When Someone Stops Eating
More than once we have been told by the staff in hospital or nursing home that a client has stopped eating. The staff's interpretation is that it is a choice by the client who has decided that they wished to die.
We need to be very careful about the interpretations we make about the behaviour of clients who are not able to speak for themselves, whether because of an advanced dementia, because of stroke which has impeded their ability to speak, or even sometimes because English is not a person's first language. The fact that a person has stopped eating DOES NOT mean that someone has decided to die. It does mean something is occurring, but a wish to die or let go is only one explanation.
Staff and family should work together to figure out what is happening. The staff contributes expertise, the family/caregivers contributes their knowledge about the person. But sometimes people have no family, and sometimes staff do not have the training, time, or inclination to do an assessment. In this case, it may be a lawyer, trustee, private Care Manager, friend, or someone else who has to step in to be an advocate.
Some of the reasons someone may stop eating include:
1. They are in pain (and it is not being treated and the person cannot say that they are having pain).
2. They are on too much medication or inappropriate medication. Some medications have side effects impacting on intake. For instance a medicine prescribed for agitation or other behaviour, can dull someone's senses, making it harder for them to focus or causing drowsiness.
3. Problems with taste. As people age, their sense of taste changes. Sometimes medication may make food taste off.
4. There is too much stimulation in the environment.
5. They need more time to eat, and the staff does not have the time to feed them. This is especially true in a hospital setting.
6. Staff do not have the skill to help someone eat.
7. Anxiety, depression, loneliness or lack of sleep.
8. The texture of the food is inappropriate to their needs. A person may need food cut up or pureed or mashed.
9. If someone is receiving pureed food, it is unappetizing and/or tastes bad.
10. Food is too hot or too cold.
11. They have a sore, or infection in their mouth which has not been treated.
12. They have a toothache.
13. Their dentures are causing them problems.
14. Constipation, bloating/gas, or stomach aches.
15. Swallowing difficulties.
16. They can't cook, shop for oneself, afford groceries.
17. They are unable to use utensils.
18. They do not remember how to eat, due to dementia, or the process of eating or swallowing.
19. They cannot see the food or plate or glass on the table. (This can happen through stroke where "neglect" occurs meaning people cannot see something on one side, or cataracts or other visual problems that have not been detected.)
This above is a long list of course and it shows the importance of a thorough assessment from people dedicated to problem solving. The assessment can take time, but should be done with a sense of urgency. If someone becomes malnourished or dehydrated, it can swiftly bring on other serious complications.
