Question

I would welcome any feedback!!! My mother was diagnosed with Alzheimer's about a year ago. She recently within the last 8 months has been losing weight.

The doctor wants to insert a feeding tube to supplement the food that she eats orally. She is still mobile and can recognize people. Alot of time she said that she is not hungry. She did have thyroid problems and she is taking levolyx for her thyroid. I asked the doctor is it possible that her thyroid is causing problems. The doctor indicated that her thyroid is fine. Has anyone experienced this type of situation before? If so, what did you do to address this situation?
 

Answer

We can appreciate your concerns, as having a loved one suffering Alzheimer's disease with all the accompanying problems can be quite devastating. Your mother's doctor has suggested a feeding tube, but as your mother has only been diagnosed a year ago, perhaps just knowing that weight loss with Alzheimer's is common, and being offered some constructive advice on dealing with your problem, the insertion of a feeding tube may be able to be averted.
 

A number of studies have consistently observed weight loss in patients with dementia, and in particular, Alzheimer's disease. This weight loss increases the risk of infections, skin ulcers, and consequently decreases quality of life in Alzheimer's patients. The cause is mainly related in part to reduced functional capacity in Alzheimer's patients, but other hypotheses hold that neuro-endocrine or metabolic factors are implicated. One study has even correlated the burden the disease places on the caregiver with the degree of weight loss in the Alzheimer's patient. This implies that supportive measures aimed at relieving caregivers' stress may indirectly impact patient's nutritional status. The link below "Help for Caregivers" will help you, as it is so important that, as well as care for the patient, care and support for the carer is vital.. When you open it scroll down to "The personal and emotional stress of care giving and looking after yourself" and click it open.
 

Feeding someone with Alzheimer's is indeed a challenge and there is no one answer. Some strategies that often work are - Limit noise and distractions while eating - Have someone dine with the person to "model" eating - Only provide one type of food at a time if the person is overwhelmed by choice- Provide verbal prompting for eating, chewing and swallowing as necessary - Offer high calorie nutrient-dense snacks if weight loss is occurring - Monitor weight and food intake on a regular basis to ensure nutritional adequacy - Seek assistance of a Registered Dietician to develop a nutritional care plan if nutrition is not adequate. It is important to allow a person with Alzheimer's Disease some sense of control. Being able to save face is important even in a person who is very confused. However, some eating problems are caused by factors that can be changed. So the first step is to figure out what exactly is causing the problem. An example is ill-fitting dentures. As a denture wearer ages, the fit of his or her false teeth tends to loosen. This can cause pinching or rubbing that can make eating painful. Make sure dentures fit properly, and regularly check your loved one's mouth for sores.
 

If you're having a hard time getting your loved one to eat enough, you might try to take advantage of the fact that many people with Alzheimer's disease are most alert and hungry in the morning. You may want to offer more food at breakfast time or even serve your loved one several breakfasts, each featuring just one food item. The first breakfast could be a glass of juice, the next one could be eggs, and the next one could be toast or cereal. You could try adding high-calorie snacks, such as protein milk shakes. Other helpful tips are:1) Mark plates and utensils so it is clear that they belong to your loved one. 2) Locate a comfortable place to eat. 3) Do not allow your loved one to eat alone. 4) Encourage healthy snacking. 5) Enhance foods with spices. 6) Control intake of snacks. 7) Assist with handling of utensils. 8) Helping differentiate between food and non-foods. 9) Dealing with hidden foods:10) Encourage adequate fluid intake For more involved advice regarding these tips offered, please see the provided links below.
 

There are many different stages of Alzheimer's so this information on tube feeding will perhaps be of more importance later on in your mother's disease. This is an excerpt from our article below "Is tube feeding the way to go?" - "The use of tube feeding for older adults with terminal illness is growing rapidly. There are several methods, but the one most commonly used today is percutaneous endoscopic gastrostomy (PEG). Unfortunately, there is very little evidence so far to show that it's use leads to improvement in the nutritional and general health status of patients, or in their 'quality-of-life'. Spouses, close relatives and caregivers of old people with terminal illnesses really need this sort of information, to help them handle difficult questions about what is best for their loved one. "Your loved one has a fatal illness, and is not getting enough nourishment. Should we start tube feeding?" This may come from a health professional, or well-meaning friends and relatives. Often, it's the patient's close family that suggests the tube is put in. The second question comes later: "Your loved one is clearly not getting better, in fact he/she is probably experiencing severe discomfort that we can't control. Should we stop the tube feeding?" - There seems little justification for the increased widespread use of percutaneous endoscopic gastrostomy (PEG) in seriously ill older people. An editorial accompanying the article from Indiana advises physicians on how to respond when asked about tube feeding: "We do not have any information that makes us think your loved one will live longer or be more comfortable or functional if we do this procedure. We do know that if PEG is placed, there is a very high chance that he/she will die soon." Until better results are reported, this advice seems appropriate". See the link below for further reading.
 

Related Links
Tips on Eating (Early and Middle Stages of Dementia)
Tips for making mealtimes easier
Getting Alzheimer's patients to eat
Managing the Nutrition Needs
Is tube feeding the way to go?
Help for Caregivers