My mother in law is 95 and diagnosed with dementia. She will eat for the caregiver, but if we try to feed her she holds the food in her mouth and refuses to swallow for long periods of time. She also refuses to take pills - we've tried adding them to applesauce or yogurt, crushing them into foods . . . but she'll take them for the caregiver. The problem is the caregiver is only there 6 days a week from 11-7, so we need to feed her breakfast, and the days she is off we need to get her to eat. My husband is convinced she wants us to help her die, but since she eats for the caregiver, I think he's wrong. Anyone have a suggestion?
Definitely ask the doctor if a swallow study is indicated.
The issue was raised again as he began to decline and eating was impaired. We went through the pureed diet with mushy foods and thickened liquids, and he was able to tolerate it. But there was literally no appeal at all to the mushy food. Eating wasn't a pleasure; it was just contributing to life sustainment.
But as swallowing difficulty progressed, the option was either gamble with the continued dysphagia diet, eat at will and just enjoy eating food instead of mush, with the knowledge that this was in an end of life stage and could accelerate decline (and cause aspiration pneumonia). Or get a tube and accept intubation for the rest of his life.
He chose to eat the dysphagia diet; another feeding tube was just not an option at his age.
Veronica, a nurse who posts regularly here, has had a feeding tube for sometime; she usually responds to threads on feeding issues, and she'll offer a different perspective. But she's also still youngish at around 80.
Cindi, if a speech therapist recommends a feeding tube, then either she's making her own recommendation, or there was a videoscopic swallow study done which would be reflected in your MILs records.
Was there, and what did it show? These studies can determine whether frank aspiration is occurring, and the speech pathologist can recommend specific diets.
I had to hire a home care agency in which a speech therapist overstepped her bounds and recommended either a tube or hospice. She refused to discuss speech exercises, as the better speech therapists always did. (The other therapists from this outfit were bad as well; I fired them after 10 days of putting up with their irresponsible attitudes and arrogance.)
Was MIL getting a dysphagia diet before, when she was eating for the therapists? Was she choking and coughing? Face turning reddish? Pouching food in her mouth as she did when you fed her?
I think the first order of business is to determine the results of the study, get the report and discuss it with a doctor (not a PCP) such as a pulmonary or GI doctor. Our pulmonologist was very knowledgeable, but in going through the rounds of trying to figure out which kind of doctor would be a follow-up doctor, a GI doctor was always suggested.
Therefore, if the caregiver is dressed in a uniform type garb, your Mom-in-law will see that caregiver like a nurse, as cwillie had mentioned above. Wonder if dressing like the caregiver does would help?
Does Mom-in-law indicate what foods she likes? I believe once a person had reached 95, if they want ice cream for breakfast you ask that person "one scoop or two". My own Mom was a fussy eater but oh how she loved pie, cake, muffins, cupcakes, ice cream, etc. As we age, we do tend to lose our sense of taste except for sugary foods.
I know that for myself and my mom I feel that insisting on eating is a real moral struggle - it is one of the few things they still have any control over and cajoling, bullying or tricking someone who is nearing the end of life to eat may not really be a kindness.
They don't bother her too much and she seems to get the food in. When she was here, I watched her closely and when she stopped, I tried to fill in by feeding her.
Maybe that's the answer...let her pick at what she can at the table or her room alone.