It’s early morning and Louise found herself sitting at the breakfast table. She’s very hungry yet when someone puts a plate in front of her, she didn’t recognize what it was. “What’s this?” she asks. The person who brought it replied, “Aren’t you hungry? Go ahead try and eat some” then puts the fork in her hand.
Louise thinks, “What does she want me to do…What’s eat? She couldn’t remember what the fork was either or what to do with it. She used to know. The food looked unfamiliar and she poked at it with her finger. It felt soft, sticky, and unpleasant and she wiped it off on her blouse. Her stomach began to make rumbling sounds. Louise was hungry but couldn’t identify the feeling of hunger or food.
Once while visiting a nursing home in Costa Rica I noticed a very elderly woman sitting in a wheelchair surrounded by concerned family members. I noticed she seemed very frail and had a feeding tube hanging from her nose. It was not one of Costa Rica’s better facilities to say the least. I held her hand and started talking to her asking her name. She seemed in a great deal of distress. Her grandson explained she refused to eat and they had to agree to the feeding tube. When I asked her in Spanish, “Aren’t you hungry, don’t you want to eat?” She looked at me confused and replied, “What’s eat?”
It’s often difficult to get the person with dementia to eat. Maybe it’s because they don’t recognize the food or what they are expected to do with it. They could be hungry but can’t manipulate utensils and don’t want to seem stupid.
They may have a toothache or not enough teeth to chew properly. They may aspirate food when the body forgets how to swallow and the food goes into the lungs. They choke feeling like they are suffocating. Later they might fear food not remembering why.
Be the investigator and don’t just assume they are being difficult. Try to find out what the reasons might be. Could it be any of the above? Are they having a hard time chewing? Maybe you need to cut the food into small pieces, help feed them or begin serving pureed food.
My friend Frank was in later Alzheimer’s and steadily losing weight. I sometimes helped feed him at the nursing home. One day with an open mouth full of unchewed food, he looked at me with a pleading expression and said, “Can’t”. I turned to one of the CNA’s and said, “He says he can’t eat this.” She replied, “Oh he always says that. “Quite angry I replied, “BECAUSE HE CAN’T!” He was put on pureed foods and gained 10 lbs. in a week
I always recommend fresh fruit smoothies daily and getting a veggie juicer to be sure they are getting their nutrients. Be inventive. Sometimes giving desert first jumpstarts them to eating the rest of the meal.