DM struggling to eat and drink

[Pedestriancrossing]

Oh God we've been here before. DM now in her nineties has had a few episodes of very poor health over last 7 years or so, each time she completely loses appetite and struggles to drink anything. She's ended up being admitted via A&E on previous occasions (nightmare) and on drip and antibiotics. Each time we've managed to get her well enough to be discharged back to her supported living flat (which is what she wanted). Managed to get through COVID which was a miracle. But we're here again, Mum feeling awful, not eating and barely drinking, she's fully aware of need to eat and drink but can't make herself do it. She doesn't want to go into hospital or care home. She's lost weight and now very frail. A paramedic came to check her this week and no signs of infection or cardiac event. I just feel such a cow to keep trying to get her to eat and drink. Not sure what the point of my post is but just so stressed, upset and frustrated at situation.

Does she understand that without food and drink she will become more frail and die?

Does she want to die?

If yes then I suggest contacting her gp and asking for an advanced decision and statement of intent. That way things can be put in place for her to die peacefully at home.

I don't mean to sound harsh but if she's refusing to eat and drink and also refusing hospital admission then that is where things are heading. Getting the statement of intent and advanced decision in place will give her a more dignified death as extra care etc can all be arranged.

Yes she knows what will happen if she doesn't eat or drink but seems fixated on the GP beings able to prescribe something to "fix" things (which obviously very unlikely). I don't think she is ready to die but knows this is where things are heading unless something changes. Very difficult to have that conversation with her.

What about if the gp prescribed some build up drinks? To get more calories in without having to feel full?

We've tried some fortified drinks but she doesn't like them, and won't eat/drink anything she doesn't like (this is not a new thing for her). We've tried so many things to try and tempt her to eat but usually met either rejection.

Jelly?
Not as nutritious as fortified drinks but contains lots of liquid and sugar for a bit of energy.

Sadly our much loved Dgran was like this in her last months. We gave her fullfat and full sugar everything in snack size portions to try and build up her calorie intake. Added cream to soups, butter to veg etc. Little and often snackwise. Her tastebuds had gone and all that she could taste was sweet. Also replaced her dentures as she had lost so much weight they no longer fitted which meant that biting, chewing, and swallowing had become tricky and painful.

Sorry, don’t know how to put this in a gentler fashion … is she actually dying? If she hasn’t long to go the body may be beginning to shut down.

Have you tried sweets and chocolates?

If the body is starting to shut down, it's uncomfortable for the body to try and digest food. And making an issue of it isn't going to help her. I'd just leave things by her that she can grab easily (small packs of 2 biscuits, small bags sweets sort of thing) and offer very small drinks. As my Dad was dying, everything tasted funny and he rejected his favourite tea as he was convinced we'd bought the wrong brand.

Don't spoil time with her by nagging. She knows

I am trying really hard not to nag, it's the fact that she complains about the lack of appetite so much and wants me to "do something " about it. If she was ok to just accept the lack of appetite I would leave her to it, so to speak. It's so hard to know what to do and I'm exhausted.

Yes, I get that OP. My mother lost her appetite last year due to some kind of cold virus. It affected her smell and taste and she lost weight as a result. She complained a lot about it - but ultimately there was little to be done if she chose not to eat. Her smell and taste came back and she ate more, but she didn’t put the weight back on and if anything has lost a little more.

I get it, @Pedestriancrossing. My DM is not at that stage yet but her frailty has steadily increased over the last 5 years (also in supported living thankfully) and she has multiple comorbidities but still thinks her GP will be able to fix everything and is genuinely surprised when they can’t. She is terrified of dying and talks about living for another 15 years even though on the current trajectory she will be bedbound and incapable in another 3-5 years…

She is a long way from acceptance despite her advanced age which is a shame as it would make her less anxious but there is nothing we can do about that.

That must be so difficult

This is so incredibly hard. I appreciate that she expects something impossible and is not really thinking clearly about it. Is it that she can’t chew and swallow, and needs purées? Or is it just the thought of food is off putting and overwhelming? Has she had problems with digestion? Would it work at all if you were completely factual eg “Mum, your stomach will have shrunk a lot and there’s no way you’ll go straight onto eating meals. Try just a small thing, 3 or 4 times a day”. These could be things like: a small cup of creamy soup, a few cubes of cheese, some nuts, a slice of ham, a teacup of cereal with 2 strawberries, a spoon or two of jelly or applesauce, half a slice of buttered toast. Anything to get her in the habit of regular ingestion - if she is actually able to swallow and digest okay.

I realise you’ve probably tried all that actually. Is there any chance that any meds she is taking are suppressing her appetite? And if she is not on a lot of meds, could she possibly (in consultation with pharmacist) take a CBD supplement? There could be unrecognised pain, and some CBD supplements do apparently improve appetite in elderly people.

She feels nauseous first thing in the morning and just getting up and dressed is exhausting for her. She can physically eat but absolutely no appetite so finds anything we offer unacceptable. Sorry to moan but we are just frazzled with the situation. She only drinks a tiny amount. Just dreading reaching a crisis point and having to go to A&E and endure the long wait.

It's very tricky to deal with and exhausting running round in circles trying to prop up her nutrition and fluid intake - and you can't force her to eat/drink. Other PPs have mentioned little and often but sadly I don't think there's a quick fix here and those of us who have been or are currently in a similar situation understand and feel your frustration.

With elderly Dgran we ended up being quite blunt and said she needs to force herself to eat/drink or she'd end up back in hospital and possibly die there, but by that time she was really too tired to care and that's what happened. The hospital gave her an iv drip of fluids but her kidneys and other organs had already started to shut down. Looking back throughout her life she'd always been fussy about her food intake and probably used it to control her feelings - and towards the end to control us and her end of life as well.

It may be worth asking your GP or surgery pharmacist for a medication review... my grandmother went onto a medication for heart failure and anorexia was the main listed side effect in the elderly. GP's can be prone to adding med after med and sometimes a complete review can be a godsend?

TBH if someone of over 90 no longer wants to eat and drink, IMO they should be allowed that choice.
In my DM’s care home I’ve witnessed people being badgered and pestered to eat and drink when they don’t want to - albeit it was with the best of intentions, but to me it’s distressing to see someone crying and whimpering and repeatedly turning their head away.

As for those fortified drinks, I can’t blame anyone for rejecting them - they’re mostly pretty foul.

I agree with this 100%.