MIL won't eat

[Faranth]

Has anyone got any recommendations of what we can do to get MIL to eat?

She's mid 80s, has just been diagnosed with Alzheimers. She's been struggling to eat for months, has no appetite and says she chokes. Now that Alzheimers has been diagnosed we've been told that trouble swallowing is a symptom. She's been prescribed Complan which she says is vile, and she refuses to drink it. I've just ordered some Fortisip and some Aymes cup. A soup type things from Amazon as I've heard that tastes better, and hopefully it will get at least some calories in her. I suppose if she does like it the next battle is to get that prescribed instead of the Complan. Her GP couldn't be less interested.

If she doesn't like the Fortisip or soup what can we try? We've been told no rice or bread as they're apparently the worst for choking. SIL says the paperwork for carers says she's on a 'mush diet' but they obviously only heat stuff up so SIL has been thinking perhaps baby food is an option? I'm worried it won't have all the nutrients and calories she needs but obviously it's better than nothing. I've been looking at meal replacement stuff online but none of it is high calorie. We're going to be lucky to get 2 or 3 Fortisip in her a day - that's still only max 900 calories!

She's 4ft 6 and size 8 clothes are hanging off her - I think size 6 would still be too big. She needs to eat, she's not going to survive much longer if she doesn't.

She's been assessed for care needs, has carers 3 times a day for meals and meds, but they can't force her to eat. She just pokes at it and won't eat.

She's got capacity, but she's been told she needs to move to a retirement type flat, not a nursing home but with a red button call system etc. She doesn't want to leave her current flat, I understand, it's her home. But it's up 2 flights of stairs and she has trouble just getting out of bed. It's a loft conversion with low ceilings and crap communal heating. It's completely unsuitable for her needs now.

She's so apathetic about everything. She just can't be bothered to eat, to get out of bed, to wear her hearing aids, to do anything, and the less she does the less she wants to do. We're 100 miles away. SIL is nearby but in ill health herself, is really struggling and is understandably frustrated that her DM won't even make the minimum of effort. And feeling guilty for being frustrated. She is returning to work next week after being off with stress. I want to take some of the stress and burden off her but don't know what I can do.

[VictoriaBun]

Are you blending her meals ? So perhaps mince in a gravy , with some vegetables blended up. Or a banana with custard blended, same using tinned pineapple and custard.

[UCOinaUCG]

My FIL is 93 and in a care home. He barely eats and the staff are clear that they cannot make him eat. He has some build up type drink he will sometimes accept but not always. We have agreed that this is his choice and if it hastens his death then so be it. This is maybe your DMs way of imposing her will on her life. Even moving to a care home wouldn't help if she just does not want to eat.

[trunumber]

I know it's not a long term plan but the only thing we could get into MIL was ice cream. Fortisip is awful stuff, I've never known anyone take it easily. Maybe ice cream and a liquid multi vitamin for now until a better plan arrives?

[FadedRed]

Wiltshire Farm Foods do a specialist soft diet menu, where the food are ‘shaped’ to look more appetising. Might be worth a try?
www.specialistnutrition.com/our-products/softer-foods/?gclid=EAIaIQobChMI18KYkOrm7wIVciB7Ch2a0A6tEAMYASAAEgIPSfD_BwE
However, and I am trying to put this gently, it is common for people to go off eating I’d depressed or when they are getting near to end-of-life, so a general check up by the GP or elder-care specialist would be a good idea. OT assessment in regard to what will make things easier in regard to activities of daily living is also a good idea, and Speech and Language Therapist can advise on the swallowing problem.

[Faranth]

Hi, and thank you.

The trouble is it's carers doing her meals, they pop in and microwave something. So we need something they either blend (tbh I don't even know if they would do that) or is ready blended, but I don't know what is available or suitable as a complete diet. It needs to be something packed with calories becuade the volume she's eating is miniscule. SIL bought some of those 'little dish' toddler meals from Tesco, but she won't even eat a whole one of them.

I'm so worried that she's lost so much weight and she needs to start gaining asap, I'm worried we haven't got time for her to gradually build her appetite on normal blended foods.

There must be high calorie convalescent type foods for this situation?

[CMOTDibbler]

When my mum was having a lot of problems eating, she would eat ice cream. Dad would buy high quality ice cream (so real cream types) and the nurses said that it had protein, fat and carbs so kept her going nicely. She wouldn't drink complan, but would also have little trifles, choc mousse and managed chips (thin, crispy ones) till the end. The texture prompted her to chew better than soft things

[helpfulperson]

Wiltshire foods do a blended range. Other companies probably do as well. My dad used to get a custard type thing but it was provided by the care home. Has she been seen by a dietician?

[MichelleofzeResistance]

I'd agree it may just be she's had enough now. That has been the case with two elderly relatives and one terminally ill one who followed their bodies' cues at the end of their lives. However another relative has been helped by a change of medication, as one of them was making her too tired to eat and suppressing appetite. You may find looking at the Quench plan book on Amazon useful for some ideas, it was designed by a doctor looking at how to raise hydration for elderly people not wanting to eat and drink, and you may find talking to the Alzheimers and Dementia charities useful, or specialist nurses who know their stuff on best ways to support patients.

[bookish83]

Please ask the GP to refer for a swallowing assessment. This will be done by SLTs

[MrsFezziwig]

She's so apathetic about everything. She just can't be bothered to eat, to get out of bed, to wear her hearing aids, to do anything, and the less she does the less she wants to do. We're 100 miles away. SIL is nearby but in ill health herself, is really struggling and is understandably frustrated that her DM won't even make the minimum of effort. And feeling guilty for being frustrated.

I’ve been through this so entirely sympathise, but she is not apathetic by choice - my mum was the liveliest person out but Alzheimer’s completely changed her personality, she gave up eating and just wanted to stay in bed all the time (while she was still lucid she told her friend that bed was the only place she felt safe - I guess with the advent of carers even her own house felt like a strange environment).

On a practical level we entirely gave up the idea of ensuring food we gave her was a balanced diet - her particular favourite was a Magnum ice lolly which have about 300 calories each.

[UCOinaUCG]

I know it is hard to get your head round but you may have to accept she is not going to eat or gain weight as she has decided that she doesn't want to continue living with Alzheimers with the possibility of losing capacity. Its so hard when it is someone you love and you want them to continue living but maybe from her point of view to isn't worth it? I hope I don't sound heartless because I doing mean to be. I have long since accepted that we should all have some choice in our old age about how we do or don't continue to live.

[DogsSausages]

You could try Build Up milkshakes if she likes them ir Fortijuice if she prefers fruit juice but it canbe diluted to make it nicer. There is a high calorie powder available that you add to food and drinks but I dont know if its on prescription. Add cream to anything she eats. There are jelly sweets for people who wont drink enough. I would speak to her g.p or the community matron and ask if they can see her and maybe the community dietician.

[justanotherneighinparadise]

To be honest this tends to happen towards the end of life. My father was the same. He didn’t have any neurological conditions but eating made him feel ill and slowly he cut down what he ate until he hardly ate at all. It was part of a deterioration that eventually led to death.

[MrsFezziwig]

This is maybe your DMs way of imposing her will on her life. Even moving to a care home wouldn't help if she just does not want to eat.

I entirely agree with the first sentence. The second wasn’t true in mum’s case, as when she was moved to a care home (after falls at home) the carers got her eating. Whether I would do it in retrospect is another matter, as although the home was fine I don’t think she had one moment of true happiness in the five years she spent there.

[Faranth]

She's had OT assessment, that's who's said she needs to move flats. Multi agency type assessment where they looked at everything and came up with reccomendations for what was needed.

It's so hard, pre Covid she was going on multiple foreign bus holidays a year. Really active and sharp. She got isolated during first lockdown and got an ear infection which caused delerium and she's never recovered.

It's been an ongoing battle with the GP. They won't see her face to face because of covid. They didn't even come out when she was discharged from hospital repeatedly, even though it was a condition of her discharge, which we only found out when she was readmitted because she hadn't had the prescriptions the GP was supposed to do (that we didn't know about).

I know, realistically, that this might be a sort of 'natural progression' I think I can be a bit more objective because it's MIL rather than DM, if that makes sense. But it's just a hope that if we can get her into this new flat, she'll have some company in the communal lounge, she'll have a bit more incentive to try and each time she does a little more, it'll be easier the next time. But she needs to eat to have a fighting chance.

I can't let her just starve herself. I just dont know what to do.

I am going to look at those Wiltshire farm foods meals though, thank you!

[Faranth]

Also, and this is a bit of a bone of contention with me, she doesn't know she has Alzheimers.

I think she has the right to know, that she currently has capacity and is an adult. But she wouldn't talk to the consultant on the phone when he called to tell her a couple of weeks ago. So he told SIL instead. SIL and DP are worried she'll give up completely if she's told she has Alzheimers and will get even worse. So they're just referring to her 'memory problems'.

I'm so worried someone's like a carer or doctor is going to blurt it out to her assuming she knows and give her an awful shock.

[UCOinaUCG]

I know you say you can;t let her starve herself however you can't force her to eat either. I wonder if the more you make this an issue, the more she may resist. I have no answers but I think you need to just make sure she is offered food and allow her to eat as much as she wants when she wants.

[Faranth]

Will look at the build up drinks, thank you.

[drinkingwineoutofamug]

I work with dementia patients. I know not all are the same.
We have found that many gain a sweet tooth and dislike savoury foods
Try her with yogurt and cakes.
I get it's not really good but at least she will eat.
Also finger foods.
On colourful plates
Possibly try ensure drinks. It's a milkshake but not sure in the community where you can buy from

[BaggoMcoys]

If she will eat ice cream you can mix it with complain or other similar products. It hides the taste and gets in extra calories. Sorry, this sounds like it must be very hard for you and your family.

[Mylittlepony374]

She needs a swallow assessment by a Speech and Language Therapist and ideally also referral to see a Dietitian. They will give you the best advice. There are loads of things they can do to help. Until then, just get the highest calories into her that you can. Icecream, custards, etc that are easy to swallow. Put butter and cream in/on everything, é g. Mashed potato. Protein powders in smoothies etc. Protein milk. Colourful plates help some people with dementia, the contrast makes food more visually exciting. Sometimes very cold/hot helps as extra sensation gives more feedback to swallow e. g. Ice in drinks etc. Good luck, it's tough to see your family struggle like this.

[Iluvfriends]

She needs to be assessed by Speech and Language Therapists for her swallowing as she is at risk of aspiration if given the wrong consistency of food.
Giving someone cake eg that can only cope with a level ? diet can cause that food to be inhaled into the lungs and cause aspiration.

[DPotter]

Have this situation with my Mum.

It is very difficult and takes time. we cut thing up into small bit size pieces, sit with her and literally tell her to pick up the piece of food, put it in her mouth, chewing and swallow. Then a sip of water / tea.

It takes ages for her to eat enough to keep a bird going. I'm talking 45-60min per meal.

we tried the fortified soups and drinks but they are very thick, which made Mum gag so we would dilute them. Sweet things go down better than savoury and spicier things better than bland.

You talk about her having capacity - but there are 2 aspects to this. She may well be able to express some views (I don't want to eat, I don't want to move house, type thing) but it is unlikely a solicitor would take instruction from her, as she may not have legal capacity. If she has a power of attorney set up - get it active now. If she hasn't then get one set up for both health and finance asap and activate it straightaway.

Rather than pressing for the GP to do anything, approach social services for an assessment. I have to warn you it takes a lot of time and effort to get someone the care they need, and from a distance this is even worse.

[eurochick]

My gran went through this. I think it's a way of imposing her will. It was hard to watch but I can see why she didn't want to prolong her life at that point. Dementia is incredibly cruel.

[CMOTDibbler]

What will she drink? If she'll have a milky coffee, then you can get a lot of calories in with a gold top milk latte, or a ovaltine. And a chocolate or calorie laden biscuit with each drink adds up.
If the carers left her a few small things to eat out, would she pick at them?