"My mom is 84. She was in a hospital & rehab from a fall and her appetite is no longer there. If she eats a few spoonfuls of something that’s a lot. She will drink a little Ensure. The doctor in the rehab put her on Megace -- no change in appetite. Any suggestions? If this a normal part of Dementia?"
For caretakers and family members the issue of appetite and feeding is a stressful one. While it may be the natural course of the illness, it is difficult for friends and family members to see their loved ones stop eating.
Yes, failure to thrive and malnutrition may be inevitable in patients with advanced stages of dementia as they lose the ability to chew, swallow, and deal with their own oral secretions. The important issue in is to ensure there are no reversible causes or treatments for your mother’s lack of appetite.
Failure to thrive in the elderly is a syndrome of global decline, often associated with physical frailty, functional disability, and neuropsychiatric impairment.
Treatment for failure to thrive involves treating contributing factors, including medication side effects, concurrent medical problems, and psychosocial factors. Unnecessary medications should be discontinued. Dietary restrictions should be removed and favorite foods made available.
Strength and aerobic training can improve the situation in frail elderly patients. Vitamin D deficiency and anemia should be evaluated and treated. Patients with depression should be treated with antidepressants. Some Geriatricians suggest a trial of a low dose psychostimulant methylphenidate
(which is Ritalin 2.5 mg) for moderately depressed elderly patients with failure to thrive.
Management of weight loss may include oral nutritional supplements between meals, Ensure in your mother’s case. It is NOT routinely suggested that we treat patients with appetite stimulants (Megace or Marinol) due to marginal benefit and potential side effects. Family members also commonly ask about feeding tubes to provide more liquid nutrition directly to the gut -- yet this has never been shown to improve quality of life or mortality in Dementia patients and, in fact, can lead to many complications.