Alzheimer`s Disease/surgery

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Question
Hi
My Dad had emergency surgery for a twisted bowel about 3 weeks ago, his Alzheimer is a little worse but we can't seem to make him understand that he needs to eat & drink.  He will not even look at the hospital food.  We bring in things & he will eat them some days & sometimes not.  He was taken off IV fluids but has been put back on the IV as he became dehydrated again.  My father was a very active member of the community and at 83 years old worked out 2x a week & walked everyday.  He has had Crones for most of his life with not to many problems.  He suddenly was in a lot of pain at Christmas & we had him at the emergency ward many times with no results.  He was finally admitted & they did some tests when he completely crashed & the result was emergency bowel surgery.  In December he weighed 160 pounds & was in very good shape, he now weighs 120 pounds & lost most of the muscles that he had.  We are at a loss as to what to do to encourage him without causing him further issues.  He also ended up with thrush & this is causing an issue for him I'm sure!  Any advice would be great.
Thank You
Debbie

Answer
Is there any chance they could get him out of hospital and potentially into a nursing facility or Alzheimer's unit where he may be given better care and attention than in hospital?

My personal experience is that hospital is no place for people with cognitive impairments. The staff really don't have the time and training to adequately manage the needs of people who are confused or memory impaired.  When my mother in law was in hospital for a broken hip, she lost a lot of weight, because the hospital was not prepared to serve her many small high calorie meals, snacks and frequent drinks daily, do a lot of coaching and encouraging and even hand feeding, and monitor her intake to the degree she needed. She was in an orthopedic ward, and they just couldn't deal with her dementia at all. They also didn't realize that she really couldn't understand or follow verbal instructions, and would repeatedly tell her to do things with words (or worse, assume she couldn't hear and yell instructions at her). They would do things like bring a tray in with a lid and leave it - not realizing that if they didn't take the lid off and put food right in front of her, she wouldn't realize what it was or even know to look for food. They would leave drinks at her bedside, not knowing she might not know a juice box was a drink - they needed to put it it a cup and put it in her hand and encourage her to drink.

He needs to be assessed with respect to his diet and the best strategy for getting fluids and calories into him. Is the thrush causing discomfort with chewing and swallowing? Is his advancing dementia causing coordination problems for him ? This can result in dysphagia, which means trouble chewing and swallowing, and manipulating food in the mouth, which can result in the person not eating enough. It can mean they have trouble with certain textures or consistencies or mixed textures, like cereal in milk. Sometimes a softer diet or thickened liquids can help.  A speech pathologist is usually the specialist who evaluates patients for this issue.

Have they brought a dietician in to see what they can do to get more calories into him? He likely needs calorie and nutrient rich foods - and besides more frequent and smaller feedings that can mean adding supplements like Ensure to his diet, or adding fats such as cream and butter to his food. If he has favorite foods he will eat, let him have them, and throw out ideas about having to give him specific foods at specific times. If he will eat rich puddings for breakfast, let him have them! If there are times of the day when he seems to eat more, load him up at those meal times with high calorie foods - there is no reason he can't have dinner foods at 8 am if he'll eat them rather than lighter fare like cereal.

He may have limited appetite, and there are medications that might help. Many people with dementia also do better if they are eating with other people. There is something about seeing others eating that can stimulate them to eat as well. You might want to time your visits to eat with him.

Many people with dementia also don't take in enough fluids. They don't seem to feel thirsty the way a healthy person does. The only solution is to actively give him drinks frequently, and NOT leave it to him to voluntarily ask for them or reach for them. I'd also avoid sugary drinks like juice, as they can kill appetite for more substantial fare at meal time.

He is not going to understand or retain your very logical arguments, much less cooperate with what he needs to do - he cannot internalize instructions or understand what actions are required for his own recovery - he can't plan for a future state. Surgery frequently really knocks people with dementia back in a major way, and they often never regain the ground they have lost. It seems to be something to do with the anesthesia, as much as the trauma and stress involved with major illness and hospitalization. They seem to really be set back mentally. Given time, as he recovers physically, he may come around cognitively somewhat.

Another alternative for the appetite issue is to have family with him in shifts to try and get more food and drink into him, or hire an attendant to stay with him all day and do the same. Has the hospital and his doctors/care team suggested any ideas? If they are not concerned, they should be, since nutritional status is a major factor in patient recovery. Obviously someone who is dehydrated and malnourished is not going to get well in any kind of reasonable time frame.

My best advice would be to get him out of there as soon as possible and into an environment where he can get a lot of one on one attention to  see if you can't get him on the road to recovery and weight gain.

Hope this helps.  I know this is upsetting.  

Alzheimer`s Disease

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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!

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