Grandmother w/ alzheimers - Malnourishment question

Nurses General Nursing

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So they say my Grannie has Alzheimers. I'm not sure how you can know for sure - she definately has dementia problems, but doesn't do the "strange" things or say the "strange" things that alzheimers pt normally do. Mainly she is just loosing her memory, and ability to reason - nontheless - my question is not really about her disease as it is about a malnutrition concern. Over the past year, her appetite has diminished. She is not 'dried up on the bone' --from her size she looks healthy, but I swear if she takes 10 bites for the whole day, we are lucky!! She has no appetite, she has lost her sense of smell/taste, so food does not appeal to her at all. we do manage to get her to drink about 1/2 of an ensure drink per day. Other than that and a few drinks of water / juice here and there - she basically doesn't eat enough to keep a kitten alive. Last night I was there and trying to get her to eat (she took 3 small bites), and so I took her BP because she has a history of hypertension, and I could NOT HEAR it at all. I took her pulse - and it was 81 bpm, so I tried her BP again, thinking I wasn't paying attention, and I could not hear it again. Now I am only a 2nd semster student, so don't have all the pieces of the puzzle yet, so I'm asking could this be because she was dehydrated? I did the skin turger thing, and it did not immediately retract, but did not stay tented - it just was tented for a second, and then went back down.

My grannie has told me numerous times she's ready to go, and she does not want to end up in nursing home, so I am actually hoping she goes one night in her sleep (she wants to die at home). If she continues not to eat much - could this weaken her heart? What signs should I look for - like if she was fixing to die?>? Don't get me wrong - I will be so heartbroken the day she passes on, but I know her wishes, and I know the time might be soon, I was just wondering how to know. And if she could die from not eating much. She's 80 years old.

Sorry if I rambled on.

PB

Specializes in OB/PP/Nsy.
OK I just went to a class on this 2 days ago.Hormel meals makes things that are tasty with High protien .Like cookies and shakes when people will not just eat .Its amazaing a person will eat a 200 cal cookie and pass on the regular food That just takes to much effort to eat .I tried a cookie and they wern't bad.They also had tasty shakes as well.

Awesome class

Daine

Wow - that's sounds promising. Did they say where to get this stuff?

PB

So they say my Grannie has Alzheimers. I'm not sure how you can know for sure - she definately has dementia problems, but doesn't do the "strange" things or say the "strange" things that alzheimers pt normally do. Mainly she is just loosing her memory, and ability to reason - nontheless - my question is not really about her disease as it is about a malnutrition concern. Over the past year, her appetite has diminished. She is not 'dried up on the bone' --from her size she looks healthy, but I swear if she takes 10 bites for the whole day, we are lucky!! She has no appetite, she has lost her sense of smell/taste, so food does not appeal to her at all. we do manage to get her to drink about 1/2 of an ensure drink per day. Other than that and a few drinks of water / juice here and there - she basically doesn't eat enough to keep a kitten alive. Last night I was there and trying to get her to eat (she took 3 small bites), and so I took her BP because she has a history of hypertension, and I could NOT HEAR it at all. I took her pulse - and it was 81 bpm, so I tried her BP again, thinking I wasn't paying attention, and I could not hear it again. Now I am only a 2nd semster student, so don't have all the pieces of the puzzle yet, so I'm asking could this be because she was dehydrated? I did the skin turger thing, and it did not immediately retract, but did not stay tented - it just was tented for a second, and then went back down.

My grannie has told me numerous times she's ready to go, and she does not want to end up in nursing home, so I am actually hoping she goes one night in her sleep (she wants to die at home). If she continues not to eat much - could this weaken her heart? What signs should I look for - like if she was fixing to die?>? Don't get me wrong - I will be so heartbroken the day she passes on, but I know her wishes, and I know the time might be soon, I was just wondering how to know. And if she could die from not eating much. She's 80 years old.

Sorry if I rambled on.

PB

I'm sorry to hear about your Grannie. It's hard, I know. I've lost both my parents in the last several years. It's hard to see them go downhill, too.

If you weren't able to get her blood pressure, were you able to feel a radial pulse? Usually you have to have a SBP of at least 80 to feel a radial pulse; if you don't feel one, then her SBP is probably less than 80 and she may need to be rehydrated. My late father, who had prostate cancer, had blood pressure that would get real low, then he would go to his doctor's and get a few liters of fluid and it would come back up. Getting her rehydrated is something to consider...

NurseFirst

Specializes in Critical Care / Psychiatry.

How wonderful of you to be taking care of your grandmother! I can't imagine a harder task. You'll make an awesome nurse. :)

You'll know if she's going to die from malnutrition...

It's a pretty slow process, for the most part. From what I've seen she will become more confused and lethargic. You'll find her slumped over in her chair, not able to sit up properly. If she becomes bedridden and is ready to go, her neck will distend and her color will be a dusky yellow if she is Caucasian. I've also heard that a death of starvation/dehydration is pleasant and that no pain is felt.

This is just from my personal experience as a CNA in a nursing home watching people die this way.

Shel

Specializes in Utilization Management.

ensure makes tasty high-protein puddings. they also make a fortified powder that can be added to foods.

http://www.ensure.com/ourproducts/ensurepudding.asp

these are the ice creams that another poster mentioned by hormel. i used to give all my alzheimer's patients their meds crushed in ice cream magic cups because so many of them had such poor nutrition and were so burnt out on applesauce.

http://www.med-diet.com/magiccups.htm

i think maybe if you got the information, one of your local drugstores might order the products for you.

another thought: have you tried pureed foods? maybe granny's dentition is not what it used to be and she simply can't chew as well to get the flavors out of the foods? it's a thought. now you have a lot of ideas to try anyhow. please keep us posted and let us know what works! :)

I make some of my patients "special" milkshakes of ice cream, ensure and ensure pudding. Orange Sherbet and vanilla ensure is a favorite of alot of them. Tastes like a dream sicle. I even make that one with regular milk for some of my patients.

Finger foods are the key for alzheimers patients. Just give it to her, don't mention that it's time to eat...just try handing her part of a sandwich and say "here, grandma". I have 3 ladies I get to eat that way.

Marinol is a GREAT appetite stimulant!

My grandmother has it too:o . Even when she won't eat, she will drink a McDonald's milkshake. Mom takes it and the nurses mix Promod in it for a little extra protein.

I had one Alzheimers patient that we couldn't get to eat nothing. One night we ordered Chinese at work. She wandered in to the dining room with us, we made her a plate and she ate every darn bite:) . After that, if any of us had take out food, she'd check out our bags and just take what looked good to her:chuckle .

I took hot krispy kreme donuts to work yesterday. I think they lasted all of 5 minutes.

Good luck with your granny. It takes alot of trial and error to find things they will eat. It's frustrating but when they do eat, it's worth it.

Has she been checked out to see if she has pneumonia? I have seen residents who don't eat and sleep all day. They don't cough they don't have any symptoms of pneumonia but when they get checked out by the doctor they sometimes are found to have pneumonia. Perhaps sending her to adult day care will stimulate her and get her interested in life. My mom goes twice a week and enjoys it. Of course, I have to lie to Mom and tell her adult day care is free. And since it is free Mom be sure to enjoy the "free luch" they offer. I am lucky. My mom's appetite has not decreased so much. Fortunately, she forgets that she has eaten and then will eat again. I also take her to "free potluck lunches" at the church. I also go to the all you can eat buffets and buy tickets. I then tell mom "look I got some "free tickets to the all-you can eat buffets. Best of luck to you. I have sure learned a lot of great information here on getting someone to eat. Thanks all

Has she been checked out to see if she has pneumonia? I have seen residents who don't eat and sleep all day. They don't cough they don't have any symptoms of pneumonia but when they get checked out by the doctor they sometimes are found to have pneumonia. Perhaps sending her to adult day care will stimulate her and get her interested in life. My mom goes twice a week and enjoys it. Of course, I have to lie to Mom and tell her adult day care is free. And since it is free Mom be sure to enjoy the "free luch" they offer. I am lucky. My mom's appetite has not decreased so much. Fortunately, she forgets that she has eaten and then will eat again. I also take her to "free potluck lunches" at the church. I also go to the all you can eat buffets and buy tickets. I then tell mom "look I got some "free tickets to the all-you can eat buffets. Best of luck to you. I have sure learned a lot of great information here on getting someone to eat. Thanks all

thank you blackcat. the first thing i'd do is r/o uti or pneumonia or even impaction. and then if all come back negative, then yes, strategize away.

leslie

Thanks for the advice - I will try that this week - and pass it along to my aunt who fixes most of her meals (lives next door). You know - now that you mention it - the things she does eat tends to be sweets. She nibbles on those Little Debbie's alot - which is not the best choice of food, but guess it beats nothing.

Thank you very much.

PB

When I was growing up, we cared for my great uncle at home, then my grandma, and finally my grandpa. From 1983 to 1995, we had elderly relatives in our home. My uncle had cancer, and as he deteriorated we had many problems getting him to eat and drink enough. We learned a lot of creative ways to get him to eat.

First keep in mind, that our grandparents grew up eating many different foods than most people eat today. Get grandma talking about food and see what memories you can stir. If she has an old recipe box, get it out and look for the recipes that are wrinkled, splotched and stained because are the ones she used the most, and ask her about each one. Maybe something will appeal to her. Ask her what things her mother made that she liked best. That was a winner with me uncle and the memory he came up with was easy to do for him. He just wanted buttermilk and a piece of homemade cornbread.

Something that works for kids might also translate well in your situation. Always keep plenty of food within grandmas reach. Little snack trays with bite size pieces of fruit and cheese are good. If she likes little debbie, see if you can slip in some of those new soft energy bars, or breakfast bars. I used to give them to my kids and tell them they were candy :)

Another plus to talking to Grannie about foods she used to like is that it will give you some good memories of your time with her. Make it fun, humor and laughter are great appetite stimulants.

Good luck, and God bless Grannie

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You guys are all so compassionate and smart. I am sure the OP appreciates all these ideas and thoughts.

to the OP, I am sorry about Gramma. I hope they get to the bottom of this, and if it is indeed near the end, she does go as peacefully as possible. I miss my Gramma every day. (((HUGS)))

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