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.

Tips for Helping When Someone Stops Eating

There are a number of professionals who may be able to help diagnose a problem with eating. Assessments are usually interprofessional collaborations, but here is what some of them do: Occupational Therapists, Dietitians, and sometimes Speech Language Pathologists look at swallowing disorders and feeding problems. A pharmacist can look at medications. Ask about effects of medication on taste, about which medications may be inhibiting thinking or alertness, and even which ones are no longer needed. A dentist or dental technician can look for problems in the mouth with teeth, dentures, or gums. The physician can order tests and exams for system related problems which are not apparent through observation.

There are many, many very caring nurses, care aides, and home support workers who are creative, loving, and persistent in their efforts to help someone eat. Care aides especially can have excellent observations about behaviour, response and mood. Family members should talk to them and observe as they are trying to help someone eat.

It may be advisable, if it can be afforded, to hire help privately to help someone with eating. This provides the individual attention and time that someone may need to eat. For our clients, we have not only hired Home Support Workers, we have our music therapists and recreation workers sometimes helping to feed someone in the time they are with someone.

Bring in food or liquids that you know a loved one enjoys. Look for flavour enhancers or appetite stimulants. Change the environment or bring someone to a restaurant or cafe for a change.

Try small amounts of food at different times, and using different textures and types. Foods that can be eaten with fingers, foods that can be consumed while walking.

Supplements such as Boost or Ensure are easier to swallow and sweetened. If necessary they can be thickened. They are full meal replacements, and can be offered often during the day. Make sure that the flavours are ones the individual likes, and that they are varied so “food fatigue” is less likely to occur. Along with that, see if there are appetite stimulants which could be used. (A little glass of sherry, anyone?).

Review and monitor for mood problems, sleep problems and pain. As pain is especially hard to diagnose for someone who cannot make their needs known, it might be wise to consider giving some kind of pain control such as Tylenol to see if it makes a difference.

Encourage eating through touch, gentle encouragement, and visual cueing. Use soft words, and follow whatever cues you might get from the person.

Ultimately, family members may have to be the advocate and problem solver for their loved one. If you question what you have been told, you have the right to input and direction into the care of your loved one,even if it goes against the recommendations of the professionals. At the same time, you need to be aware of the risks that you may be incurring.

Remember too, that there are times when someone stops eating because they are dying or ready to go. When death is near, the body is shutting down, and it is no appropriate to try to get someone to eat or drink, although keeping lips and mouth moist and comfortable is. Talk to the care professional in this situation.

If you are unable to give direction, living far away, want an outside professional opinion, or there is no family and you are acting on someone’s behalf, consider hiring a private Care Manager from Diamond Geriatrics who can monitor care and problem solve for you.

For more in-depth solutions: Caring.com http://www.caring.com/articles/common-eating-problems-with-alzheimers