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About Mary Gordon
Expertise
Several years direct experience as caregiver for family member who died of end stage AD. Did lots of research and dealt with a lot of health care professionals and caregivers over the 7 years from diagnosis to the end. Used various care options from community based resources to increasing levels of institutional. Mother of three, two born during our loved one's decline, so I know what it is to be the ham in the sandwich, taking care of the older generation and the younger at the same time and trying to balance everyone`s needs. Ask me, I`ve probably been there, done that. We made lost of mistakes and learned everything the hard way - but you don`t have to! If I can`t answer your question, I`ll steer you to a place or person who can.

Experience
Currently a program manager for a large utility company. My Alzheimers experience comes from having the illness in our family. Out of necessity, we did a lot of research in order to understand the disease, plan for what might come next, and make the right decisions to help and support our loved one. Please note, I am a Canadian living in Toronto, and therefore am not the best person to ask about US regulations and insurance rules!

You are here: Experts > People/Relationships > Senior Health > Alzheimer`s Disease > Weightloss

Alzheimer`s Disease - Weightloss

Expert: Mary Gordon - 10/24/2009

Question
Hi my mom has Alzheimer in a severe stage. What concerns me, is the fact that she is losing weight very fast. She cant eat by herself anymore, and get pulverized food

Answer
Hi Henrieta,

It's very common for a person with late stage Alzheimers to begin to lose weight steadily. As you probably know, they lose the coordination needed to properly chew and swallow regular food, and to be able to feed themselves. Pureed foods and thickened liquids can help with the problems they have chewing and swallowing (which are called dysphagia). Patient feeding by hand, spoonful by spoonful, and holding a cup to their lips is really the only alternative once the person can't handle utensils and feed themselves. It can be very time consuming, but it is the best method. You might be tempted by the idea of tube feeding, but there is a lot of research on the subject, and there is no evidence that tube feeding improves their health, keeps weight on better, prolongs their life or reduces their suffering.

Another thing that seems to happen to people in later Alzheimer's is that they lose their interest in food. Some of this is because they literally lose their sense of smell and thus most of their sense of taste. Nothing is going to taste or smell good to them, and there isn't much you can do about that - not much will seem appetizing. They also don't seem to feel hunger or thirst like a health person does. They often really seem to have no interest in food - or no idea why they should eat it. It is as though they don't have the physical sensations of needing food or drink, or if they do feel these things, they don't know what the feelings mean. They certainly don't seem to relate the activity of eating or drinking to quelling their hunger or thirst. I know with my mother in law, it was as though she had no idea what food was for. It just seemed like people trying to feed her were just a bother to her - she seemed not to realize that food was something she needed, or should want or take any pleasure in.

A couple of other thoughts -it can help to increase the number of times a day she is fed - many small meals may be more effective than fewer larger ones. She may tire easily, so getting a little into her many times a day, might mean she gets more calories in total than having marathon feeding sessions. Feeding her alone in a quiet place can help, if she is getting distracted in any way. Hopefully, if she is being fed by aides and staff, they know enough not to ask her verbal questions about whether or not she has had enough, since she may or may not be really able to understand or answer, and they may take the food away too soon. My mother in law could not be taken to the dining room, since she was distracted by the noise and commotion and would end up eating much more if they sat with her and her tray away from the bustle.

Watch her carefully - if there are particular times of the day when she will eat more, then use those times to get the most into her possible. Some people are most receptive in the mornings when they are rested and relaxed. Throw out traditional ideas of what she "should" have for particular meals like breakfast. There is no reason she can't have "dinner" foods for breakfast if that is the time she will eat the most. You can also let her have high calorie custards or puddings or ice cream rather than traditional breakfast or lunch foods. The whole goal is to get as much nutrition into her as possible, and if there is something she likes and will eat, let her have it.

I would avoid giving her much juice, since they are little better than some sugar water, and can kill the appetite for more substantial foods. You can also add fats to food to increase the calories, so if she only eats a little, at least she will get as many calories as possible - examples include adding butter or cream or cheeses to foods. I would also be offering her fortified liquid supplements like Boost and Ensure between meals. You want every bite and swallow to count.

I know this is very difficult. It really is a sign she may be entering into her final months. All you can do is your best. Don't beat yourself up too much. I know you love her and want the best care for her possible. There may not be much you can do to keep weight on her beyond trying these ideas. It seems to be a part of the natural progression of the disease, although it is very frustrating and saddening.

Hope this helps a bit.

Mary

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