Anyone handle anorexia in the elderly?

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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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