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She's still very sharp--only a little memory loss (remembering words for things--she works crossword puzzles!), and she's competent to use the bathroom. But she hates the damned bag and is depressed by it. She's sarcastic and witty and so damned funny, but I worry so much about her!


She's always been tiny, and not much of an eater. I'm currently going broke (well, not really, but it's expensive) trying to supply her with Glucerna and Ensure Hi-Protein drinks which she loves (she must drink six a day).


I make her breakfast (instant Cream O' Wheat--maple flavored, yogurt, apple sauce or diced peaches, and a half a banana) and dinner (often a "Lean Cuisine" or other frozen entree, half a banana and bread or crackers). She makes her own lunch which she writes down for me: little bits of Spam, crackers, yogurt, and a half a banana.


Her ostomy nurse (who we saw once) said she can now eat anything--even though she has a short history of high blood pressure--I guess because she can't absorb as much now.


Mom also has "urge incontenence" which also dehydrates her. I make sure she has a steady supply of water available and she knows the symptoms of dehydration.


Anyway, she started out eating most of what I gave her, but lately she just doesn't get hungry. She says she gets hungry when the food is in front of her and when she takes her first bite. But she only eats about a third of it all now.


Am I doing something wrong? Bringing her too much/wrong food? I've read everything I can find on diet for ostomy patients (there isn't anything specific for tiny, aged ostomy patients). Maybe she just doesn't need as much as I give her? She's never been a big eater.


Any advice would be welcome.


Thanks.

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People with ileostomies require special diets - as someone stated above. The biggest issue with ileostomy management is keeping the person hydrated. As long as you have that down and as you said you are giving her 6 ensure/glycerna a day continue that and back it up with plenty of fluids. She should not have seeds or high fiber,as stated above. And really vegetables are great but don 't provide a lot of carb or proteins that she needs to keep up to prevent muscle loss.
The caregiver sounds like she knows what the person needs just has seen a decrease in appetite.
Protein sources - maybe chicken salad, turkey bits, hamburger meat, meatloaf...she needs a special RD. Contact her ostomy nurse and ask her to connect you with a nutritionist for a review. I commend you for taking such good care of her, and she sounds like a wonderful mom. Good luck!
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continued from above....she eats 1/2 to 1/3 of her meals for lunch or dinner, has a snack in between when she is hungry. occasionally has a desert. If you are in doubt have a full blood screen. This will tell you if she is anemic, pre or diabetic, high cholestreal, etc. Mother is 99 1/2 years old. This should be at least 2 x a year. Fluids are very important too. Ask the Dr. what he recommends. Around 32 oz is usually good, 28 oz is ok for my Mom. Check with the Dr.
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How is her weight? If her weight is ok and she hasn't dropped too much, she may be getting enough food. My Mom is tiny. She has weighed the same since high school and hardly varies but for a few ponds, Mom eats eggs and toast w butter and jelly for lunch with coffee and OJ.
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I just read an article concerning insure. Not good. I would ask her doctor if six a day is too much. You can get too many vitamins and protein. My daughter can't drink these drinks because of the thickening agent that is used in them. Does a real number on her, if u know what I mean.
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Had the same issue with my mom. She was prescribed medication and helped with appetite a lot.. Couldn't get her to stop eating. I would speak to her physician and see about getting medication for her appetite.
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Agree with person who suggested consulting a dietician or nutritionist. That said, if she is not restricted from eating anything, consider some other factors. My father has a much better appetite with a dinner companion than if his food is prepared by someone who isn't eating with him. He has dementia and now likes food a kid might like. He's also a nibbler, so we keep several healthy things around in small packages that he can forage (nuts, for example). When his mother was at that stage without hunger, she did well with a McDonald's shake and M&Ms. His sister liked cheese and crackers. My mother gave up bread and would eat 4 triscuits with ham/cheese.
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Seek out a geriatric doctor for her.
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Keep in mind, at 90, her caloric intake doesn't need to be what is was years ago. Quality of food and nutrition are more important. It sounds like you are both doing very well. I am in a similar circumstance, my mom is 89 and physically doing very well. However, she has dementia but so long as I keep her engaged in some busy physical activity, she is doing OK.
I think you can make your own protein drinks which she will like. There are so many ideas and recipes online and if you need to "fool" her, you can save one of the cans she likes and fill it with your own concoction. I have done some research on these supplemental drinks available, such as Ensure, and have learned that they have too much sugar and unnecessary additives. But, all things considered, she is 90 after all and you are doing buyout very best to take care of her. People always tell me I have earned my angel wings. I'm sure you have too!
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Be aware that an ileostomy diet excludes all seeds/skins/high fiber fruits and vegetables ( ie tomato skins apple skins, cabbage and on and on)
There are 2 issues here. One is the lack of appetite and one is the need for a diet compatible for an ileostomy .
My personal dislike of the ensure-like products is mainly because they market to the idea that this will "ensure" health and so on. To me you are just as well off with some water corn syrup, and a vitamin pill mushed up . One can get this nutrition from ice cream and a vitamin, which might not be a bad idea.
The first thing is to make a list of the allowed foods for an ileostomy diet. ( which you may have already done). The next is to make them as palatable as possible and use the power of added ingredients to enrich the nutrition. You can add rice cereal to scrambled eggs, or dried milk powder to anything you blend. These will add nutrition. No chia seeds, nuts or high fiber foods. She cannot digest them. There are liquid vitamins to add if you would like.
Yes, my 90 year old parents' appetite has decreased dramatically over the years. My father who never ate sweets, now does. My mother who was always a tad overweight , now isn't . I know my mom will not eat unless food is put in front of her or I remind her. Peanut butter is her go to easy to eat thing. Peanut (smooth)butter and banana sandwiches are good, and usually can be followed by lots of liquid to "wash it down" . Gelatins and ice pops are nice alternatives for hydration when that glass of water or whatever juice isn't hitting the spot. Yogurt is a great choice for in between snacks. Also it is more advantageous to have 6 small meals a day than trying to get all one's nutrition in 3 larger meals. There is nothing wrong with it and it maintains the body's constant energy level. And if she " grazes " all day that's ok too.

Manufacturers add salt to their frozen foods for shelf life longevity and palatability. When sugar is removed from a product the food manufacturers add fats. When fat is removed from a product, they add sugars. These products are not necessarily " nutrition friendly". But on the other hand they may be calorically helpful.
Exercise of any kind- including gentle chair exercise ( tape or CD is fine) or a neighborhood class at the library or local "Y" increases appetite and if she goes out, she can meet new acquaintances .
A registered dietician who specializes in ostomy diets is a resource. But like with any other care giver it is the particular person doing the advising that makes the difference. A degree doesn't bestow caring or personality on the professional. Find someone who will be " a partner " with your mother in her quest for health. There are medications that increase appetite that you can discuss with your Mom's gastroenterologist as well.
I understand your concern totally. I hope some of these suggestions are helpful and help her to have a sense of humor about the absurdity of what our bodies do to us as we age .Sometimes all we can do is laugh at the ridiculousness of the things that happen to us, that we were never prepared for, nor had anything to do in causing them. ( Because crying is exhausting)
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@RayLinStephens--You mentioned V8 Juice and then made a comment about watching sodium, so I wondered if you are using the reduced sodium V8 Juice (which still has plenty but less than the "original" type). For some reason unknown to me, food manufacturers (at least in the US) tend to load any processed food with exorbitant quantities of salt (and often sugar as well).
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Hi RayLinStephens, the time lag of the postings may have confused the interpretation of my response to the gLucerne and ensures, etc. they are the ones with water and sugars first. The link I posted first takes you to their listed ingredients {this is not the Greens First link}. (Though it doesn't apply here, the same is true about infant formulas - most have corn syrup first) . Hydration is so important, that is why water is probably the first ingredient in the Ensure type supplements. However, I believe we are making a poor assumption to think one can thrive on sugars. Reduced appetite may be mixed up in a cycle of our bodies not agreeing with so much sugar to process AND medications often interfere with our lack of wanting to eat with their side-affects. A Geriatrician looks at a much broader picture to help balance all the associated issues that come with comorbidities, meds, diet, age, etc.

...and Greens First does sound potentially helpful, I haven't seen that product yet as I hadn't heard of it until this conversation.

I'm careing for my mom. This job is so difficult but I'm grateful we have this extended time together. I'm sorry about those that are taking care of their spouses. I can only imagine the heart break in saying goodbye. May God bless all of us as we try to do our best for our loved ones.
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Not all supplements are garbage.

And with little to no appetite, as good as fresh is - it won't work for the lack of being able to consume enough to make a difference.

I'm living with this right now and have heard your arguments - mostly from people who are not dealing with the underlying problem - no appetite.

How much nutrition do you think you can get from 1/8 cup vegetables? This is equivalent to 1 coffee scoop. And you're wrong about Greens First being all water & sugar. Check your information again please.

I do agree about asking a professional.  Unfortunately, dieticians mostly do not deal with this - better to inquire with HomeHealthCare or your personal physician.

P.S.  Any and all seeds can create problems for seniors due to diverticulosis/diverticulitis.
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If you go to this link https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/Therapeutic.pdf you can see that the first ingredient in ALL these meal substitutes {glucerna and ensure type drinks} is water followed by sugars, then the real nutrition begins. Sugar , like drinking soda , is an enemy to our well being. Combine that with a diet high in fat and salt but lacking in fresh vegetables and fruits, healthy proteins and high fiber carbs, one will have a continuous decline in health. Shakes/smoothies made of the fresh alternatives would allow your mom to get better nutrition even as her appetite naturally decreases RATHER than the EMPTY calories from sugar. The personal Ninja type blenders make it easy to enjoy things like potential blood pressure reducing almond milk, proteins, etc. Seeking the expert knowledge of a dietitian that leans towards the Mediterranean and or the Heart Healthy diets is well advised. BTW the Caregiver also benefits when they join their loved one for meals and eat whole and healthy foods similar to mom. Breaking "bread" together is a gift for the time you have left together. Take care of you both.

Chia seeds are amazing if you are interested in stirring up some NEW fun. Try adding a quarter teaspoon to a bottle of water. After they swell they will look like tadpoles. They are high in omega-3 , a good fat , and antioxidants. We live in Florida and have to keep working at hydrating. As you know hydration is very important in the elderly too. Improper hydration sets off complications to health. UTIs, etc.

After saying all the above, please consult with a medical professional such as a Geriatrician, they are a wonderful resource to balance the problems that are a natural process of aging.
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My Ray is 95 and the appetite does wane with age. His DIL sent him a 'care package' full of supplements; not pills, powders. These can be looked up: Greens First, TigerNut Smoothie, and I have added Barlean's Chocolate Greens.

When Ray was sent home to die Christmas 2015, he wanted Hot Cocoa every morning.  I add a spoonful of Barlean's Chocolate Silk to it.  The recipe I use is one Strawberry Ensure, 1 tsp cocoa mix, 1 tsp Barlean's Chocolate, 1 tsp Chocolate TigerNut and ice cream.  I heat the Ensure in the microwave but place the powders into his mug.  It's better to use some boiling water just to dissolve the powders.  The idea is to incorporate as much nutrition into as small a package as possible.  He likes the ice cream added just before I serve.  This is a complete breakfast for him.

What the supplements do is add needed vegetable & fruit supplements to whatever Ray will eat which is pretty much 'noodles' as they are soft enough for him to swallow (my Ray has Dysphagia).

The TigerNut is supposed to add Prebiotics & Probiotics as well as Protein & Fiber. Chocolate is the most popular flavor but I prefer the TigerNut Original. Nice neutral color and I can add a spoonful to his gravy.

And I prefer the Berry choices on the Greens only due to the color. Most of the Greens Supplements are - green. This is not palatable looking at all. The Greens First Berry (and Barlean's Strawberry-Kiwi) are more a Beet Red color and will incorporate into a nicer color. I can add either to his Strawberry Ensure with him being none the wiser.

I've only been doing this for a month - but he is showing a lot of improvement and is even asking for meals now. I make him shakes to drink during the day and evening using Orgain Organic Shakes and/or Ensure Plus mixed with V8 Smoothies! He loves them. Just remember to watch the sodium.

You can find BlenderBottles online at Walmart for under $10 and they work like a charm! So much easier than a blender or mixer. Average price was about $6.50. You can even incorporate ice cream using a BlenderBottle.
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It's not often you'll hear me say this, but it does sound as if a dietitian might be the right type of professional to consult.
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well my mom is 81 well she had a bad time in december for a week ..did not eat much of anything ..so after that sometime when she came out of it she had to go her Dr. so it was in jan when she went ..they weighed her she was at 140 so maybe a month in a 1/2 she went back she weighed 149 ..for the most part well all i got to cook for her .she had about 3or 4 slices of bacon for breakfast then she would snake on russell stover candy ( i am jealous cause im diabetic ) so at supper we have mash potatoes & either fried pork chop or chicken breast meat from walmart ...so watch the weight go with that ..but id say try to give her what she really likes ..& maybe she will pig out on it ..ask her why does she not eat a lot my mom dont .my favorite is spaghetti .. so try that if she has good weight go with that ..good luck
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You can always try to balance the shakes and food meaning offer food before the shakes are offered but it sounds like she is getting to choose what she eats which is fine. They do get their nutrition from those shakes and can stay full on them. My mom lived off them for almost 3 years before cancer finally took her life. She was adding ice cream to them. Occasionally she would eat a pureed soup but just loved the shakes more.

If you really are worried about food and are with her, with my grandma I spoon feed her the first bite sometimes just putting it on her lower lip so she can taste it. Often times as long as it's something she loves, she will eat it right up.

Just be patient and understanding and be glad she is at least drinking even if she's not eating as much as you would like. She's been through a lot and seems to be doing great so just keep encouraging her and try not to get too bothered by the shakes rather than food. If she likes the shakes due to the fact she doesn't have to eat, you can always chop up the food really small or puree it so the food is easier to eat.
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It sounds as though Mom is getting plenty of nutrition with the high protein drinks. She is doing very little so does not need the calories? Is she loosing weight? Keep an eye on that but don't make it a big deal.
If she will only eat a this of what you provide only give her that sized portion and put it on a smaller plate. She can always have more if she wants.
It is amazing that someone of her age survived an illiostomy and I am sure she does hate it, nothing unusual about that.
Overall it sounds she is doing extremely well for her age. If I live to be that old I hope I can do as much as Mom, she really is amazing.
Towards the end of life everyone begins to slow down and the need for food diminishes. Stop worrying you are doing a fantastic job. keep up the good work.
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