Eating problems (hamstering)

[andrean]

Until a few weeks ago, Mum would eat everything put in front of her (and much that wasn't: if you had to get up during a meal, it was sensible to take your plate with you or mum would be tucking into it while you were gone). After moving house recently, she's gone downhill very rapidly and now eating is a real problem.

She eats incredibly slowly, putting the fork down between each bite and obviously forgetting she's having a meal. When you remind her, she looks at her plate as if she has no idea what it is, then reluctantly takes another bite. After a few bites you realise she hasn't swallowed but has all the food stuffed into her cheeks (a habit dad now refers to as 'hamstering').

When you tell her to swallow, she puts her head back and gulps hard, but often the food doesn't go down and sometimes there's no option but to tell her to spit it out. We try not to give her things that require a lot of chewing (it's hard to hang on to custard too long) but don't want to go on to a pureed diet unless we absolutely have to, as it seems so unappetising and limiting (unless anyone can tell me otherwise?)

As a result of all this, she's eating very little compared to a few weeks ago - partly because she's eating so slowly, partly because she's no longer interested in eating anyway.

Any tips on how to proceed? I guess what she needs is a diet which is high in nutrition so she doesn't need to eat loads, but also appetising enough that she can be encouraged to eat it. And is the not swallowing thing something that can be addressed or do we just need to accept that's how she is now and just give her things that she can't hold in her mouth?

 

[jenniferpa]

I think you need to get a referral to salt (speech and language therapist), These are the people who deal with swallowing difficulties and help with techniques to avoid them. The name they tend to use for this type of behaviour is pouching I believe, but hamstering is pretty descriptive. Contact her GP for a referral.

 

[Acco]

I had the same kind of difficulties with my wife. A small bowl of breakfast cereal, or an evening dinner, would take 3/4hr each to get through, if indeed they were ever finished. She would refuse to open her mouth, push food out with her tongue, nibble food, store her tablet medication in her cheeks and spit it out when she thought I wasn't looking. She often put her fork or spoon down shortly after starting eating and effectively gave in (I believe she found it very tiring trying to remember what to do with them, etc.). After dropping from size 18 to 12/14, and for other reasons, she was put on Metazapine which can have the side effect of encouraging appetite. She was only on Metazapine for 4wks (taken off because of a suspected adverse side effect) but since that time has got back to her usual normal healthy eating and has regained some of her weight loss. That was probably 12months or so ago and she is now just starting doing some of the same things again!
In total innocense and lack of knowledge that there was such a condition, I have refered to her as 'like a hamster' to our sons when describing what she has done (I have also said she was like a magician). Indeed, today she spat out a prune stone when I was getting her to clean her teeth. She is a little constipated on her new medication and I put some prunes (supposedly pitted) on her cereal yesterday morning. Since then we have had lunch, fruit and drinks in between meals, dinner comprising main course and sweet, bedtime drink, night medication and water, slept for 7hrs, breakfast cereal (no prunes) and tea, and tablet medication this morning and through all this she has managed to tuck that prune stone in her cheeks!! At times I suspected something was wrong but despite my best efforts she defeated me.
Her dietician suggested high protein food, creamy yoghurt, ice cream, double cream, condensed milk, etc., and also suggested bright single coloured plates, bowls, as an aid to focussing attention on the food. Hope you soon manage to get the problem sorted in everyones interests.

 

[andrean]

Thanks for advice. I'll look into a SALT referral as I suspect this is a long term problem, and suggest to dad the idea of brightly coloured plates etc.
Mum is also on mirtazapine, to address her night time perambulations, but so far it doesn't seem to have had the common side effect of increasing her appetite. I think a lot of the problem is that she no longer recognises that what's in front of her is food, so has to be constantly reminded to eat - then each time she's had a spoonful, that's it as far as she's concerned, and she can get quite cross if you keep reminding her.
The only things that go down easily and without constant reminders are soft sweet things like yogurts and ice cream so perhaps we should just give her more of those and not worry too much about a varied, or even particularly nutritious, diet - I guess at this point in her life, if there's something she likes, that's the most important thing.

 

[Wirralson]

Eating problems

I have just learned that my mother is displaying some eating problems, though not pouching. She has macular degeneration, and is effectively almost blind, and her hand/eye co-ordination is now very poor, although it varies. She cannot cut food and needs to be fed. My father is concerned she is losing weight, and wonders if she is eating enough. The food in the nursing home is basic and not terribly appetising. I am due to visit in a couple of weeks and will be looking to get a SALT referral, inc ase there are swallowing issues. I'd appreciate it if anyone has any advice on handling food issues, as I doubt the nursing home can or will do one-on-one feeds for every meal. I'm reluctant for my mother to go on to pureed foods if it is avoidable due to them not being very pleasant. There is also a loss of dignity aspect, which my mother seems to feel quite keenly.

Wirralson

 

[Canadian Joanne]

Wirralson, pureed food is not necessarily unpleasant. My husband tasted his mother's pureed buttered toast, and although it looked horrible, he said it tasted just like buttered toast.

I completely understand your feelings about pureed foods. They do look unappetizing but they are simplly well blended foods. I believe they may add some liquid to certain types of foods.

Andrean, have you considered someone feeding your mother? It may help in getting her to take food in. Get a spoonful in, then give a sip of water to encourage swallowing. My mother still eats very well but sometimes she just keeps chewing and chewing and chewing. I use the drink to stop her chewing and get her to swallow.

 

[Nebiroth]

The only things that go down easily and without constant reminders are soft sweet things like yogurts and ice cream so perhaps we should just give her more of those and not worry too much about a varied, or even particularly nutritious, diet - I guess at this point in her life, if there's something she likes, that's the most important thing.

Any dietician will tell you, if someone is not eating then the most important thing is calories. Effectively starving through not eating is worse than any 'unhealthy' diet is ever going to be, no matter how desirable it is under other circumstances. Moreover and even more important, people tend to overlook just how much of our daily water intake comes from food. If lack of food is not made up for by increased intake of fluids then this is setting up for dehyration problems in the future - and that's more serious than lack of calories. The human body can tolerate low calories or even none for quite a long time. It cannot tolerate lack of water.

Fortunately, easily eaten and appealing things (most people with dementia seem to develop a sweet tooth, even if they disliked such fare before) can be packed with lots of calories and are not necessarily lacking in nutrition either.

Puddings are often accepted and can be packed with things like whole milk, eggs, cream and sugar - not necessarily 'healthy' but much healthier than nothing.

Using small portions of big plates can help as appetite can be supressed by simply being confronted with 'too much food to eat'.

It sounds to be as though your mum has actually forgotten what to do with the food when she's got it in her mouth.

A SALT is the best person to advise on all of this though.

A possibility is that she has a problem with saliva production and therefore the food just feels to dry to swallow. Again, puddings to the rescue! Most of them have plenty of moisture and are soft. And the added bonus is, allthat moisture will keep her hydrated too.

 

[Onlyme]

Mum hamsters and I have to really watch her or she will spit her tablets out when she is asleep. It can take 15 minutes or so to get her to take them with loads of water and I keep havingto check her mouth.

She has started to do the same with her food but still thinks she can eat loads. She can't feed herself now as she forgets that she is doing halfway to her mouth and just returns the fork or cup to the table untouched.

 

[drmclarke]

My mum often forgets to eat even when the food is placed on a tray in front of her. My daughter works in a CH and suggested 'co-eating' - sitting and eating the same/similar appearing meal while she eats. I was jealous to hear this is something my daughter regularly gets paid to do at the CH with dementia patients (and there was me thinking how hard she was working). We haven't yet managed to persuade any home carers to take their sandwiches along and eat with Mum, unfortunately...

 

[Wirralson]

Food issues and dehydration

One thing that has struck me in the light of Nebiroth's post above is that my mother regularly used to spit out pills. Some of this seemed to be rejection of the idea of illness, but I wonder if lack of saliva production may be an issue. She regularly developed UTIs and showed signs of dehydration before she was sectioned. I will raise this with the Nursing Home and SALT.

Wirralson

 

[1954]

Thankfully MIL is not pouching yet but her coordination is getting worse. She saws through her finely sliced meat, like it is rubber or concrete. She is right handed but sometimes uses her cutlery like she is left handed! Dread the time when we fight to get anything into her mouth but I know it will come!

 

[Acco]

Mum hamsters and I have to really watch her or she will spit her tablets out when she is asleep. It can take 15 minutes or so to get her to take them with loads of water and I keep havingto check her mouth.

She has started to do the same with her food but still thinks she can eat loads. She can't feed herself now as she forgets that she is doing halfway to her mouth and just returns the fork or cup to the table untouched.

My wife went through a phase of pouching her tablets and spitting them out hours later when she knew I wasn't looking, or taking them out of her mouth and secretly stuffing them down the side of her seat squab (crafty or very clever?). Same experience as mentioned about not eating and lost considerable weight, then recovered and eating well for many months and today getting resistance to eating again, despite all my encouragement etc. And the same today with drinking which is presently particularly important in view of suspected UTI for which taking antibiotics. Also kept giving me a very cheeky grin and laughing at my attempts to feed or hydrate her which I found very strange. Suspect the grin and laughter are due to her recently new course of Ebixa, as a few times she has awoken middle of night laughing (that is a new one for both of us). Just another puzzle or challenge along the way with her AD/VaD. It may be useful to know that some medications are in solution form despite what I have said about her drinking today; l was given this option with her Ebixa due to previous attempts at avoiding pill taking and thus far it had been very beneficial. I mix it with a little of her favourite soft drink - I'm not beaten yet!

 

[kd7279]

Acco,
My wife is on liquid EBIXA. Before she went into care, I used to crush all her pills mix them with the Ebixa and some cranberry juice and give it to her through a straw. It worked for 3 years until she went into care and the CH wouldn't do it that way with some awful consequences, i.e pouching and low blood pressure due to not taking the medication.
I know some of the pill instructions say take whole, but if that's the only way, heh, so be it, it worked for me.
Keith