The elderly often show less interest in eating and weight loss can become quiet noticeable. They may also stop drinking as much – especially if they have problems with incontinence. In the face of advanced dementia and/or a terminal illness, this disinterest in food and drink can become even more pronounced. Family dinners become less of a social event and more a battle of wills as children focus their energy on what is being eaten and how much is being eaten. If there is extreme weight loss, artificial nutrition or hydration may be considered.
Before considering alternative methods of nutrition and hydration there are certain questions that need to be asked:
- Has there been a swallow study (Modified Barium Swallow) done to rule out a physical problem which makes swallowing difficult? Muscle strength typically decreases as we age. This decrease in muscle strength can effect the muscles involved in swallowing. Strokes or TIAs (“mini”-strokes) can affect the muscle control needed to swallow effectively.
- Are ill-fitting dentures or poor dentition to blame for a decrease in eating? If dentures do not fit well, eating can become problematic and even painful. Chewing and eating can also be difficult if natural teeth are broken or missing.
- Is there a fear of drinking or eating because of problems with incontinence? The elderly often have problems with incontinence and may refrain from eating or drinking if they are afraid that they may have an “accident” or not have easy access to a bathroom when needed.
- Is depression a factor? Clinical depression can cause a lack of appetite which may result in weight loss. Depression can also cause a lack of interest in activities such as family dinners, eating out, etc.
- Are medications to blame? Many medications can cause a lack of appetite or make food “taste funny”.
- Is dementia a factor? Elderly people with dementia may forget how to prepare food, how to feed themselves, or how to chew and swallow.
- Is a decrease in appetite the result of a terminal illness? One of the problems encountered with terminal illness is a natural decrease in hunger and thirst as the body prepares for death. Medical professionals should be involved in helping patients and their families to understand the disease process and its impact on nutrition and swallowing.
If alternative means of nutrition and/or hydration are being considered certain questions should be considered:
- Will alternative nutrition/hydration improve nutritional status?
- Will alternative nutrition/hydration decrease the risk of disease or prevent disease?
- Will alternative nutrition/hydration help to increase life expectancy?
- Will alternative nutrition/hydration improve the quality of life?
- Is alternative nutrition/hydration a short-term or long-term intervention?
- What are the risks involved with alternative nutrition/hydration?
- Are there any considerations if alternative nutrition/hydration is provided, but there is a “change of heart”?
All of these questions need to be considered very carefully before taking steps to pursue alternative means of nutrition. Professionals need to educate families on the benefits and contra-indications of tube-feedings, nutritional supplements, appetite stimulants, etc. before a decision is made. This education needs to be specific to the patient involved and take into consideration the overall medical condition of the patient.