Grandmother w/ alzheimers - Malnourishment question

  1. 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
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    About RN2Bn2006

    Joined: Sep '04; Posts: 152; Likes: 15
    Labor & Delivery Nurse
    Specialty: OB/PP/Nsy

    20 Comments

  3. by   canoehead
    I know a doc who says that finally not eating is what takes most Alzheimers patients, and that it is a kind death. Not painful, very peaceful and they die in their sleep. Just love her for the time you have, and wish her safe journey when her time comes.
  4. by   RN2Bn2006
    That's a comfort to know - that it is peaceful and not painful. That's what I wish for her. How do you know when the time is near? Do you know why I couldn't "hear" her BP? does that mean it is weak? I guess I know she is going to die soon, I just want to have some kind of warning sign - if there is such a thing.

    Thanks
    PB
  5. by   lovingtheunloved
    My grandma was VERY hard to feed. Very frustrating. I don't really know what to say as far as her BP and heart and dying and all that, but if you want to get her to eat more, there's a few things you can try.

    1. Put sugar on everything. That sounds really disgusting, I know. The sweet taste is the last taste to go. I have gotten many a patient to eat that way.

    2. Condiments. I have a resident who LOVES ketchup. She will eat anything if it has ketchup on it.

    3. Ice cream. A bite of hot food, a bite of ice cream. The contrast between hot and cold may stimulate her to eat.

    4. Mix Ensure with everything you can. Ice cream, milk, cereal, etc. Make every bite count.

    I hope this helps. It has been my experience that dementia affects everyone differently. What works for one person doesn't work for someone with the exact same dx. It's very trial and error. Best of luck.
  6. by   dbsn00
    So sorry about your Grannie...she is lucky to have you as her granddaughter & advocate. Beginning stage Alzheimer's (assuming she's recently dx.?) doesn't manifest sx. the same way it would with someone who has had the disease for a few years. The loss of appetite and/or the care to eat or drink seems to be common in the residents that I care for & not just those with Alzheimer's but also depression. You may want to talk to her MD about an appetite stimulant such as Megace suspension for quality of life; had some good results with it before. The elderly get dehydrated & malnourished fairly quick (is she on any diurectics?) so speak with her MD ASAP to prevent further complications.

    :angel2: Good luck :angel2:
  7. by   dbsn00
    Quote from lovingtheunloved
    My grandma was VERY hard to feed. Very frustrating. I don't really know what to say as far as her BP and heart and dying and all that, but if you want to get her to eat more, there's a few things you can try.

    1. Put sugar on everything. That sounds really disgusting, I know. The sweet taste is the last taste to go. I have gotten many a patient to eat that way.

    2. Condiments. I have a resident who LOVES ketchup. She will eat anything if it has ketchup on it.

    3. Ice cream. A bite of hot food, a bite of ice cream. The contrast between hot and cold may stimulate her to eat.

    4. Mix Ensure with everything you can. Ice cream, milk, cereal, etc. Make every bite count.

    I hope this helps. It has been my experience that dementia affects everyone differently. What works for one person doesn't work for someone with the exact same dx. It's very trial and error. Best of luck.
    I don't know if you are planning to or are attending nursing school...but if you are...thank goodness!! We need more caring & creative nurses like you in LTC!!!
  8. by   RN2Bn2006
    Quote from lovingtheunloved
    My grandma was VERY hard to feed. Very frustrating. I don't really know what to say as far as her BP and heart and dying and all that, but if you want to get her to eat more, there's a few things you can try.

    1. Put sugar on everything. That sounds really disgusting, I know. The sweet taste is the last taste to go. I have gotten many a patient to eat that way.

    2. Condiments. I have a resident who LOVES ketchup. She will eat anything if it has ketchup on it.

    3. Ice cream. A bite of hot food, a bite of ice cream. The contrast between hot and cold may stimulate her to eat.

    4. Mix Ensure with everything you can. Ice cream, milk, cereal, etc. Make every bite count.

    I hope this helps. It has been my experience that dementia affects everyone differently. What works for one person doesn't work for someone with the exact same dx. It's very trial and error. Best of luck.

    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
  9. by   RN2Bn2006
    Quote from dbsn00
    So sorry about your Grannie...she is lucky to have you as her granddaughter & advocate. Beginning stage Alzheimer's (assuming she's recently dx.?) doesn't manifest sx. the same way it would with someone who has had the disease for a few years. The loss of appetite and/or the care to eat or drink seems to be common in the residents that I care for & not just those with Alzheimer's but also depression. You may want to talk to her MD about an appetite stimulant such as Megace suspension for quality of life; had some good results with it before. The elderly get dehydrated & malnourished fairly quick (is she on any diurectics?) so speak with her MD ASAP to prevent further complications.

    :angel2: Good luck :angel2:
    I will definately check into to that appetite stimulant. Grannie does have depression, she was on Paxil for awhile with some improvement, but it quit working, so now they have her on Zoloft - which can decrease your appetite. I really can't tell if that's working or not as far as her depression goes. She was hospitalized for 3 weeks over Christmas in a Geri/Psych unit to try and stabilize her meds - her mood swings were so bad my Papaw had moved out (she cursed him 24/7) She is taking the anti-alzheimers meds & an anti-psychotic which has her subdued as far as that goes - she loves my Papaw again . I'm sure taking all the meds she takes could have something to do with her appetite, but it's been waning for a long while - before this hospitilization - in fact that was one of the issues they addressed when she was admitted - nutrition. She did do better while she was there. It's so hard to watch them go down hill so quickly.

    Thank you for your advice.

    PB
  10. by   renerian
    Is she still up and walking around alot? Maybe some finger foods grab and go type things. Breakfast bars and carnation instant breakfast. Ovalteen might work. What were some of her favorite foods before? Does she live alone? Maybe you could offer to have her help you cook something. Maybe that might bring out some memories which might trigger her to eat. Have small glasses of fluids around and offer it frequently. She might need something to stimulate her appetite. Is she taking any supplements?

    renerian
  11. by   webblarsk
    Quote from dbsn00
    I don't know if you are planning to or are attending nursing school...but if you are...thank goodness!! We need more caring & creative nurses like you in LTC!!!
    I was thinking the same thing!
  12. by   RN2Bn2006
    Quote from renerian
    Is she still up and walking around alot? Maybe some finger foods grab and go type things. Breakfast bars and carnation instant breakfast. Ovalteen might work. What were some of her favorite foods before? Does she live alone? Maybe you could offer to have her help you cook something. Maybe that might bring out some memories which might trigger her to eat. Have small glasses of fluids around and offer it frequently. She might need something to stimulate her appetite. Is she taking any supplements?

    renerian
    She is still able to walk some, but is very feeble. She no longer cooks or cleans - her days consists of sleeping, and getting up to sit in a chair because that is all she is able to do. I don't believe she is taking supplements. The ensure stuff is all. I do know the stuff she does eat is usually something she can pick up and eat from her hands because her hands are so shakie the food falls of the spoon most times. I usually feed her when I'm there. She lives with my Grandpa - who is still able to get around fairly well - he cooks breakfast for her. My aunt moved into a MH next door, and she makes sure she gets her meds everyday, and usually brings food to them that she's cooked. So there's always someone taking care of her, it's just convincing her to eat...... she just don't want food. Says she just can't make herself eat.
    I am going to try the sugar thing - because when I talked to my mom tonight - she said Grannie had told her at one time that sweet things was all she could taste anymore, so we are going to try that, and to get a prescription for that appetite stimulant.
    She will pinch off like a 1/2 inch piece of bannana and eat it, or eat 1/2 of a sausage patty, little things like that. So the finger foods ideas is a good one. i know sometimes she will eat stuff just because I 'ask' her to.
    Thanks for your good idea.

    PB
  13. by   happthearts
    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
  14. by   RN2Bn2006
    Quote from happthearts
    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

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