How do I help my father with vascular dementia and Type 2 Diabetes control food intake?
My dad suffers from the early(ish) stages of vascular dementia and full-blown insulin-controlled Type 2 diabetes. He is struggling with high blood sugar readings even with the daily insulin dosage. His GP is working on adjusting it, but I strongly believe much of this is due to his inability to moderate his food intake. I prepare the evening meal, balanced, with mainly meat and veggies, a small side of carbs on occasion, but he prefers to fix his own lunch - he orders a grocery delivery that contains canned soups, bread products, cookies and sweets, with some fruit and veg (often carb-dense). He also orders a lot of take-out food and hides it from us as I had a discussion with him when I started preparing more meals about how the amount of Chinese food and pizza ordered worried me. I want to find a way to help him eat healthfully and prevent bingeing behaviors. Does anyone have any resources or product suggestions I could look at? When I try to research I tend to find the opposite problem being more common for seniors with dementia - an unwillingness to eat, and we are definitely not dealing with that at this point. Any suggestions at this point would be welcome. My husband and I follow a low-carb lifestyle and my dad had showed some interest in it but does not care to stick with it.
22 Answers
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After all, there's not much attraction to pureed food, especially after it's been cooked, shipped and reheated. Yuck.
I think that some younger folks, especially medical personnel, who see our elders as patients rather than family don't realize that at some stage it's appropriate and acceptable to allow deviations from completely healthy lifestyles. After all, emotional gratification and enjoyment can be just as important as eating properly and doing all the right things medically.
Thanks for sharing your insight.
My husband, Coy, was encouraged by doctors to eat what he wanted to. Fortunately Coy liked a lot of healthy food, but lifting all his dietary restrictions was like an end-of-life gift. (Sort of like the Make-A-Wish program.)
In addition to dementia Coy had CHF. His heart clinic ordered a scale for him, hooked up to the clinic via telephone lines. It was useful in letting us adjust things for a few days if his weight went up suddenly (which would indicate water retention.) A nurse monitored Coy's weight and called if she had any concerns.
Once she called and told me that Coy's weight was up 3.6 pounds from yesterday. "Oh yeah," I replied. "That was probably the big pickle and sausage at the German restaurant. I'm watching his diet today and tomorrow a little more closely."
The nurse was horrified. "A pickle? A pickle? Don't you know how much salt is in a pickle? Why would you let him eat it?!" She really sounded mad at my negligence.
"Ma'am," I told her, "Coy is dying from dementia. His geriatrician and neurologist encourage him to eat what he enjoys. I am not watching his salt intake. I like knowing when he is starting to retain water so I can make some temporary adjustments. I'm trying to keep him comfortable and happy, not get him well or to live longer. If that makes us ineligible for this service, you can order the scale to be picked up."
Nurse: "Oh no, no. We want you in the program. Watching for sudden weight gains will keep him more comfortable. I understand your approach and I thank you for explaining it."
I think you have some good suggestions here. You are wonderful to care so much for your father and his health. But I whole completely agree with those who say not to stress about this.
I guess my view is this, if you had his health problems and were constantly made to feel as if you were doing something wrong by what you , as an adult chose to eat, how would you feel? Even with early-ish stage of dementia, he may be forgetting the rules, and the reasons behind them, or he may not care. That is his right. I say make him the meals that you want to , and do not worry about what he eats on his own. If it isn't causing him pain and assuming he isn't reading at 400+ on a regular basis, I'd say let it be.
When people start losing control over their lives as happens too often as we age, all too often the only thing we have left to control is what and when we chose to eat. Let him have it his way for as long as he is able.
I wish you well.
Best,
Margaret
I would take the patient to a dietitian since they specialize in diets and proper nutrition. They can help you find a diet that's right for you no matter your condition, especially if you're overweight or even obese. No matter your condition, a dietitian is definitely the first place I would look in order to correct whatever condition is correctable through diet because many if not most conditions are correctable through proper diet. Remember in the days of our forefathers when disease was less common than it is now? That's because they farmed and grew their own food. They had gardens and even huge plantations back then. I even heard a story somewhere where a pregnant woman would go out with the other workers to work the fields and come back with a baby that night, that's how healthy they were. If only we could follow the diets and lifestyles of our forefathers, we'd be more healthy than we are sick. Such was true when I was a ward of the state at one specific campus. They made sure we ate right and we were well cared for even if people weren't exactly fair towards us but at least we survived and we were more healthy than we were sick. That's because we had proper diets and lots of exercise
As a Type I diabetic, I believe that I do have a unique perspective on managing diabetes. I'm no expert, but, I do manage mine pretty well. It has taken me years though and it is a full time job. It requires a lot of planning, checking, counting, and discipline. If your dad is not on board, I wouldn't get overly stressed about it. You can't force it. I would focus on what you can help with.
First, I would get him to a good Endocrinologist. Preferably, one that focuses on diabetes. If you can find a division of a teaching hospital, that's good. I go to UNC Endocrine. Top notch. The Endocrinologist can evaluate your dad, provide options that he can handle and look to the future. Once, his dementia progresses, it'll be easier, because his food and meds will be administered to him by others.
Second, I would ask the doctor about finding a way to cover the carbs your dad eats, since, you can't prevent him from eating them. There are pills that can be taken along with some insulins. The key is finding the right combination. Having too low blood sugar can be as dangerous as too high.
Does your dad have any interest in checking his blood sugar throughout the day? Most people don't. If he will do it, it would help figure out what his needs are.
I wear a Continuance Glucose Monitor, (you wear a sensor that sticks under the skin on your belly. You also have a receiver that shows your blood sugar level. A device (you wear on your belt or may use your phone) for a senior with early stage dementia? I'm not sure how that would work. It requires a lot of work, education, and supervision. I can't see a senior with early dementia managing it. Not very practical. You can discuss it with his doctor and a Certified Diabetes Educator. A pump also requires a lot of work, management and care. And it runs the risk of too much insulin. I can't imagine they would prescribe that for a person with dementia.
I hope you can get the answers you need to help your dad. Once, my LO's vascular dementia progressed, she did fine with her pills being given to her in the morning and then a regular healthy diet the rest of the day. She isn't restricted that much, but, gets treats occasionally. Her meals and snacks are provided to her by the MC staff. Her A1C has maintained at a very good number for several years. This keeps her more comfortable. That is my goal now.
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
You'll only make yourself sick trying to change his habits. Let him know you're there if he want assistance but he's a big boy and he will do what he wants and eat what he wants.
The only option you have is to make sure his doctor(s) advise him what lies ahead if he doesn't change his habits. But "sugar consumption" is an addiction for a lot of people.
I think you need to look at the entire picture here. Your dad has vascular dementia. Studies show the average life expectancy after diagnosis with this condition is about 4 years. Now that is an average, meaning some people die sooner than that, and others live much longer. But it is fairly unlikely that your father will live to be 80 no matter how good his diet is and how well managed his blood glucose is.
That blunt truth helped me to establish my caregiving goal for my husband, who had Lewy Body Dementia. My goal became to help him have the best quality of life he could under the circumstances.
That your poor dad thinks he has to hide his fast-food purchases from you is sad. I don't think that contributes to his quality of life in these last few years, do you? I know that your intentions are absolutely sterling. I'm just not sure how realistic they are.
Let an endocrinologist keep making adjustments to try to manage the blood sugars a little better, without being depressingly restrictive in the diet. And do consider an insulin pump!
My husband had followed a "heart healthy" diet all of his adult life. Once he was diagnosed with dementia both his neurologist and his wonderful geriatrician said let him eat whatever he wants now. That relieved stress from both of us.
If not, your intentions are admirable, but your father is not cooperating. You can't change his behavior; he has to want to do that by himself.
But you might try some tough love. Print out some articles on the short and long term side effects of uncontrolled and/or advanced diabetes, including having to wear an insulin or facing amputation of a deceased limb. That might scare him into compliance.
It seems cruel, but he has to realize the chances he's taking, and only he can change his attitude.
Good luck.