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I believe my client is anorexic. She is 88 years old and refuses to eat. She says she doesn't want to get fat. In the last two years she has gone from 98 to 85 pounds. She has gotten so weak she has been hospitalized twice. She only takes in around 600 calories a day and most of them are empty calories. She refuses protein. I am at my wit
s end.
The doctors give her potassium and hemoglobin. But they are not talking to her about the need to eat. Should I be trying to get her counseling or should I just do the best I can? I feel like the people around her just think she is too old to help.

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Thanks Countrymouse for your response. I am a caregiver by occupation. The client I am working for now is not Diabetic that was a different client.
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Your profile says that your client's primary problem is diabetes - is that well-controlled? Are there any other health problems?

I was going to ask about painkillers - Tramadol is the culprit I had in mind which can cause anorexia - but if your client is managing even 600 calories' worth of food daily she's not technically anorexic. Anorexics literally cannot bring themselves to eat: once seen, never forgotten.
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I'm new to this site and have been reading alot of your questions and answers on anorexia,dementia and alziehmer's. I do agree with alot of the answers especially yours..cwill as well as your knowledge on the stages, Although there are techniques that work as well for all of these diagnosis and the difference stages. You will just have to figure out which one works, ex; 1. Do they drink better than they eat. 2. Do they like sweets. 3. Is seeing too much food or things around them overwhelming. I have techniques that have worked for each one of these problems. .if anyone interested . I run a Dining program for clients with these diagnosis ..it's a challenge but very successful with these techniques.
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Cwill
I totally agree! Very true. It's exactly what I have observed with my mom.
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Lots of people lose interest in eating for may different reasons. Some have issues swallowing, some have problems with their teeth or dentures, some may have indigestion or chronic constipation. Medications may decrease the appetite or make things taste funny. As dementia reaches it's later stages some forget how to eat or that they haven't eaten already, some will eat constantly because they forget that they have already eaten. At the end of life eating becomes a burden as digestion and organs shut down. And yes, some have lifelong issues surrounding food and eating. Each problem has its own solutions and needs to be to be dealt with differently.
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My mom has been given a mechanical ground diet and for honey nectar thickened. Mom continues to ask, why am I eating so often. She feels that each time she eats, even if it's two bites, at each meal, she thinks she's getting fat.So therefore, mom doesn't understand that it's two bites and not enough is entering her system, she thinks every time she eats its a full meal . Also, for those that have been writing about anorexia question. has your dr evaluated her for, disphasia, aspiration which deals with difficult swallowing
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Just remember that protein does not have to mean meat, which a lot of older folks have trouble chewing anyway. Look for the Ensure with added protein, include dairy products like greek yogurt and cheese. Egg custards, quiche type meals, bread and rice puddings all contain both eggs and dairy. If she wants to eat a more vegan diet soft tofu can be added to smoothies or made into tasty puddings simply by blending with sweetened fruits. The others have offered some good ideas to get her eating more. Loosing too much weight can have lasting consequences, leading to frailty and loss of mobility.
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Thx for all your suggestions. I have some new things to try. We just got back from the doctor and she said she needed to eat protein. I had her print it out so my client will remember.
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Walkwithsmile: Your client is not anorexic. She is suffering from a rather typical old-age phenomenon: She does not feel the need to eat....very little appetite. How is she receiving the K and Hemoglobin? My suggestion: Spoon feed her. Prepare the food according to nutrition guidelines including the protein, and feed her yourself....just like a baby. Don't let them tell you otherwise.
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It is good to hear that there are people like you that are willing to go the extra mile when professionals basically give up on the elderly.

This is exactly what I have been going through with my grandmother. She has never weighed more than 100 lbs her whole life, has a 24-in waist & thinks she's fat. Everyone tells me to let her eat only what she wants but I am concerned with her getting so much protien in her diet too. This is probably not a probable expectation for you but it literally took me sometimes 5 hours each day for her to eat a small balanced meal with all her restrictions on flavor. They were tiny bites of food & frequent breaks. I fed her first to not let her see how much food I was giving her. I let her finish each meal on her own when I could say "it's only a few more bites!" She is almost 100 yrs old, on no meds & can still walk on her own but she weighs 64 lbs. Her PCP said her body has adapted on so little food her whole life. When she first declined & I took over her care, she gained 30 lbs but she has since lost it & then some. It may be a losing battle.

To help you out, your patient is probably on a drink like Ensure Plus. For a while, my grandmother couldn't stand the tastes of it. Her PCP suggested Carnation Instant Breakfast. I would mix it w/ warm (her preference) vitamin D milk, melted ice cream & add chocolate or caramel syrup. Because I had to go through all that, she drank 16 oz instead of 8. Just like JoAnn29 said about taste buds failing, sweets are what elderly can taste. It's true. My GMA never ate sweets until now. She loves chocolates & wants Godiva or Lindt, not Hershey's. She knows the difference. Can you find foods that your client really likes & really encourage it because it may be all you will be able to get down. I sometimes tell my GMA that she can have all (the sweets she wants) but it is really important to eat other foods if (her goal) is to make it to 100.

I would stay away from protein powders like whey because it is geared towards athletes & individuals that train for high physical activity-it helps with pre-workout & muscle recovery after. I thought the same thing too because I use the product for my training. I was told it will cause dehydration in the elderly because they are not drinking lots of water. Will your client eat yogurt, especially Greek? It is high in protein. Basically, anything promoted as "protein" is junk unless it has at least 10 grams -something to keep in mind. Nut butters (sunflower, almond, cashew & peanut) are a good source of protein along with eggs, cheese, lean chicken, tuna, salmon, halibut, lentils, tofu. You could point out that this is clean eating & not fattening foods.

Since you are around at meal time, it takes positive reinforcement. You may sound like a broken record but something will click & take advantage when you can. Counseling will not help because at 88 years old, your client is set in her ways. You will have the greatest impact because of your role in your client's life. Good Luck!
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Does she have family?
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JoAnn29, I did not know about the brain not telling us when we're hungry. Rose's doctor reminded me of her needing protein, and just offering food. She has one meal a day, and that is because we all sit down for dinner. We don't ask her, we just say Dinner is ready. Come on to the table. When she says she's not hungry, we tell he to come have milk and just visit with us while we eat. Inevitably she eats the food in front of her.

Thanks for asking the question Walksmile. I will try the above suggestions too.
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My daughter is an RN in a nursing facility. She says when we become elderly our brain no longer tells you your hungry or thirsty, add Dementia to that and they don't eat on their own. Taste buds fail so sweet they taste better. They lose muscle mass so lose weight. My Mom tells me I'll make her fat. She maybe gets 1500 cal. a day and weighs less than she had for years. Like the suggestions, try everything. In my opinion, its part of them leaving us. The body just starts to shut down.
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Mom has been borderline anorexic as long as I can remember. Over the years we have pulled her back from malnutrition and dehydration. She barely eats, looks at her plate like it is going to rise up and attack her. She weighs 95 pounds, but she is 100 and healthy as a horse! Somehow she is getting enough nutrition from Ensure, yogurt, and snacks because she is sure not eating meat or vegetables! Denying her the yogurt and snacks, she simply doesn't eat at all, so we have given up and give her something that at least keeps her alive. If you can get Ensure into him, that should help a lot - its sweet and seniors seem to crave more sugar anyway. I know someone who cannot eat any solid food due to a health problem and has lived for 10 years ONLY on Ensure and supplemental vitamins - and lives a pretty normal life.
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Oh gosh....yeah. My dad has always been a bit nutty about weight, but now he is an 82-year-old man who talks like a 15-year-old ballerina. His pants are falling off him and he talks about his "spare tire" and skips meals. The thing is, when you put food in front of him he wolfs it down...he is starving.

I don't know if this is the case with your client, but a lot of times the elderly can't be bothered with making food but they will eat if the things they enjoy are just placed in front of them. I agree with terryjack; find out what foods she enjoys or used to enjoy and just put them in front of her. Don't talk about it a lot just make the food easily available.

A lot of foods have surprising amounts of protein...wheat breads, vegetables, grains...so I wouldn't worry too much about protein specifically as long as she is getting some decent, wholesome foods.
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The doctors must be aware of this based on her weight loss and the fact that she is given hemoglobin & potassium. She may not feel well or it could be a side effect of medications or supplements. It could be an act of passive suicide. Find the kinds of foods she likes and make sure she has them. If she will drink more than she eats, carnation instant breakfast has vitamins and minerals and tastes better than ensure. If she will eat peanut butter, add some and use a blender, you can add yogurt, fruit & even cottage cheese. This will give her some protein which she needs to maintain skin integrity and other functions. I had a client that was anorexic, she was over 80 years old, had medical issues and peanut butter was her staple. She was unhappy, had lost her husband and could no longer care for herself so she entered a nursing home. Counseling may help her to understand her feelings and could make a difference with her eating habits. Maybe it's time for hospice, she needs to explore all of her options.
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My mom is 88 and lives independently. She is also lightweight and also doesn't eat very much protein. In an effort to control high cholesterol, she avoids a lot of meat and eggs. She is also diabetic, so planning her food intake is a problem she'd often rather not deal with. I'm not sure she eats enough, but she keeps up with her doctors' appointments and so I think it's being monitored.

I wonder if your client would allow you to make smoothies for her. You could use protein powder and add berries or other fruits. There are many options if you do an internet search for recipes. That might replace some of the empty calories. She might benefit from some dietary counseling if she's able to understand and follow the guidelines. Psychiatric counseling might help with the dysmorphia, I don't know how it would work with an elder. What do her family members think? Are they concerned? Good luck, I think you are right to be concerned, especially since she has been hospitalized already.
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