I did research this topic and found somethings on it but towards the end of the thread it started going awry so I needed to start a new one because I didn't find anything about the nutrients and benefits of using ensure or some other drink that may help. My DH has lost 4 lbs. in the last 2 weeks and he is still losing. I weigh him on Wednesday nights. He doesn't even have an appetite of any kind that I can tell. Just a few weeks ago he would be hungry for lunch by 11 oclock but now he is not even close to being hungry by 1 oclock. One of the things I learned on the thread I looked up is that dementia makes the brain not able to remember how to process food in the body. I didn't know that. When hospice came to see us the first time they said that I needed to call them if I see that the sides of his face start to look sunken in. I told that to someone that I know and I told her that I haven't seen it yet but she said that she already sees it so...I guess things are going to change again(right on schedule, every 4 to 6 months)
The other thing that the thread mentioned was not putting them on any feeding tube(not being a good idea) I discussed this in simple terms to my husband the other day and he said "No, he doesn't want any means of being kept alive" and I said, "That also means a feeding tube" (I simplified to him what that meant too) He said, "No, he doesn't want a feeding tube." We already have a living will but I just wanted to make sure that is still how he feel(as far as he can at this point understand) I agree with everyone on the thread that this is a very hard thing to watch. He has just started the extreme weight loss but I can already tell that it is going to be a difficult decline to watch.
How do you know that your dh is not hungry? I find that my dh always says he isn't hungry but I still put the food in front of him and he eats with appetite. May they have forgotten what "hungry" really means. Sometimes the doctor will suggest ensure along with food to give extra calories. I am certain the body doesn't utilize the food properly.
You are making good decisions re feeding tube. My dh told me years ago when we did our living wills that he never wanted that so I certainly would follow his wishes. My heart goes out to you as you watch dh decline.
Deb, you are doing what you can do....will he eat if you feed him? I would suggest you try something like Carnation Instant Breakfast....much cheaper than Ensure or Boost and I hear that it tastes better and has the extra calories.
But, that being said he may refuse to eat. That is what happened around here. My husband ate like a champ....of course he had to be fed, but would open up his mouth whenever the spoon came near. Then he just would refuse to open his mouth and he never ate much after that. Not that I didn't offer him anything and everything, but he and his body knew more than I did.
I hope he starts eating and gaining weight.....it is not easy to watch. But, remember....it is what it is.....
My DH eats like a horse and is loosing weight... anyone know what this means...He'd eat 12 times a day if I set it before him...However, I make sure our 3 meals contains what he needs in nutrition.. AND he snacks all day, nab crackers, cookies if I don't hide them, candy, whatever he can find he will eat... I don't notice any change in his looks, stomach still large but he's tall... I hadn't thought to look for his face to look sunk in.... He sleeps ( naps) several times a day and goes to bed about 11PM, gets up at 5:AM... We discussed the feeding tube issue along about the time we made wills and made each other POA... Now, what if he doesn't remember any of that??? I make a point at appropriate times to bring the subject back up... Still don't know if he remembers....The POA will take care of that, I suppose.. So much to take care and plan for..
My husband was in the hospital and lost 25 pounds. He is 6foot 4 and went down to 153 pounds. This was in March and the previous September, he had been 192. On the advice of a couple of dieticians, I came up with a plan. I put skim milk powder in any food I could ,to add protein. I bought high calorie powder from Sick Kid's Hospital and put it in what I could. I give him pasta every lunch and ice cream by the ton. When we went to the doctor for a followup visit, he had gained 12 pounds back. The doctor was very impressed and said that he had not expected a good outcome.
I was warned to look for dents in the temples and just above the armpits. That apparently indicates malnutrition.
My wife still has a decent appetite although eating the food is becoming difficult. Any sandwich, hotdog, sparerib, taco, pizza, anything she has to pick up and bite into she can't deal with. Bite size everything. Bowls not plates because she will push the food off. I bought 10 inch simple bowls that can take a quart of volume. Nothing slides out and the sides angling make it easier to shove stuff on the fork or spoon.
I put out grapes, raspberrys, blueberries, and strawberries into a bowl and leave it on the counter. It is always empty within a few hours. That's in addition to meals. I peel a banana for her every day along with a small yogurt.
I leave out mixed nuts and she helps herself. Glasses of water on the counter (I have to turn all taps off) and pie and icecream for dessert 3 nights a week. Also lots of chocolate. I buy her candy bars as well and leave oatmeal cookies and chocolate chip cookies out where she can see them. She won't do anything else but she will snack on all that stuff as she feels like.
The only thing she wears is stretch pants where they make good looking jeans like that so that her waistline can move around a bit without discomfort. She sleeps in her clothes. I was advised months ago to let that go because I have too much to deal with already. Right there a small chunk of my frustraton sailed out the window.
The best advice I got was not to feel guilty. If I don't feel like cooking because I've had it, I have tins of salmon and cans of decent soup or I will make peanut butter/jam sandwiches or pop in a couple of chicken pies or chicken strips I always have around. We eat anywhere between 5 and 10pm depending on what I feel like. If she says she's hungry I cook earlier. She never does.
I keep all bread in the freezer. Bread handles that well for several weeks. The toaster is set so that a double pop will bring it up brown but not burnt the way she likes it and that way I can get some fibre rich bread and some raisin bread and just plain french/italian breads - from seeds, through fibre, sweet, and plain whatever works. I pile on the peanut butter (reduced icing sugar but your choice) and pile on the jam (reduced pectin/sugar).
I also freeze the bacon. I split a pound out into 3 portions, fry one up and freeze the other two. If I put the frozen bacon and frozen bread out on the counter by the time I've brewed and had my coffee both are defrosted enough to work with or I take a cleaver and make a western or omelet from frozen.
I retired 8 years ago when I was 53 and since then I have done all the cooking. Tonight I did back ribs in the oven. She can't deal with them but sometimes it's about me. I finish them a bit earlier and let them cool so I can slice her's off the bone with a knife. I snack on three or four while I wait because I like them hot.
Everything is a compromise between me and her which I decide because we're late stage 6. The operative is me and the function is to compromise between good nutrition, what I want to eat, and what I feel like doing that day.
My geriatric specialist agrees it's working. I don't need ensure yet. I just need to get calories into her and with the lack of physical activity we don't need the 2000 plus a day that normally active people do.
When she goes further we're going to morph towards purees, shakes, and soups. People ask what they can do for you? Make a nutrious soup, put it into containers, freeze it, and bring it over.
I get chili, soup, and some stews that way. Not often but everything helps. All previous structure is gone. All the out of box thinking around this topic has helped me no end.
Thank you everyone so much! shirley, I think it is very possible that they forget what hungry is but the difference with my DH is that even when I put the food in front of him he doesn't change his mind just because the food is in front of him. Sandi, Carnation Instant Breakfast is a really good idea I never thought of that and I know for myself that it does taste better than ensure. peggy, not my DH but I know someone else that fluctuates a lot in his weight from day to day and they are trying to find out why. He is on 23 different pills a day so it could be the interactions with the medication he is on but anyway I digress. My DH use to snack ALL the time and now that is even cut down to almost nothing. That is why I think he is just not hungry. It is really hard to see him losing weight so quickly. I knew that it would happen but actually seeing it happen and knowing it is going to happen are two different things. jang, thanks for the info about the dimples and the armpits. He already has the dents above the armpits. I was also told by someone else that dealt with hospice that the big belly but losing weight is a sign of malnutrition. But like was Sandi said earlier...it is what it is. We can only do the best we can, I am not going to force him to eat and I don't even thinnk I could if I wanted to. Wolf, I love all your suggestions, I think some day you are going to make someone a good wife...husband! LOL ;-)
My husband was still eating well, mostly by himself, when he went into the nursing home after breaking a hip. Over the past year he was bedridden and gobbling food. About a week before he died he stopped eating, just like that, shutting his mouth tight when anyone tried to feed him, even yogurt or ice cream. He then had a stroke and died within 24hours. His cheekbones were sunken in. He couldn't have been showing malnourishment after just those few days of not eating. The hospice nurse said it was just the disease progression. The NH asked me to reaffirm no feeding tube. I did.
Hi Deb, as you know from the other posts this is something we have been battling for several years now.
You said, " I knew that it would happen but actually seeing it happen and knowing it is going to happen are two different things." Indeed!!
I wont go into our struggle because it is just to painful for me to revisit, but I can offer what we use for the "nutrient drinks"
Lynn gets the standard boost daily, but he also gets TwoCal HN (twice daily) and Mighty Shakes (with every meal) He LOVES Mighty Shakes! I have tasted them and they are better tasting than any of the others IMHO
Here are a couple of links if you are interested....
Thanks Nikki, I will look at them. Last night a friend of mine told me that the qualifier for hospice and weight loss is 10 percent of their body weight, which for my DH would between 18 and 20 lbs. Has anyone else heard this?
Unintentional weight loss is a common and complicated problem. The things that cause it is very very long. Generally, I divide it into 5 categories when someone comes to my office with this problem: Depression, progressive dementia, uncontrolled chronic medical problems, cancer, social issues. Under dementia, there are a bunch of reasons: forgetting to eat, forgetting how to eat (how to swallow/chew), dysphagia (disorder of the swallowing muscles), apathy, behavioral/psych issues. If it is a problem of forgetting how to swallow, sometimes varying the taste (salty, sweet, spice), texture, and temperature (cold and hot) of foods can make a difference (the 3 T's). It triggers different sensory areas in the brain. I often blame medications (dry mouth, nausea, gastritis, constipation, sedation etc). Keep teeth clean as much as possible (a sore tooth will keep someone from eating)
Patients may not be hungry and eat out of habit. They may not feel any pain when not eating (unlike me). I liken it to morning sickness. Just no appetite. Generally, it is not as uncomfortable as people think (my cousin who was 35 and passed away last year said he wasn't hungry and felt fine even the day he died).
One thing patients do complain about is feeling thirsty but the good thing is that keeping the mouth moist takes care of that really really well.
See my last post on hospice but Stage 7A dementia with 10% weight loss is a guideline recommendation for qualifying for hospice. http://www.eperc.mcw.edu/fastfact/ff_150.htm