What can be done regarding refusal to eat anything?

When my DHAunt, 97 with dementia, went into the NH she wore a size XL pj. Now she wears a medium. She is less than 5’ and went from 140 lbs to 110.
She got sick about a year ago and was really losing fast. She had a speech study to make sure she was okay for swallowing. Had speech therapy. Is on an appetite stimulate, actually on her second one as the first one didn’t seem to be working. She needed to be hand fed for a few months and still requires a good deal of extra attention with her meals. She is on a protein drink along with her three meals. She is weighed weekly.
When I visited her this week she was eating chocolate pudding with her mashed potato’s and enjoying it.
She also does better on an antidepressant.

It is hard to know if you are doing anyone a favor to encourage them to eat if they are near the end of life and have no quality of life.

My goal is to make sure aunt is not neglected in any way that I can help. She clearly enjoys her food now so I’m glad we made the effort to get her back on track though it takes a good deal of effort to keep her at the 110.
She is certainly not worried about it. Once, when told she lost 10 lbs she said “good”.

Thanks to all for your input. Swallow test is scheduled some time this week. We shall see. Never considered this fatal aspect of her condition. We learn as we go.

I think it may be time for hospice/palliative care. Some old_old people in poor health with no (or very low) quality of life may do their own "unofficial" version of VSED (Voluntarily Stopping Eating & Drinking) as EOL approaches. As I understand it, VSED can be a relatively less difficult way to make a Final Exit, but adequate medical support for symptom relief is needed in most cases.

Do you think this may be a ‘game’ to say ‘you can’t keep me here in prison, I have to go ‘home’ and you have to care for me there’?

"She complains about the smell of the food and that she can not swallow."
Is the staff aware she can no longer swallow? If so, has a swallow test been done? A person who can't swallow should not be forced to eat or drink, it could be aspirated and cause pneumonia.

If a test has not been done, it should be. But usually when a person can't swallow it means end of life. First thing is the ability to swallow is gone, then the body shuts down. At this point a feeding tube maybe recommended but I personally would not have it inserted. Not on a person who has Dementia and 84 yrs old. I found the Nurses can't suggest Hospice, the doctor does. Butu can request it.

My Mom shut her eyes and would not get out of bed 2 weeks before she passed. I was called and told she could no longer swallow. They were willing to give her the test, I said no call in Hospice. No more poking and prodding. Mom passed a week later.

Yes, I recommend palliative and hospice care be brought in. You are likely looking at the end stage which is when this happens. You will be discussing with the MD now, if you are the POA, choices going forward which will include forced feeding through peg or NG or allowing nature to take its course in providing a choice to eat of not. Also a swallow eval is required now to know if the swallow reflex is intact; it likely is, as with food no longer appetizing by look or by odor, this is likely a brain change.

Only the MD responsible for an individual can guide you now.
It is a merciful end to stop eating and drinking and in fact VSED (vountary stopping eating and drinking) is a choice for those who wish to do a final exit on their own terms; legal in almost all the states). She will be medicated with hospice so that those few days where organs shut-down caused restlessness and confusion, before coma, at medicated so that there is no discomfort.

I am sorry. I think this is end stage from all you say, but as I said, only the medical team can guide you now.

Let's assume mom does not have a swallow issue. If she does, that's a horse of another color and end of life is approaching.

Without a swallow issue at play, and being obese ( you don't say HOW obese?), your mother can live off of her own fat for quite some time as long as she drinks some fluids. She may be repulsed enough by the non-junk food she's being served in LTC that she's flat out refusing to eat. It happens with very heavy people who are used to eating pizza and chips and donuts etc. They are repulsed by regular foods they do not normally eat, especially veggies, and cannot bring themselves to eat it. Throw in dementia and there is no logic to help them understand the consequences of their own actions. The stubborn factor takes their behavior over the top.

If I were you, I'd bring in one of moms favorite foods like pizza and see what happens. If she wolfs it down, you have your answer.

Wishing you the best of luck with a difficult situation.

I haven't read all the posts.

If you were to bring in some of your cooking, will she eat it?

Smell and hunger are related. If the food doesn't smell acceptable, the tongue won't like it. Pureed foods have nearly no flavor, especially to someone who has their tastebuds.

My Mom wasn't super keen on the food at the MC. However, I used to augment her diet by the fruit/food that I brought in. She would chow down on my stuff and barely eat the food at MC. It could have been due to the fact that they gave her a "soft chopped" diet, which is a texture similar to oatmeal all the time. Not only that, in order to get the food that way, the food is overcooked, pulverized, and rendered nearly tasteless (my Mom didn't do gravy). Then you have the issue of low salt diet, etc. I used to take my Mom out and she could eat the large chunks easily. They just didn't want to have to cut up the pieces of meat for her or risk her choking.

We also gave her a daily vitamin to make up for the tasteless stuff that she didn't eat. I was perfectly fine if all she ate was the muffin or cookie at MC. At some stage of life, any food, good or bad, is better than no food at all.

That said, the other possibility is that the food and water really does not taste good to her. When you visit, does she eat and drink what you give her? I would talk to her doctor and allow him to do a complete analysis to make sure she isn't suffering from some infection/drug that is messing with her smell and taste.

...also, if she is losing weight, some of the drugs that she is taking, might be an overdose now, which also will cause loss of taste.

...and yes, it could be near the end of life for her. My Mom said that water tasted bad about 2 months before she passed. However, tea and juices (those few that she liked) were perfectly fine. Eventually though, she didn't like the tea or juice either and her tongue didn't know what to do with cookies.

This scenario is very painful to watch.

Talk to the staff (is there a nutritionist or case manager on staff?) and see if you can observe her swallowing problems for yourself. Bring her food that she likes and see if she's able to eat it. Tell the staff what kind of food your mother likes (and they should have checked if she has food allergies with you). My mother used to "pocket" her food (stuff it in her cheeks and not swallow it) when her dementia got worse. At that point they switched her to "soft" foods that don't require chewing. Ask the staff if she will get Ensure (or other similar products) to supplement her diet if your mother won't eat the meals. You can also ask them if she is losing weight. She may be weighed every week or month. Perhaps they can let you know her weight when she is weighed. If she's obese, it may be good for her to lose some weight, as long as she is getting enough nutrition to stay alive. All the best to you both!

Hospice worker told me, if she doesn’t ask for food or water, don’t give it to her..
it’s the beginning of the end.. you don’t want to prolong it..
that was tough for me to hear… but reality straight up..
maybe don’t fight her.. give her her favorite treats.. at this point.. let her tell you what she wants, if anything.. if not, that’s your other answer…
support her and remind her she is loved… and get the caregivers in who can help with this transition… its so sad… maybe, just maybe, she’ll pull out of this if everyone just stops fussing about feeding her…let her guide you… to a point.. hospice etc should come in to evaluate ..
its hard.. I’m sorry…