the first bite or two and them let them eat on their own if they will.

If they like ice cream make them a shake with ice cream, whole milk and carnation instant breakfast.

Hope this helps.

leslie :-D · Jul 17, 2008

for all you future nurses/aides who read this:

if any of you ever come across an elderly red-headed pt with big, brown eyes and an equally big mouth to boot, don't ever, ever force-feed her green veggies.

it will likely result in being spat on your face:

and this poor pt ( :saint: ), being zapped w/haldol and 4 pt restraints.:rotfl:

leslie

Kunzieo · Jul 17, 2008

If you can get over the "yuck" factor, share their food with them!

Take a small portion and put it on your "own" plate and (please) get your own fork, and have the meal with them. Some people eat better this way, or don't want to seem rude by eating in front of you. Also, some believe that the food is poisoned or otherwise dangerous or un-fit to eat, so this method works well with paranoid dementia.

Or try feeding them outside of the dining room. While they are sitting in a chair, suggest "a little tea while you visit." Prepare some small sandwiches and fruit cups, and other, light "tea-time" foods. Then have some line of conversation prepared and sit down and stay a while. This works very well with women, especially.

Especially important is that the food looks appetizing and is simultaneously easy to eat. Anything that has to be cut, like a big piece of chicken, or even just looks big, like a hamburger is much less likely to be eaten. Small pieces of easily chewed food are good. Try to avoid all the mush from running together though, because that looks very unappetizing!

Have them "help" make the food. Take the sandwich apart ahead of time and let them "make" it themselves. Bring dried oatmeal or fresh fruits and let them mix it in with yogurt, ice-cream, or pudding.

Just keep trying. Remember that they probably will not remember that you just offered them food 1/2 hour ago!

Good luck to you!

MedSurgeNewbie · Jul 18, 2008

finger foods help too in small portions - sit on the patients level if you can, i like to take a coffee in and "have dinner with them" some times that gets them more relaxed.. This works if you can steal the time