Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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My mom has stopped eating, is this normal for Dementia?
Posted in Dementia by Dr. Sharon Orrange on Feb 12, 2010
"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.

Dr. O.

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9
p.s......a bone fragment from a hip injury can cause infection in the urethra area which can also create the symptons you speak of.
By dakotagem  Jun 01, 2010
8
Have the docs check to see if she has either a UTI, Hyponatremia, or SIADH. My mom doesn't eat or drink when she has these issues and always appears to have dementia due to these issues when, in fact, all of the above creates confusion, memory loss, appearance of a stroke, lack of appetite, etc. Make sure your mom is not on Zoloft which is an SSRI and can create SIADH. Good luck.
By dakotagem  Jun 01, 2010
7
Thanks, that was really helpful even though I did not submit the question. My MIL (who lives with us) also has really slowed down her eatting habits and has lost a lot of weight. I had not thought about "failure to thrive" but I will talk to her Dr. about it at her next apmt. which is this next week.
By Susanlhb  May 07, 2010
6
can some one help please my soon to be mil all she wants to do is eat all the time she has ad and is 86 years old i take care of her like give her her pills and have to make her walk but when she walks she ask to sit all the time and when she does sit she talks about food all the time even when she see it on tv is this normal its getting so bad that me and her son fight alot and for myself i have ms so its hard on please help
By Tacklems  Apr 06, 2010
5
Thank you so much for all of your comments because they are not unlike what my patients and families goes through and I think those of you who have been through it...can help guide those in the midst.
By DrOrrange  Feb 17, 2010
4
My father was not so far advanced in his dementia that he could not swallow, but it seemed he would forget what he was doing while he ate and only at a little at a time. Thankfully, he passed via a stroke before he got so bad he couldn't recognize us.
By catrice  Feb 15, 2010
3
My mom, 81, who has AD, stopped eating quite some time ago, but Dad was still able to get her to drink through a straw by offering her drink often. Unwilling to see her literally starve to death (though she still eventually will,) he began taking a can of sliced peaches,putting them into a blender, adding some milk and liquifying to a consistency that she could drink through a straw. He does the same with a can of chicken noodle soup. Since he offers her water often, she can still drink through a straw and accepts the liquid peaches and soup daily. Dad has now begun to pulvarize her meds and put them into the peach mixture.I think death would be more merciful.
By silvurphlame  Feb 13, 2010
2
thanks for the info. i had this problem with my mom last year who is 87. she wouldn't eat and it was hard to even get her to take ensure. her doctor also presribed megace which didn't work. after seeing her day after day just miserable and listless, i took her back to the doctor and told them that i realize that she may be near the end of her life but isn't there something we can do just to make her more comfortable and maybe feel a little better? her doctor and her cardiologist got together and reevaluated her meds. she was on 7 at the time. they took her off 4 and cut one in half. within two days she was a different person her blood pressure came back up, she feels great most of the time and eats like the ship is going down. i know this wouldn't work for everybody and she won't be around forever but sometimes it doesn't hurt to just ask.
By martyE  Feb 13, 2010
1
Both my mother and father with dementia refused to eat or drink at their end stage of life and passed away after about a week.

We were told that since her power of attorney for healthcare stated to not prolong their life at this stage we did not. However, with my mother if I would have had the power of attorney for healthcare instead of my brother, I would have at least given her meds and some oxygen so she slept instead of gasping for breath on and on. It was a horrible thing to watch and I think mean also to see them go through this. The nursing home was not caring nor was my brother at this point. I still grieve that I did not do something but I did not know what to do.
By gretann  Feb 13, 2010
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