Dealing with Food Issues

Lyn currently wants to eat the same thing day after day.  If she had her way, she would go out to eat daily and she would order one of two dishes.  Either she would order chicken fettuccini alfredo or she would order a bacon cheeseburger with only mayo and a side of ranch to go with her fries.  She might, just might think to ask for Mom to make spaghetti.

We've known for some time that her food preferences seem to be changing.  Some days she will say "I've never liked..." or she may say "You know, I've always liked..."  Yet, when you ask her what she wants, the answer is "I don't know" or she gives a bit of a scowl and a shrug which conveys much of the same thing.  They really are not changing.  She just doesn't remember.

Such issues are common in Alzheimer's patients.  Food issues can drive a care giver crazy trying to guess what to fix.  So, if I may, this is unsolicited advice but I hope it is of some use to someone who is faced with the challenges of feeding an Alzheimer's patient.

1. Decide what you are going to provide them to eat.  Alzheimer's patients really don't remember what they may or may not like.   Their statements of "I've never liked..." or "I've always liked..." are covering statements.  They don't know what options are available to them.  If they look in the pantry or the fridge to see what options are available, they may not be able to recognize that the cheese, the bacon and the ground beef are components to a dish they like.  They may just see "stuff."  If you list of three choices of "Do you want A or B or C," they may become overwhelmed by their options.  So, remove the burden of those choices from them.  Say "We're having meatloaf for dinner tonight."  
2. Provide them with healthy choices.  This may seem like obvious advice.  It takes a bit of knowledge and logic to decide you should not eat a cookie because you're watching your sugar intake.  This kind of thought process is extremely difficult for the Alzheimer's patient.  They may see the cookie and just want the cookie.  The impact on their health is not in their capacity to determine.  
3. Recognize that an insistence on eating the same foods is an effort by the Alzheimer's patient to have some control over their life.  They really do know their brains are changing and this causes anxiety and a desire to be able to have some control over things.  They know that they should know what they want for dinner but they just can't remember what they like or want or even what they should avoid.   They may limit their selections to the few things they can remember to ask for as a result.  They're not trying to be difficult.   
4. Control portion sizes.  Alzheimer's patients drop weight as a result of the disease.  Their body is not as efficient at digesting food and making use of the available nutrients.  As a result, you may be inclined to give the patient a large serving in the hopes that sheer volume of calories will help stop the weight loss.  It won't.  You will start to realize that no matter how much you succeed in getting the person to eat they still will loose the weight.  Additionally, you may find that the person has no appetite because they forget what hunger is and what it feels like.  Instead of getting upset or frustrated at how much food is being wasted, give the person smaller portions so that if any is not consumed, less goes into the trash.
5. Have liquid alternatives on hand.  The Alzheimer's patient may not be willing to eat but they may be willing to drink a meal replacement shake.  While it may not be the preferred method of providing sustenance to the person, they may find a shake to be an acceptable alternative from time to time.  They may even think they are getting a special treat.
6. Roll with the changes.  Food is not a place for a battle of wills.  You will not win.  You cannot force a person to eat.  The Alzheimer's patient is not being a difficult or picky eater by choice or doing it to frustrate or spite you.  It may feel deliberate.  It is not.  If you offer them something they don't like, just apologize and move on.  Tomorrow is a new day.  If they request a particular dish, try to make it.  Otherwise, don't let yourself get caught in the challenge of always trying to know or guess what will be considered a liked food today.  Chances are you'll get it wrong.  
7. Be willing to intervene.  There are going to be times when you're going to have to say "No" or "Stop."  You can be polite and respectful but you may have to intervene for the safety of the Alzheimer's patient or another individual.  The Alzheimer's patient may not recognize that food they've taken out of the fridge is not safe to eat.  You may need to make sure that the food they have access to always is safe to consume.  The Alzheimer's patient may not remember to turn off the stove if they've tried to cook.  You may need to take steps to prevent them from turning it on such as by removing the knobs.  You may need to actively prevent them from overfeeding the dog by giving the dog all of the food they don't eat.  You may have to remove their plate for them right as they finish under the guise of being helpful.  If they do succeed in feeding the dog, at least you have hopefully reduced the portion on the plate so that even the scraps going to the dog are reduced.