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Dealing with Poor Appetite

Eat-papa-Eat!

There are many causes of decreased appetite in the elderly and/or memory impaired.  Many times it is related to medication, trauma, or infection.  Lack of appetite or poor nutrition due to memory impairment or failure to thrive is not easy to overcome.  Frequently the caregiver grows frustrated and overwhelmed.  Here are some strategies that may help.

  • Get to the bottom of it:  A medical professional should try to determine the reason for the appetite loss.  It could something fixable and transient, or it could be a long term issue.
  • You need guidelines.   You need to know dietary restrictions and caloric goals.  Talk to your physician or a registered dietician.  This isn’t guesswork, it’s science.
  • There are some medications that can stimulate appetite- ask about them.
  • There are some medications that decrease appetite-a medication or dosage change could be the answer
  • Don’t present a bountiful, three course meal:  When a person isn’t hungry, and they already feel full and satiated, eating an entire meal is next to impossible.  In fact, because the meal presented is so “balanced” and comprehensive, the inherent message is that it all must be consumed.  Saying “just eat what you can”  implies failure.  The appetite center simply shuts down and says, “No thank you”.
  • A banana will do:  And an hour or two later, a few crackers with cheese, and an hour or two later, an ensure milk shake, and after that, a bowl of ice cream, and after that, a half of a sandwich.  Small  treats spaced evenly apart will be more manageable than an “all at once approach”.  It doesn’t matter when they get the calories, so long as they go in.
  • Fortify their favorites:  If you find that ice cream is rarely refused, then go with that.  Stir in some fruit pieces, protein powder, or a nutritional supplement.  Make a milk shake using Ensure and ice cream.  You can even pour the ensure into a bowl and freeze it… looks like a bowl of ice cream when its frozen.
  • Keep a log, use an online calorie counter, or download an app… find some way to track the calorie consumption so that you have some objective feedback about your efforts.
  • Create a routine… dementia behaviors tend to be repetitive.  Use that to your advantage.  Same thing, same presentation.  It sometimes works.
  • They don’t remember anyway:  present an item several times, especially if it was well received.  Frequently, a person with dementia doesn’t remember eating just an hour before.  Use that to your advantage.

If the person lives alone…

  • Prepare and package snacks and small meals 
  • Label each item with a day and time it should be eaten (all “Wednesday” food should be eaten in one day)
  • Throw out unused food at least weekly

Remember that adequate nutrition is vital to good brain health.  Poor appetite and failure to thrive are common phenomena in dementia.  Poor appetite is not something you attack, it’s something you work with.  Be patient, creative and unconventional- and let us know if you have any other tips!

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2 comments

  1. Hello my name is Deb Davis I am an Occupational Therapy Assistant and went back to school to get my degree in Health Care Management. I have worked in LTC for 22 years. Geriatric/psych has been my passion which has led me to Dementia care.

    Today I have been Program Director of a Therapy Department in a Dementia specific facility for the past 3 years.

    The lack of appetite is a very large part of our program.

    There are often many things that contribute to the lack of appetite. As mentioned in the initial blog rule out possible medical issues.

    The bodies’ elimination process plays a very large role:

    The elimination process: Urinary tract infection and constipation will greatly interfere with their status and particularly affect their desire to eat.

    Additionally, as the disease progresses the person with dementia will lose their sense of taste. Don’t be surprised that sweet foods are what your loved one gravitate towards. That’s okay…. just know its part of the disease process.

    How to increase their intake when all they want are sweets:
    • Make high calorie protein nutrient shakes
    • Use chocolate milk, protein powder and ice cream
    • Cut your banana in half length wise and load with peanut butter and jelly place the halves together.
    • Offer the high protein food first and sweetener
    it as needed. Honey, maple syrup, stevia are great alternative ways to sweeten any dish.

    Keep in mind taste buds are dulled and sweet are the last taste bud we lose. Don’t be worried or afraid to add sweetness to any food you prepare that may increase your loved one’s desire to eat.

    Make meal time pleasurable… prior to meal reminisce about food favorites, family gatherings where food brought you together, use pictures to discuss these events this will assist in stimulating the appetite. Keep in mind lack of appetite is often related to their inability to process and initiate. Modeling and providing a meal time experience are vital for individuals with dementia. Provide one food item at a time. Too much food and items in front of item will only distract and interfere with the itake process.

    Most Importantly, I want to mention that individuals with dementia often develop dysphagia, they may demonstrate the following:
    • Extreme difficulty with time and effort to consume their meal.
    • Runny nose
    • Watery eyes
    • Coughing
    • Weight loss
    If these signs are recognized it may be in the best interest of the individual to be evaluated by a speech therapist that specializes in Dementia and dyspagia. An often time the individual has develop an aversion to various foods such as texture and consistency… the support of an SLP is very beneficial.

  2. Just found your site and will definitely come back to read more. Thanks for the well-written info.

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