Expert: Mary Gordon - 8/5/2011

Question
Dear Mary~My mother-in-law has end stage Alzheimer's. She is very rigid (which I understand is due to her years of immobility. Amazingly though, she will eat and drink (even with her eyes closed, which are closed 95% of the time). My question is why is she so thin yet she eats pretty well. Thank you for an answer.
Also her blood pressure is very low and has been for years.

Answer
Some of what you are seeing is wasting, due to inactivity and immobility. As you can appreciate, she has lost almost all her muscle mass. Older people also lose their subcutaneous fat with age, which is why they are so often cold even in you or I would think was a warm room. Weight loss is also a characteristic of Alzheimer's as it progresses, so be glad that she will eat. I get many frantic letters from families whose loved one's are just not interested in food at all, or who eat so little, their weight is plummeting.

It doesn't seem to matter if they are cared for at home or in a facility. Even with very careful hand feeding, most people will get thinner and thinner. I know it's distressing, as we watched the same thing with my mother in law as well. She was so thin and frail looking the last two years of her life, it was hard to believe she could live on like that.

The best strategy is to make every mouthful count in terms of calories and nutrition. Avoid sugary drinks like juice, which can kill appetite for more substantial fare. Throw out your ideas about regular menus. If she eats more at certain times of the day, such as breakfast, let her eat her main meal then, so you can get the most nutrition into her. If she will eat rich puddings for a snack, let her have them. Add fats to her food (i.e. cream or butter to up the calorie count). Try supplements like Boost and Ensure.  

There is some association of dementia and low blood pressure in older patients - mostly with low systoltic pressures rather than diastolic pressure, which tends to lower with age anyway. No one really knows if the low blood pressure itself leads to forms of dementia, or if the low blood pressure is from the disease process that causes the dementia. It's a bit of a debate, it's also true no one really knows what ideal blood pressure is later in life. Certainly, high blood pressure is not good either.

I'm so sorry you and your family are going through this. She's a lucky woman to have a caring family looking out for her best interests and comfort.

Mary G.