When a patient with Alzheimer’s disease (AD) reaches the late stages of the disease, besides behavior and memory problems, eating, drinking, and swallowing also become issues. Many family members report Alzheimer’s patients not eating and having great difficulty swallowing. Weight loss can reach a significant level and the individual can eventually appear emaciated. Alzheimer’s disease affects the brain and causes a severe loss in appetite, as well as making it difficult for the individual to swallow food. Often if patients do eat, they will spit the food back out. At mealtimes, they may just stare at the food and become angry/agitated if they are forced to eat it.  If the individual does not eat his/her food, within a few weeks, you may notice weight loss, less muscle strength, and lack of energy. The loss of weight also makes them frail and less able to recover from an illness or fight an infection.  What to do when Alzheimer’s patients stop eating?  At the same time, Alzheimer’s patients not sleeping and not being able to rest well can put a strain on a person’s mood and also interfere with the ability to be able to perform everyday tasks.  It is called “sundowning,” when patients get more agitated toward the evening hours.

WHY DO ALZHEIMER’S PATIENTS DEVELOP A POOR APPETITE?

There are many causes of a poor appetite in these individuals including the following:

• Physical issues: When Alzheimer’s patients not eating becomes an issue, it could be due to difficulty chewing, loss of teeth, or weak oral muscles that give the person the inability to easily swallow food.
• Mood: The loss of appetite may be due to underlying depression, which is very common in dementia. If you suspect that your spouse with AD has depression, consult with your healthcare provider because there are treatments to help cope with depression.
• The wrong type of food: As people age, their ability to eat hard foods or foods that require chewing gets to be difficult. Most seniors prefer softer foods, like Jell-O, soups, or broth. Hence, if your family member with AD refuses to eat, consult with a dietitian and try changing the diet to softer or liquid foods.
• Communication: In many cases, the other problem with AD in the later stages of the disease is the difficulty with communication. They are simply unable to tell the caregiver what foods they prefer to eat or what they like. They may communicate their dislike for foods with abnormal behavior, like getting angry or becoming irritable, but they often can’t tell the caregiver what foods they like. You may show him or her pictures of different foods to help determine what they might like to try to eat.
• Pain: Sometimes the refusal to take food may be related to discomfort or pain, like sore gums, poor oral hygiene, or loss of teeth. Therefore, a dental check-up is recommended regularly. Try and maintain good oral hygiene as it is a common reason why these individuals do not eat.
• Fatigue and loss of concentration:  What to do when Alzheimer’s patients not eating becomes another one of the symptoms? Another reason why AD patients may refuse food is generalized fatigue and/or loss of concentration. Some individuals may lack the necessary concentration to eat food and simply give up. To get around this, be supportive, offer food in small amounts, and do not rush the individual.
• Medications: Some of the medications used to treat AD may have adverse side effects that not only cause dry mouth but also make food taste poor. You may wish to consult with a pharmacist or your healthcare provider to ensure that the medication is not the cause of poor appetite. There are over-the-counter products that can help with a dry mouth. Constipation is also a very common adverse side effect of medications and can diminish appetite.
• Lack of physical activity: In general, when a person is not physically active, this also causes less hunger and worsens constipation. Therefore, one suggestion is to encourage the individual to at least walk regularly as it may increase the appetite. Exercise can also help with bowel movements and reduce constipation.

CAN APPETITE RETURN?

How can you help return an appetite to Alzheimer’s patients not eating?  It requires you to be proactive. The earlier you act, the higher the chance of success. Once the individual has stopped eating, nothing will work. Therefore, be observant of the individual’s appetite early on and start making the following changes as soon as possible.

1. Know the types of food the person likes and dislikes. Write the foods the person prefers in a diary.
2. Know the individual’s preferred mealtimes. Some individuals eat a big breakfast and others have a big lunch. Some prefer light foods for breakfast or a snack during midday. The more you know about the person’s routine and way of life, the better you will be able to manage the situation.
3. Prepare appealing foods. Cook and present foods that look pleasant, appealing, and are colorful. Try to use foods with good aromas to enhance the appetite. For example, baked foods, like cake or fresh bread, can enhance the appetite.
4. Offer small portions. Try serving small portions and avoid overloading the plate. Consider half portions and keep the food warm. Cold food usually loses its appeal very quickly.
5. Offer foods that are agreeable to the individual.  At this point in time, do not worry about calories, etc. The goal is to make sure that the individual eats. As people get older, their food preferences also change. 
6. Try a variety of foods.  Always try different types of foods with different colors, flavors, and textures. For example, if the individual likes potatoes, you may try wedges, mashed potatoes, French fries, potato cakes, baked potatoes, boiled potatoes, etc.
7. Always be gentle with the individual when offering food. Tell the person what type of food you are offering and try to make it sound delicious.
8. Do not hurry a person with Alzheimer’s disease.  AD patients usually take a long time to eat, and you should never push them to hurry. If they have stopped eating, do not assume he or she has finished eating.
9. Do not pressure an AD patient to eat.  If they get agitated, wait until he or she is calmer before offering them a drink or more food.
10. Keep snacks readily available. In case the person does not like to eat meals at set times, keep a variety of snacks on hand. How do you cope with Alzheimer’s patients not eating? Many AD patients prefer eating several small meals as opposed to larger, organized meals.
11. Create opportunities that encourage the individual to eat. For example, while watching TV, you may consider offering some snacks or while going for walk, you may wish to stop at a cafeteria for a coffee and sandwich.
12. If the individual refuses to eat food, it is nothing personal. At this stage, the disease most likely has overtaken their thoughts and actions. Remember, it’s the results of the disease you are seeing, and try not to take their actions personally.

WHAT IF THE INDIVIDUAL SIMPLY REFUSES TO EAT?

As Alzheimer’s disease progresses, there will most likely come a time when the individual will simply refuse to eat no matter what you do. At this stage, the weight loss can be severe and there is obvious evidence of malnutrition and failure to thrive. In this scenario, caregivers and families are left with difficult decisions. The first thing to do is to speak to your healthcare provider. The decision to use forced feeding is not recommended as not only does it not help reverse dementia, but there are also complications associated with tube feedings. Plus, the quality of life is very poor. The best recommendation at this stage is to seek hospice care where the primary goal is comfort, alleviation of pain, and minimization of suffering. Speak to your healthcare provider about hospice care. It is a recognized form of healthcare for those nearing end of life situations and it can also ease the burden on the caregiver and family.

CONCLUSION

When Alzheimer’s patients not eating becomes a problem, there are several things you can try to help get them to eat.  You must know what to do and what not to do in that situation.  As well, when Alzheimer’s patients not sleeping interferes with daily activities, it is a problem that must be dealt with gently.  Cano Health Services is recognized as a five-star provider by the Centers for Medicare and Medicaid. Its mission is to offer quality healthcare services to all seniors.  Call them at 1-855-208-7877 today to learn more.