Mum seems anorexic. She is eating less than a bird, thinks she is fat and likes her new "slim" (scrawny starving) body. Any advice?

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Mum always struggled with her weight but now she is 90 years old, with Alzheimers and in a NH. She has lost a huge amount of weight and is down to 90lbs. She is starving herself and eating less than a bird but says she eats as much as she wants and what she enjoys. Her body image does not match reality and both staff and family are really worried. She is on various meds already for ALZ and depression. We are at a loss as to how to treat what seems like anorexia given her mental state and age.

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The doctor gave my mother Mirtrazapine - the side effect is that it makes people want to eat. It's working to keep her at the same weight, but she had already lost about thirty pounds. Be prepared though - it seems to make them want to eat sweets and carbs.
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Weight loss is very common at the end of life from many causes.
Swallowing difficulty, lack of exercise, poorly fitting dentures, loss of taste, being presented with unappetizing food and many other things contribute.
In one's nineties is not the time to introduce a healthy diet and more exercise. Give the poor lady anything she wants to eat. Ice-cream for breakfast is fine if she asks for that. There ar lots of protein powders which are tasteless and can be mixed with everything.
Naturally moving around is good for everyone but try and encorporate it rather than doing "exercises". To me there is nothing sadder than watching a group of elders , wheelchairs in a circle struggling to raise their poor old arms. A walk by the river with bread to feed the ducks would be more to my liking or being allowed to roam around a craft store for an hour. i even enjoy volunteering to do the shopping at Walmart because I can cruise around in one of their electric carts and look at everything not just buy groceries. I do get exercise because i have to get in and out of the cart to reach things on high shelves and lift my groceries out of the basket at checkout.
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I remember when my Mom started to lose weight, she was in her 90's age wise. It is my understanding that once someone gets up in age that they lose their sense of taste, so food doesn't taste as good. I am finding that for myself.

My parents' grocery list had some healthy food, but most was pies, cakes, Little Debbie Cupcakes, cookies, lots of ice cream, etc. Items with a lot of sugar as one usually could still taste sugar. You would think with all those sweets that my Mom would put on weight, but she didn't. I didn't say anything to her about the sweets as she had reached her late 90's, she must have been doing something right :)

Then the lack of exercise. My parents use to walk 2 miles per day, rain or shine even in their 80's and early 90's. Once they couldn't do that anymore, Mom started her weight lost. Dad also was losing weight but it wasn't that noticeable.
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Hello. Yes, at that age especially, or any age when there is a progressed disease process, appetite is low as people move towards their end of life- its a normal thing, however. It does sound like there is a psychological component here as well so a professional consult would be good to ascertain is it biology, psychology, or a mixture of both. Given her age and history you've given us, probably both I'd suggest. If you have sustagen or proform in your country may be this would be something she could have to get the calories and nutrition in.
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My mother never ate well from the time she went into the NH. Sometimes I didn’t blame her. Some of their meals were pretty awful. I began bringing her cheeseburgers, which she loved, when I visited.

I’ve mentioned before that her dementia led Mom to believe that she was a famous stage actress. She had a red jacket that she told me once was a cape from one of her performances on a New York stage. Of course, actresses had to be thin as a rail which meant not eating much. Since my mom wasn’t active, she burned few calories and her weight didn’t plummet. Make sure she has plenty of the snacks she loved; my mom loved those packaged cheese crackers, candy bars and chips. I always made sure she had a plentiful supply.
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Just my nonmedical observations...body dysmorphia is I believe a mental disorder which causes people to misperceive parts of their body, such as being overweight, and can lead to anorexia.

I think that women who want enhanced mammillary attributes can fall prey to plastic surgery to enhance their appeal, believing that basketball sized breasts make them more appealing. People who over do sun tanning and end up looking like glazed pork chops can also fall prey to this phenomenon.

My first thought was that your mother has been overweight all her life, she's older now and going through what I think a lot of people face as they age - losing control, not only of their bodies, but their whole life.

I've always thought anorexia in part reflected an excessive need to control someone's life. Perhaps, in conjunction with dementia, this control is being manifested in restriction of food to maintain the "ideal" body weight.

I think I'd try to find a really good doctor who treats these dysmorphic disorders and consider switching to meds he recommends. You might also ask what behavior modification can do to assure her that she's already thin, is a good person, a good parent, and try to shift her focus to something besides weight.

But I do think this is an issue for a psychological consult; I don't pretend to have any suggestions for erroneous perceptions of bodily images, and it's an unsettling topic because of how people can be driven to extremes that result in life threatening conditions.

I've read that this can affect female ballet dancers. Gelsey Kirkland wrote a book on her battles with bodily perception. Yet somehow she and others still were able to function in a physically demanding profession, although I recall reading in her book that sometimes she was too weak to dance.

I think in these crazy times we live in that people can easily feel adrift, unsettled personally as well as politically, and that sometimes these disorders can lead to a misperception of being control (of one's body) as opposed to outside forces well beyond the control of anyone.
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Has she had a check up recently? My grandmother was the same - only she felt full. She had a stomach tumor. Otherwise - trying supplements like high calorie shakes maybe? Good luck with your mom - i know you are worried.
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There is a sweet lady who sits at the same table as my mom and she always compliments the food but barely eats more than a mouthful, and most of that just dessert. From what I've observed staff may verbally encourage her to eat more but then just shrug their shoulders when she doesn't.

Are they willing to work with you to offer more of the foods your mom actually does eat, and to make these things available throughout the day?
Can you ask them to fortify her meals with more calorie dense options - full fat yogurt, butter on her veggies, hot chocolate vs coffee, that kind of thing?
What about supplements like boost?
Or appetite stimulating medications?
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Is her doctor familiar with treating Alzheimer's patients? What about the NH she is in? I'd think they encounter this issue a lot. Have they mentioned Hospice? From what I have read, the stages of dementia include the body shutting down and not being able to handle food, as the dementia progresses. And even if the person eats food, they may not be able to digest it.

I hope you'll get some more responses from those who have actually dealt with this first hand. I hope you can find some answers and support for your mother.
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