Choice of diet

[marjoriemac, LPN]

Just looking for views on an issue I had recently. Older lady with dementia (probably moderate) refuses to eat dinners or any food really except sweets, chocolate and the occasional jam sandwich. Sometime she even refuses these ie tells us she does not want them and if you persist you end up wearing it! Manager of home insisted that something must be done because this lady is not able to make an informed choice of what to eat, I disagree, I think eating sweets is a choice she has made, if we push food she does not like she may well stop eating all together. The lady drinks tea but does not like supplement drinks.

[morte, LPN, LVN]

i think this may be a case of "document,document, document"....offer her her regular diet, document refusal, then offer what she usually will eat and document......on the off chance this is a taste issue, perhaps a check of her zinc level is in order.....good luck

[CritterLover, BSN, RN]

hmmm, well the dementia really does cloud the issue, doesn't it?

i earned a degree (bsa) in nutrition before i got my bsn.

one thing i learned from that is that even toddlers will balance out their own diets if given enough options.

(i.e., if you offer them only liver and cake, they will only eat cake. but if you offer them two things they will eat, such as chicken and cake, they may eat cake first, but eventually they will eat the chicken, too. simplistically put, but you get the point)

that makes me think that the dementia is having an impact on what she will eat -- i don't think that it is truly "choice."

i guess the first thing i would do would be to make sure she is getting options that she might like. could it be that the sweets are the only thing that taste good to her right now? like other senses, the sense of taste dulls as we get older.

does she have family that you could talk with? can they bring her in food that she might like to eat?

unless things have changed since i worked ltc (or unless ltc in scotland is different from that in the us), budgets are small and the food quality is one of the first things to suffer. if i remember right, the ltc facility i worked at while in nursing school in the 90's was allotted $1.75 a day for meals. ugh.

is she on a low fat/low sodium/low cholestrol diet that is robbing the food of taste? honestly, i would be more behind violating those dietary rules to get her to eat a better variety of food. in the elderly, i believe that the long-term goals of diets should be sacrificed for the short-term goals of adequate intake.

(i look at those diets as kind of like taking the cigarettes away from the end-stage lung ca patient with the rationale that it is bad for them. what is the point?)

if she really is dead-set on eating only sweets, i would talk with the nok/poa about it all (legally responsible party), as well as the attending physician.

i don't know what kind of ltc regulations you have to endure in scotland. obviously, you have to cya as far as documentation goes to satisfy the regulators.

beyond that, i definitely believe that the elderly have earned the right to do what they please (as long as it doesn't hurt anyone else :) ).

[santhony44, MSN, RN, NP]

Has anyone tried putting sugar on foods we don't normally sweeten to see if she'll eat that? I've seen nursing home patients, for example, eat scrambled eggs with sugar sprinkled on top. It might not be what we would choose to eat, but worth a try here.

I would also try getting a supplement drink in a chocolate flavor and adding extra chocolate syrup, or making a shake with ice cream, to cover the "supplement" taste and see if she'd like it.

[nrsang97, BSN, RN]

I too have combined some things with sweet stuff I normally wouldn't eat to get a dementia pt to eat. I have put some mashed potatoes on a spoon and applesauce on the end and the pts eat really well. They get the sweet taste they want and eat something else too. But in any case document pt refusing meals.

[nckdl]

I work in a dementia unit and the first thing we do when someone is not eating is to mix their healthshakes/supplements with ice cream. We tell them it's a milkshake and I have not had someone refuse yet. We actually had a resident survive only on these milkshakes until she declined then she went back to accepting regular food again. Good Luck

[SuesquatchRN, BSN, RN]

Yup. Document and make them Ensure/Boose milkshakes.

:)

[nightmare, RN]

This could be a control thing,have you tried leaving a couple of sandwiches in her room,without comment,and see if she will eat them when there is no one around to make a fuss? We have a similar situation and leaving food in the room within easy reach does sometimes work. Does she eat in her room or the dining room,many of our dementia residents become too confused with the noise in the dining room to eat properly so eating in their rooms where it is quiet works mostly.

Was she a picky eater before? This could be a life long thing in which case you probably won't change it.We have residents who will not eat if there is a full plateful but if you only put a small amount on the plate to start with they will eat and sometimes will take more.

[Nascar nurse, ASN, RN]

Boose milkshakes.:)

:lol2: is this boosT or booZe :lol2:

I wanna be old and get a booze milkshake too.

Sorry, just hit my funnybone

[SuesquatchRN, BSN, RN]

:lol2: is this boosT or booZe :lol2:

I wanna be old and get a booze milkshake too.

Sorry, just hit my funnybone

Sorry, shoulda been MOOSE.

[Nascar nurse, ASN, RN]

Well I never heard of Moose either! That sounds nasty... a moose milkshake

Ok, I will quit now - no more thread hijacking from me on this one.