How do you know if it’s loss of appetite because of vascular dementia or if it’s the body’s natural way of beginning the shut down process?
I am the sole caregiver of my mom (84) with vascular dementia (2 years) I have to do everything with her in regards to daily activities, I want to say she’s at a moderate later stage. My mom was always a petite lady, under 5 feet and usually weighed between 110-115 lbs. She has not lost weight yet but I’m worried she will bc her appetite has changed tremendously the past month. She always ate very well for someone her size but after this past Christmas she has no appetite. She also refuses to put in her top dentures so I make all her meals soft or puréed, smaller frequent meals with higher calories. I spoon feed her slowly but she doesn’t seem to enjoy anything I make, not even pudding or ice cream for snack which she used to love! It’s heartbreaking to watch all this. The food is tasty it’s the same meals I eat I just put hers in a food processor with a little bit of broth or water for moisture. She’s not on any new meds so it’s not a side effect from that, she’s on diabetes meds & aspirin therapy for the past 27 years now. She does have dysphagia. Any thoughts on this I would greatly appreciate it.
I did see your message to me, but for whatever reason I can't post a private message to you.
I only wanted to add that UTIs (or other infections) can bring on such odd behaviors, or even none at all. Many years ago, doc office called me after a checkup to tell me they called in an Rx for a UTI. Really? I had no symptoms at all and wasn't anywhere near elderly! Mom's first UTI in MC brought on some serious sun-downing. Subsequent UTIs manifested with night time bed wetting (she was already in briefs AND we added a pad at night, but it wasn't enough - she would soak EVERYTHING.)
These tests are much easier to administer, usually no charge and can rule out so much, without being overly invasive. Hopefully this is what ails your mom and it clears up, allowing her to eat again. If not, perhaps the neuro can figure something out. I can see slowly eating less as perhaps being a "normal" part of aging, but to come on so suddenly, I would also suspect something was amiss!
(just now another thought - she won't wear the dentures, but you've checked for sores or other injuries... is it possible the denture is causing pain for some other reason? Recently I had part of a filling break off. What should have been a 15 m fix ended up being 2 hours to grind down the tooth, as it was too far gone to repair, and prepare for a crown. I don't do Novacaine and had none that day. It didn't happen right away, but before my crown visit several weeks later, I had to cancel. I think my cleaning was a few weeks after that, which also didn't help. I had so much pain trying to just open my mouth, and eating was difficult too. There was no way I could have opened my mouth for the crown - it was way in the back! The pain was on the other side, and my suspicion is TMJ. In general, it doesn't hurt. Only when opening my mouth, chewing or moving lower jaw side to side. It's not the kind of pain that would have you screaming or being laid out all day, but it would impact eating, and perhaps wearing the dentures. It has been many many weeks since then, and while it is getting "better", it still does make itself known. So, if no results from urine/blood work, perhaps consider this? Just ask her to open her mouth, as wide as possible and then close but move lower jaw side to side. If she can't open wide or seems uncomfortable moving her jaw, you might consider TMJ. Didn't matter if the food I ate was soft or hard, just opening my mouth for a spoon hurt!)
She's been living quite well on up to two Ensures each day, and while I have her on hospice care now, no one seems to think she's going to starve to death. They just say it's natural decline.
I so think these "virtual" appts are overrated. Unless they can SEE something or TEST something, they don't know. Both my mother and I skipped last year's exams. If you can't listen to lungs and heart, check BP and pulse, get weight, really CHECK the person and there's no "complaint", what is the point (other than they get the same amount of $ and can renew meds)?
With dementia and lock down, no way to get mom on virtual appt really. For me, no meds no real issues and no video capability, so what, chat on the phone, yup I'm fine, you're fine, we're ALL fine? No thanks.
That said, asking about fever or pain is NOT the right way for PCP to approach! In elders, esp those with dementia, there can be ZERO pain and NO fever with UTIs.
You can try a home UTI test or call to have them set up a lab test (culture is best.) Since you are there anyway, I would request a blood work as well. Another poster's mother, living on her own, had sudden change and there was no UTI, but there WAS an infection in her mouth. Once treated, she resumed her normal behavior. Blood tests can show elevated WBC, which would indicate an infection somewhere.
Everyone is different, but my mother's appetite never diminished until after a stroke. Initially she still tried to feed herself (it affected her dominant side and swallowing.) It still took a while before the nurse said she was refusing some items (due to the swallowing) and kind of picking through foods. They did eventually use thickeners for beverages, not sure she went to pureed foods. But she had early dementia still living at home, lived 4 years at MC with it and was 97. I would get the blood and urine checked.
I would get both done, save a trip/exposure (in case the UTI is neg, the blood work might reveal infection elsewhere OR some imbalance.) Many places will have you call when you arrive and call you back when you are allowed in, so less exposure to others. If nothing else, you'll have a current baseline for her.
thanks
thank you for your reply.
I checked her mouth for any sores or ulcers and I don’t see any. She’s hardly ever constipated only if on antibiotics for some reason.
I gave her a urine stick test and it came out negative, however in the past I remember her being negative with the dip stick test at the Dr office but they still sent it out for culture and it came back positive for a UTI, thanks for mentioning this, as she does not have any of the typical symptoms that go along with a UTI, I need to have this possibility checked out!
Any change in bowel habit?
But whatever you do or don't discover, I'd still report it to her primary care physician if I were you. It's a marked change in her normal routine, and there may be checks to be done that amateurs aren't aware of.
thank you for your reply.
her pcp is aware of my concern.
she actually has a bowel movement or two everyday, that’s all the fiber she drinks in our homemade smoothies, we have been drinking for about 15 years now, I even take my Nutribullet on vacay with us!
when I try to give her the partial denture and ask her to put it in, she just licks it, it’s almost like she forgot what it is and what it’s used for, it’s hard to accept all this change from a once very independent woman, my mom is so precious to me, it’s tough to handle and watch. I loved the booked the 36 hour day it helped me understand a lot and put me in her perspective of things too.
https://www.nestlenutritionstore.com/benecalorie1.html
thank you for your reply.
I am sooon feeding her slowly, she opens her mouth bc I ask nicely, but it’s like when she takes the first spoonful or two she waits she doesn’t want it, so I try again in a few minutes and get more bites in. She hasn’t spit any food out so far, and swallows after each spoonful. She takes vitamins in liquid form for the past year, so she’s good there. I make smaller more frequent meals with higher calories so as not to have her lose weight, since she’s been thin her whole life, losing weight now would not be a good thing. This is the hardest thing I ever seen, devastating terminal illness and I also took care of my dad a decade ago that pasted away from lung cancer but his mind was all there, Vascular Dementia is another animal. Thanks for your wisdom.
I found that when I puréed food for my husband, it simply didn’t taste as good as the normal meal. Maybe I wasn’t doing it right, but I really struggled to make it tasty. His appetite improved when I bought purées meals from Mom’s Meals online (delicious!).
Also, look at your Mom’s level of activity. Very likely, she doesn’t need as many calories as in the past and therefore isn’t as hungry. How is her quality of life? This also impacts it.
Maybe her taste buds have changed. I heard that it happens as an effect of aging. Food just doesn’t taste as good!
Good luck to you.
thank you fir your reply.
it’s winter here and cold so our daily walks stopped outside she uses a walker/rollator. I used to put her on the treadmill in winter season but her Neuro said to stop that bc she can fall even tho I am there with her guided her, even at a slow pace.
I have been cooking our meals forever so I know what she loves, likes, doesn’t prefer. I purée the meals now bc of her denture issue however they taste as good as my meals but maybe not to her now all of a sudden. It’s just odd to me that it happened practically overnight.
Has she seen a doctor recently, or do you have any medical advice on the status of her life? Was there anything that happened at Christmas that affected her emotionally, or her memory of her earlier life?
thank you for your reply. I have been using a food process to purée her meals these past couple of weeks bc she refuses to put on her denture, I tried once to put it in and she gagged so I won’t be trying that again myself, I ask her everyday to try, it’s a partial denture just the top. I use Thick-It for her water bc she might aspirate however she drinks tea/coffee without it, she sips fine maybe bc they are warm?
Christmas Eve was greet, dentures on, helped herself to tears on the table, even seconds. Then Christmas Day I made a lasagne that she asked me to make but she only ate half (lunch) then a made a baked ham with veggies for dinner again less than normal she ate.
she’s always had a great appetite for a small framed woman, her activity is the same, a bit more agitated however in the afternoon until evening.
Had a virtual appt with her PCP but he said if she doesn’t have a fever, or complaining of pain, it’s not unusual that her appetite is changing at her age and this stage of dementia, and if I’m still worried to make an appointment to come in for blood work, I just may do that, but just the worry with the high Covid spread Dr waiting rooms make me so nervous right now.