When your loved one has difficulty eating

senior woman eatingMeals can be challenging for someone with Alzheimer’s or another form of dementia, not to mention their caregivers. As the disease progresses, it can become difficult for the person to consume enough calories to maintain a healthy weight. But there are ways to encourage healthy eating. Eventually, toward the end of life, it’s natural for humans, and all animals, to lose the desire for food.

As his Alzheimer’s progressed, my husband, had trouble recognizing food items. Morris forgot how to hold a sandwich, and I’d have to place it in his hand. He forgot how to cut his food, so I served it to him already cut into small pieces.

Once when I handed him a sandwich to eat, he asked what it was. I replied, “Chicken salad.” He threw the sandwich across the table and exclaimed, “This chicken is dead!” It was hilarious, and shocking.

But there are ways to encourage your loved one to enjoy food and get good nutrition throughout most of the course of the illness.

Here are some suggestions:

  • Seniors and elders with health issues tend to be hungriest in the morning and eat less as the day progresses. Make a healthy breakfast packed with protein, healthy fat, antioxidants, vitamins and minerals. Eggs, anywhere you like them, served with avocado, toast, beans, and  greens provides everything needed to establish the beginning of a good day. The same goes for caregivers! You need the strength and energy to get through the day, so start it off with a nutrient- rich breakfast.
  • Setting the table–Put as little on the table as possible in order to not confuse the patient or detract for their ability to clearly see what is in front of them. Use a colorful plate mat, and a white plate so the food stands out. And serve colorful foods, which are higher in antioxidants and vitamins and minerals. Think sweet potatoes, winter squash, corn, beets, greens, etc. Root veggies can be pureed and served in a mash, which is easier to chew and swallow.
  • Make sure the environment is clean and pleasing. Put on some favorite music. It can be stimulating or soothing, depending on the mood.
  • Has the patient kept up with their dental appointments? My mother was always fastidious about dental care, visiting her dentist several times a year for cleanings. But at the end of her life, she began to lose teeth, most likely from poor nutrition. Observe your loved one and make sure there are no signs of pain, grimacing, trouble chewing, etc.
  • Sometimes, a person will not remember that they have eaten just a little while before saying, “When is lunch (or dinner)?” Or, “I’m hungry. When are we going to eat?” Leave their plate on the table longer as a visual reminder. You might have to hide food, if they have the tendency to overeat. And if you want to make sure they, as well as you, are eating the best diet possible, refrain from buying cookies, sweets, chips, and crackers, that are filled with empty calories and hydrogenated fats.
  • Provide a meal companion for your loved one. If you can’t eat with him/her, ask a friend to share a meal. Or, if he/she is still able to eat in a restaurant, have a friend make a weekly lunch date and bring them to a quiet restaurant that serves their favorite food.
  • The taste for sweet things is the last one to go. If your loved one doesn’t have any appetite, it’s almost guaranteed that they will enjoy ice cream. There are lots of options on the market to choose from ranging from traditional ice cream to frozen desserts made with cashew cream, coconut cream and soy milk.
  • Make sure the temperature of the food isn’t too hot or too cold, and that the patient is seated comfortably in a room that is neither too hot or cold.

Dysphagia

Dysphagia is any problem with swallowing. This was a major issue for my dear mother, who, at the end, couldn’t eat without the food going into her lungs instead of her stomach. In determining the extent of dysphasia, the patient does a swallow test drinking liquid of various consistency and thickness.

Food and drink categories

  1. Nectar thick, he consistency of nectar, quickly runs off a spoon
  2. Honey thick, the consistency of honey, slowly drips off a spoon
  3. Pudding thick, the consistency of pudding, plops off a spoon

My mom had to drink water that was thickened, which tasted disgusting. As a result, she often refused to drink and once became dehydrated to the point where she was hospitalized.

If your patient is put on a dysphagia diet, experiment and find ways to keep him or her hydrated. Puree their favorite foods, make shakes that are delicious and nutritious. You can puree just about anything and make it taste good with herbs, tomato sauce, etc. Please don’t add salt. Yogurt and puddings are another good option. Read the labels and try to avoid added sugars. Especially watch out for high sugar content in flavored yogurt.

Poor appetite

If your loved one doesn’t want to eat, accept it as the course of the illness. But if they are still walking and reasonably active, rule out contra-indications of newly administered drugs and illness, such as urinary tract infections.

Additionally, your patient might have a poor sense of smell, which will translate into a poor appetite. Try adding more seasoning to the food, but try to avoid salt and use herbs and spices that include antioxidants such as thyme, basil, oregano, cumin, cinnamon, and cardamom.

Laraine Pounds, R.N., an internationally recognized aromatherapist lists aromatherapy essential oils that stimulate appetite in chapter 18 of my book “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia.”

Eating issues are common amongst individuals with dementia. Experiment with these suggestions and see what makes a difference. Sometimes, just sitting next to someone and offering gentle conversation helps.


 

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

What if your dementia patient becomes abusive, aggressive or violent?

Angry, enraged senior woman yelling at a landline office phone, unhappy with customer service provided by the agent on the other side, giving off steam and smokeMy husband Morris was a gentle man. But occasionally, if things didn’t go his way, he would get nasty. Once Alzheimer’s took his brain hostage, he exhibited a darker side. But only when he was frustrated or confused.

Morris spent the last two years of his life in a memory care home. He was popular among the staff because he liked to goof around. When he walked the halls listening to music on his Walkman, he’d have a smile on his face and swagger to the rhythm. But if another resident got in his way, watch out. If it was crowded in the dining room and someone accidentally bumped him, he’d swing his arm out to shoo that person away. When one of his neighbors walked into Morris’s room mistaking it for his own, the two got into a rumble on the bed and fought like school boys. After this happened a couple more times, the neighbor was moved to the opposite side of the facility.

When Morris hit a resident in the dining room, the on-call physician prescribed a depressant to “calm him down.” Morris reacted to the drug by transforming into a zombie who slumped in his chair and slept too many hours during the day. I insisted that he get off the drug and Morris returned to his mostly cheerful self.

I once had a next door neighbor whose wife had Alzheimer’s. She threatened to kill her husband with a knife and then went on to slash a painting hanging in their living room. Was she or Morris responsible for their actions? No. A person with dementia is not responsible for acts of violence because as the disease progresses, neurons in the cortex that are responsible for language, reasoning and social behavior are destroyed. This leads to some Alzheimer’s patients engaging in aggressive or violent behavior such as biting, kicking, spitting, slapping, punching, and/or using foul language.

Research from the National Institutes of Health indicates that up to 96 percent of patients with dementia who were studied over a 10-year-period exhibited aggressive behavior at one time or other. In 2011, CNN Health reported that 5 to 10 percent of Alzheimer’s patients exhibit violent behavior at some point during the course of the disease.

There is usually a reason for aggressive behavior.

What to watch out for

  • Urinary tract infection
  • Pain or stress
  • Loneliness, depression
  • Too much noise or stimulation
  • Boredom
  • Constipation
  • Soiled diaper or underwear
  • Uncomfortable room temperature
  • Physical discomfort (stomach ache, etc)
  • Confusion
  • Anger about loss of freedom (to drive, living independently)
  • Drug reaction or contra-indication
  • Resistance against being told what to do such as bathing
  • Sudden change in routine, environment or caregiver
  • Communication problems
  • Hunger or not liking the food
  • Dehydration

What to do

  1. If your life or the life of the person you care for is in danger, get help immediately!
  2. The Alzheimer’s Association has a 24-hour helpline at 800-272-3900.
  3. Rule out UTIs, pain, discomfort, etc.
  4. Use an essential oil to help calm the person down. When my husband got agitated I’d put a few drops of oil on a cotton pad inside a diffuser and plug it into the wall. He usually calmed down immediately.  The following oils can be used in a diffuser, or put in a bath or fragrance free moisturizer. They can also be sprayed on a pillow or handkerchief. Citrus oils are generally refreshing and uplifting for the mind and emotions, relieve stress and anxiety, and are useful for odor management and appetite support. Consider: bergamot, grapefruit, lemon, and orange. Floral oils are often used as a personal fragrance and are useful to relieve anxiety, depression, and irritability. These oils are useful as an inhaler, in a body lotion, and for the bath. Consider: clary sage, geranium, lavender, rose, and ylang ylang. Tree oils are revitalizing with immune boosting properties, ease respiratory congestion, and are supportive to breathing ease. They are useful for pain relief, skin infections, and odor management, and can relieve nervous exhaustion and depression. Consider: eucalyptus (Eucalytpus citriodora or globulus), pine needle, sandalwood, or Tea Tree.
  5. Reassure your patient by speaking gently and calmly.
  6. Play calming music, i.e. Mozart
  7. Try to distract the person with a TV show, favorite snack (ice cream almost always works), or a walk outside.
  8. Maintain a regular routine.
  9. Make sure the lighting is suitable in the home or facility.
  10. Help the person to maintain as much dignity and independence as possible.
  11. Make sure the person is eating a nutritious low-sugar, low-salt diet, with no or very limited amounts of alcohol and caffeine.

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

How dehydration can lead to delirium and other health issues

Different drinks in glass jugs on white background. Ideas for summer cocktailsIt’s hot outside and it’s easy to get dehydrated. Our body is 50-65% water. The brain, which is 70% water, gets dehydrated just like your body. When it is dehydrated, neurotransmission—which is heavily dependent on water—is impaired, resulting in poor memory, concentration and impaired abstract thinking.

Dehydration can also result in delirium. Delirium is a mental disturbance that is exhibited by a new or worsening confusion, changes in one’s consciousness or by hallucinations. It has a sudden onset from hours to days. It can be reversed but it’s easier to prevent delirium than to reverse it.

When my mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear: dry lips and mouth, no tears when crying, decreased urine output, sunken eyes, headache, lethargy, dark urine and extreme thirst. The mental symptoms are not as obvious, but can result in mental confusion, irritability and delirium.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

If you are a caregiver, and that includes caring for yourself!) here are some helpful guidelines:

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

Always: Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity—in summer and all year round.

 


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Keep your cool with these 10 summertime eating tips

Colorful smoothies in bottles, detox summer diet fresh drink for breakfast or snack.It’s summertime and the livin’ is easy—or at least we’d like it to be. This summer is especially hot all over the world. If you’re tired and stressed out from caregiving, these tips will help you stay cooler in summer. The same information applies to those we care for. . . and for everyone.

According to the ancient Indian system of Ayurveda our body consists of three main elements or doshas—Vatta, Pitta and Kapha. Pitta consists of water and fire. It’s hot, so during summer when the temperature rises we want to eat cooling foods. Eating cooling foods not only keeps us from overheating, it reduces the tendency to get irritable, impatient and angry.  (Chapters 20 and 31 in “Calmer Waters: The Caregiver’s Journey through Alzheimer’s and Dementia” contain more information about ayurveda and nutrition that calms down the nervous system and supports immunity.)

  1. First and foremost, stay hydrated. It’s especially important to make sure you and your loved ones are getting enough liquids because when we forget to drink we can become dehydrated quickly, which leads to other health problems. It’s also crucial to keep the brain hydrated in order to maintain mental alertness. Drink plenty of water and stay away from carbonated and caffeinated drinks. Herbal teas, and fresh fruit or vegetable juices are great in summer. Just remember that fruit juices are high in sugar and calories. Coconut water is cooling and helps to replenish electrolytes, which is especially important during and after an illness.
  2. Enjoy the bounty of summer fruits. Peaches, apricots, cherries, watermelon, cantaloupe, and berries are especially good for helping the body reduce the fiery heat of summer. Juice them or make popsicles with watermelon juice or any other combination including yogurt. These are especially helpful to keep seniors hydrated and for people who have trouble chewing.
  3. According to Ayurveda, some of the recommended summer vegetables include cucumber, green leafy vegetables, green beans, squash, zucchini, asparagus, beets and eggplant. Juice a leafy green with cucumber and beets for a delicious cooling drink.
  4. Sprinkle on the herbs and spices. They’re easy to use and contribute added flavor and antioxidants to your diet. Cooling spices include cardamom, coriander, fennel and tumeric. Cooling herbs include cilantro, mint and dill.
  5. Avoid hot, sour and salty foods including fermented food, red meat, and greasy and spicy food. Excess pitta aggravates the tendency towards heartburn and gastric hyperacidity.
  6. Here’s some good news—Ayurveda recommends ice cream during the hot summer months! So by all means, enjoy! Dementia patients are especially fond of ice cream. If the person you are caring for refuses to eat or eats very little, try serving ice cream. It contains protein, calcium and calories, and it’s easy to serve and eat. If weight gain or cholesterol is a concern, select a dairy-free version of America’s favorite dessert. Rice Cream, Coconut Bliss and Soy Delicious make delicious non-dairy, frozen desserts.
  7. Cooling grains include amaranth, barley, quinoa, rice, tapioca and wheat. Use them in salads mixed with veggies. One of my favorites is quinoa salad. Cook 1 cup of quinoa. (Be sure to rinse it first to remove saponin, a naturally occurring chemical that coats each grain to ward off insects. It has a strong, bitter flavor. And yes, it is a pain to rinse quinoa. First soak it and then place it in a very fine mesh strainer and rinse.)  Sauté onion and zucchini, add a handful of fresh corn cut off the cob, mix with the quinoa. Add fresh tomatoes, black beans, and a dressing made with olive oil and balsamic vinegar. Delicious!
  8. Make your own granola. Once you do, you’ll never go back to buying store-bought granola, which is typically filled with sugar. Plus, it is expensive. Oats, almonds, and coconut are all cooling. First toast 1/2 cup of slivered almonds on a cookie sheet in the oven. Watch carefully so they don’t burn. Add to 4 cups of oats, along with 1/2 cup coconut flakes, 1/4 cup coconut oil, 1/4 cup maple syrup. Add 1/2 tsp of cinnamon, if desired. (Cinnamon is warming, but a little bit won’t hurt.) Stir and bake at 325 degrees for about 20 minutes. Add raisins if desired.
  9. For added protein, top your salads with these cooling legumes: garbanzo, pinto, white beans, azuki beans, and black-eyed peas.
  10. If you eat meat try to avoid beef, chicken, and pork during the hot months and use cooling meats such as buffalo, turkey rabbit or venison instead.

Happy eating. . . and stay cool!


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.