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My mom was always a picky eater, so placing her in the nursing home I knew eating would be a problem. She has been in for 6 weeks and now has lost 20 pounds. She has severe alzheimers but still pretty healthy. She is a pacer and is on the move all day. She doesn't sit for any length of time. At the dinner table she started putting her head down, I think because she doesn't want to eat the food. They called me a few days ago, and said she is not wanting to drink much and is getting dehydrated. I have been going daily to try to get her to drink some gatorade and eat. She will take a few sips and probably in 3 hours drank 5 ounces. She won't open her mouth when they try to spoon feed her food or medicine. She just takes tiny bites if at all. Her bun and creatine are high, but potassium and sodium are normal. Her bun and creatine were better today then Wednesday. If levels get to high then asked me if I wanted to give her an iv or possible feeding tube. She paces and so I don't know how she can have an iv unless she is sedated. She is not aspirating food but just seems to have lost her appetite to eat. Dr put her on remeron to try to stimulate appetite. Dr said give it another 2 weeks. In 2 weeks she will be gone. Anyway, she is a fighter and always had a strong will to live, and I know always wanted to keep living. She is not laying in a bed looking at the wall. She paces around, still says I have to pee an then sits on toilet. She still says Im thirsty or Im hungry, then doesn't eat or drink much. Maybe they are just familiar phrases. I don't know if she would try to remove the feeding tube, but if it is covered up with her clothes maybe not, unless it hurts. If she does pull it out then I guess we can say we tried. Because she is still so mobile and talking, I think she may benefit from the feeding tube. Would love for so input on my situation.

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Foods with natural steroids and protein supplements. Ensure - both powder and liquid - work wonders. A few ‘oldies’ in their nineties swear by it.
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My sister - used to work with the elderly - suggested I check my mother’s tongue. If it is white, brush it more regularly. After the first brush she ate some. Brushed it again that evening, and the bottom of her dentures. The next day, by dinner time she didn’t want the puréed food - told me she wanted ‘real’ food. Suffice to say, food taste much better and her gum does not hurt. She gets to choose and eat whatever she wanted as long as she had one nutritious meal with supplements - vitamins. She was starving to death with no interest in anything could not remember simple things to now very vibrant with an appetite, memories back, happy again and healthy almost her usual self. She is nearly 87 years old. Another thing I learned is they do not want to be told. Suggestions and patience with follow ups. She secretly hid the gum and tongue discomfort. Her tongue is now a healthy pink and the dentist has realigned her dentures. All good!
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Like Sujean's Mom, my Mom is in the same position and is dwindling in front of my eyes as well with no solution in sight. Albeit, as I read on in these feeds, I do see one and will discuss it in a minute or two. I don't think that her surroundings are responsible for her lack of appetite or that the measures you present are going to stimulate said appetite. I wish they could or I would I have thought about using them at some point instead of tearing my hair out as I do. It is definitely the disease that has done this to both these women and probably countless others. I will not subject my mother to a feeding tube. She would only pull it out and I've heard too many horror stories about it. Ergo, I am going to try something that sounds like something that could help and for my mother, could be a last-ditch effort, that is, medical marijuana, Marinol. It is natural and it probably works. Why are we so afraid to try what nature has put right in front of us?
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As to if she could pull out a feeding tube or IV, the answer is YES. Unless she was in bed and her wrists were restrained to the bed (which they rarely do now due to the change in laws) she could pull out any invasive device, even if it hurts and does physical damage. When I read you post, it brought to mind what I learned as far as manic psychiatric patients. They too can't sit still to eat even a partial meal. They taught us (nursing students) to give them finger foods. Something that they can eat on the go. What comes to mind are protein bars that you give maybe 1/4 at a time, sandwiches like egg salad or PB & jelly cut in fourths. Maybe the juice boxes made for kids to take to school. They have a tiny straw, so if dropped as she walked the spillage would be slight to none. I also found a drink at Sam's club (also at Walmart but more expensive) called Premier Protein. It has 30 gm. of protein in 11 ounces. It comes in individual boxes (like the juice ones) with a screw on cap. It's also available in 5 flavors. I got it to try for my, "I'm not hungry. I don't want to eat." mother and she loves them. The rest of the make up is good too. Low in carbs,, sugar, sodium and potassium. All things that we have to watch with seniors. I hope this helps you. Good luck.
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Oh, so sorry! I am new to this sight and just noticed how long ago you posted. Hope everything turned out well.
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My mom has swallowing issues, so her long-term care facility sent her to the hospital to get a feeding tube inserted. The doctor talked with us and advised against it. Not only is there a risk the patient will pull it out, but there is a high risk of infection. Mom is now on a mechanized diet.
Tough call in your mom's situation. I can tell you this: My mom is a very picky eater who hates the food at her facility and often wants only toast and jelly with milk, but also will eat a banana occasionally and loves Ensure or Boost. She calls the latter two products a "milkshake in a can". If you can find something nutritious your mom loves too much to refuse, perhaps your mom's facility would provide it?
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2TiredinFlorida, condolences on the recent loss of your mother. It is wonderful that hospice was there to help ease the pain. Can you imagine going through that with you mother alone? Mom was clearly dying and a feeding tube could not have saved her.

Best wishes to you as you heal from the trauma of her passing.
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Arleeda, that must have been extremely hard for you to watch! How courageous of you to carry out your husband's wishes, especially in the face of opposition from his children.

In order to pick alternate agents for my husband's POAs I held a family meeting of my 2 sons and his 3 daughters. One of the things I handed out was his healthcare directive. I talked a bit about things he had said over the 30 years I knew him. And I said, don't become his healthcare POA if any of this disturbs you and you are afraid that you couldn't carry out his wishes. None of them ever had to carry out POA duties (I was able to do that right to the end) but I think the healthcare POA would have carried out my husband's wishes.

I think you did the right thing, too (for you in your situation).
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Mom fell a week before Thanksgiving. She was in the hospital for a week, because they found she had a UTI. She was released to a rehab facility, where she did not improve. Her dementia got worse, and she refused all help. She was then sent home, under Hospice care. Mom's dementia gradually got worse. She could no longer sit up in a chair and was confined to bed. She gradually stopped eating and drinking. She passed away on January 4th. I still have some regrets about bringing in Hospice, but they did all they could. Her last two weeks were quite upsetting as she had terrible bed sores. She would cry out in pain every time we turned her. At least she was getting morphine for the pain. Mom had a living will, so when she stopped eating, a feeding tube never came up. When looking back, I realize it was the progression of the disease, not Hospice, that caused her death. The slumping over, not eating, and eventually not drinking. All were just a progression of her Alzheimers. Feeding tubes can just prolong the misery. Realize that her not eating, is simply part of the progression. All it would do is prolong her misery.
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My husband and I had advance directives that stated no feeding tubes, so when a major stroke made it impossible for him to swallow, walk, feed himself or even read and watch TV (central vision was gone), I refused the feeding tube for him. His grown children objected strenuously, but I felt I had to follow his wishes expressed when he was able to do so. He had some dementia from mini-strokes, but it was not too bad. It was very hard to watch, but he did not seem to be hungry or in pain in the hospice. I still think it was the right thing to do.
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There is not any single reason people lose their appetite. Sometimes it is something fixable, like pain with swallowing or difficulty swallowing that they just won't or can't tell you about verbally, bad constipation, kidney failure or some other organ failure, or depression. It is not always easy to know how hard to push for a full evaluation and whether a feeding tube will give some people a better quality and quantity of life, or whether it will make things worse. In the setting of advanced dementia, most literature suggests just hand feeding whatever the person will take and not starting tube feeds, as they do not generally live longer or better; in other cases such as a stroke that affects swallowing it may make perfect sense. in general if a feeding tube would require the person to be put in restraints to keep form taking it out more than temporarily, it is not gong to be worth it. on the other hand, trying meds for various problems like excess acid or just low appetite can be worthwihle though everyone's results may vary. I like to try a little Periactin before considering Marinol, generally lower side effect risk.

There is also a technique called hypodermoclysis where fluid is just given subcutaneously in boluses. There are times that people get themselves dehydrated and then feel bad and then because they feel bad won't drink; you will also find most hospice literature indicated right at the end being a little dry reduces secretions problems and should be accepted. But if you are not at that very end, being dehydrated can make you headachy and nauseous and probably should be treated. And if you are needing to fight off an infection of heal a pressure sore, decent nutrition is pretty important.

Its not so much help to give an answer here to this kind of question, but to give ways of thinking about all the options and how to formulate your own answer, which is best done mainly with both love and care, and maybe a little more knowledge and experience if you can find it :-)
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I'm with Marcia H and her recommendation to ask her doctor about prescribing, Marinol, (Dronabinol). My father was diagnosed with B Cell Lymphoma, after we finally got him begrudgingly to the emergency room. His primary care physician wasn't finding anything wrong with him over the course of about six months. He had been falling, (lethal amounts of calcium) and it was obvious he was quickly deteriorating. The consensus was that his diagnosis was not so far along, and odds were good that he could be successfully treated. However, the night before he was to be discharged from the hospital he went into alcohol withdraw (another situation that never should've happened). I had expressed my concern when he was admitted at the hospital, even though his consumption had been dramatically reduced. Dad had been a heavy drinker every night at "happy hour" until he went to bed, since he returned from Vietnam in 1968. I believe he was a "functional alcoholic," but his pride would never allow that to be a consideration to him. He then ended up being intubated, and put in an induced coma for over a week.

Needless to say, by then he was extremely weak. His oncologist gave him "marching orders" to quit smoking, and drinking and to gain weight so he would have the strength to go through treatment. Dad took all that in stride and was determined to get well. He was transferred to a beautiful rehabilitation facility where he could focus on his goals, and work with a physical therapist. Unfortunately his ability to swallow had been compromised, and he wasn't able to have anything but pureed food, and thickened beverages.

My father loved to eat, and this was nothing but a downhill battle. He "couldn't figure out how someone could screw up shrimp scampi like that!" He had been prescribed Remeron to stimulate his appetite. It wasn't effective. In fact after his death when I was looking at the bottle, I'm not sure how something like that would stimulate anyones appetite. It had strict instructions for handling the medication, that made it sound like pure poison!

Two and a half months later we were informed that the tumor had grown, and because my father wasn't able to gain the strength for treatment he was asked how he wanted to spend the remainder of his life. Dad wanted to go home. When my parents were out of ear shot I asked his oncologist about medical marijuana, for the pain he was experiencing. He looked somewhat surprised, then he smiled and ordered a prescription. Talk about the appetite that may have saved his life! After his pureed breakfast the next day he was asking for dessert! We'd been told he probably had a few months left, and all I wanted was to get him home so he could have his cigarettes, and a Jack Daniels even though he hadn't said anything about missing that stuff. I thought he deserved it. A few days later I called to check in with him, and something was terribly wrong. When I arrived within the hour I was told he was actively dying. I signed a DNR and got busy, making arrangements with hospice, and a CNA to get things set up at my parents home. My mother was a wreck, with all of this happening so quickly. I sat with my dad that entire day, waiting for an ambulance to transport him home. We finally got home that evening where he would pass away in his great room facing Lookout Mountain in Golden, Colorado. He departed this life early the next morning. He was only 72.

Although my father didn't live a particularly healthy lifestyle, he was still young enough, and he wanted to be around awhile longer. This experience has taught me many things. However, one thing is certain, we have to stay on top of our parents care, medications, and the various physicians. We can't take everything the experts tell us as the absolute truth. There are so many "specialists" instead of one doctor, on any given case. They frequently don't communicate, or read notes written by or for each other. The information available on the internet is indispensable, helping us know what questions to ask, and to read between the lines of medical jargon. I hadn't even thought about Marinol as an appetite stimulant at the time. I was concerned about my dad's pain. What they'd prescribed caused him to hallucinate! For instance he informed us to make sure we got "mustard on the ants" while we were making sandwiches one day! My dad didn't like feeling that way, and although we laughed until we cried, there really wasn't anything funny about it. As consumers of medical care we no longer have to be at the mercy of physicians being the ultimate word. The playing field is becoming more even, and being able to be informed, we get to participate instead of believing we don't know what we need, or what's best for ourselves and our elderly parents.

Good luck Sujean. These decisions are never easy, and asking about an alternative appetite stimulant certainly won't hurt anything. It's worth a try before going the route of a feeling tube.
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JUST AN ADD-ON TO LAST POST: WHAT COULD BE THE REASON MENTALLY OR PYSICIALOGICALLY THAT A PERSON REFUSES TO EAT OR DRINK?
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Sally~I don't think it a mental issue, I think it is physical (when at end of life), the body is shutting down, organs are failing...food just complicates the process.
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What is the real reason, mentally, that people quit wanting to eat?
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Two weeks before my mom passed away we did try the MARINOL and it did nothing for her. It made my mom seem more withdrawn. She was more quiet and not as responsive. This was the last chance mom had to try to stimulate her appetite. I was hoping after reading about marinol that it would help her appetite but it did not. I think it was worth a try at least in my case when there was nothing left to do.
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I want to share what happened when my father (90) quite eating. His doctor prescribed ,MARINOL (Dronabinol). This is the synthetic marijuana that is often given to cancer patients to help their appetite. This was a miracle drug for my father. He was eating normally with 2 days, and lived another 2 years. There are alternatives to feeding tubes.
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My grandfather who is 86 is doing the same. He just won;t eat and the NH seems to think that a feeding tube won't help. You can't even understand what he is saying most of the time. He;s always tired too. He is bed ridden so not much there for quality of life. They have tried Boost, ensure jello, applesauce, juice, everything but he just won't eat. He asked for a chocolate bar we brought it and he took one bite and wanted no more. He tells us he wants to go home which is in heaven with his wife (stepgrandmother). We asked about putting him in the hospital so he could get a feeding tube but they say theres no use. It won't help.
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sujean (((((((hugs)))))) Your mum is cared for. Be sure to look after you. She is going to a better place.
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The doctor has taken her off most of her medication. She is going to be getting hospice soon. My mom is still pacing, and that will probably never stop. Once she stops pacing it will be the end. She keeps falling because of being weak and not eating for 3 weeks. My mom was a farm girl during the depression and she is a tough gal. She is a fighter and won't give up without a good fight. The doctor said, he would be surprised if she lasted 3 weeks. This is the end. She will be with Jesus real soon! My heart is breaking for my sweet mama.
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When my 87 year old, was 85 and didn't feel like eating and was losing weight, I made a shake of one container of yogurt, strawberries/1/2 banana, milk,egg and honey. She ate it until she gained her weight, we thought we were losing her because the dementia was bad but it also gets bad when you do not eat or drink, if you feel it is the end, this will be a very difficult two weeks and my prayers are with you!
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If your mother does not have any advance directives, whoever is the power of attorney for medical decisions of the health care agent will have to make the decision. You need to speak with her physician; there are several factors that come into play. What is her current condition, both physically and mentally? What is her current quality of life? Will that quality be increased with a feeding tube? Will her physical condition improve with a feeding tube or is it just a stop gap measure? Speaking to the physician will help the POA in making that decision. It's a difficult decision for many. When my grandmother, who had advance dementia quit eating, my father considered a feeding tube. She did not speak, did not walk, did not enjoy anything and a feeding tube was not going to change any of these. My father decided not to insert the tube, and I believe that was the right decision, nature can take it's course.
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Thanks to all of you for your kind words and prayers. This board was my only support group other then my family. I asked many questions and got so many great answers. This board was such a life line to me. I also, enjoyed others questions and answers. What an amazing website to share your pain, and to help others with their pain. I have learned many things from friends like you. You some time never know, what you words can mean to someone who is hurting. God bless each and everyone of you who reached out and gave me encouraging words and comforting thoughts! Your kindness did matter to me and for that I am thankful!
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Sujean, I'm thinking of you and your mom...hugs.
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Sujean, my thoughts and prayers are with you . This is just so hard! Hugs!
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Sorry but I meant to say that Magic Cups are 4 ounces so they are 1/2 a cup which seems to be an easy size to eat, plus they eat it right out of the cup just like a cup of ice cream.
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(((((((sujean)))))) praying for you and your mum for peace.
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Suejean: You are in our thoughts and prayers. Your mom will finally be at peace and pain free and she will be walking hand in hand with our Lord.
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Magic Cups actually have 290 calories in a four ounce container. So, that's a lot of calories for 1/4 of a cup. They also have added vitamins, 9 grams of protein and 11 grams of fat. That's a lot of nutrition packed into a four ounce treat that looks and eats like ice cream. I know that my mom likes them as she thinks they are ice cream and since she gets them twice a day, I am really not too concerned about the pureed food that she gets but mostly will not eat.
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Sujean, thinking of you and your Mom.
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