How can I get my aging father to stop eating like a picky child?
March 8, 2013 7:11 AM   Subscribe

My dad is around 70 years old and has subsisted on a steady diet of shortbread cookies (those ones in the yellow box from the convenience store) and vanilla Ensure drinks for the past 2-3 years. How can we help him to help himself and eat real, nourishing food?

My dad is a war vet, recently retired after 30 years of steady employment. He suffers from PTSD episodes (nightmares) occasionally, so his sleep is irregular, and he's quite irritable sometimes. He throws tantrums like a small child whenever myself or my mother try to talk to him about his poor diet, or get him to do something he doesn't want to do (e.g. plan something or make a phone call). His mood is slightly more stable now that he's quit alcohol. He's struggled for years with trying to quit smoking, to no avail.

My father started drinking Ensure during his recovery from oral surgery. He got part of his tongue removed to treat oral cancer, and had to get dentures after his teeth rotted out from the radiation. He doesn't like to wear his dentures due to the discomfort, so I'm not sure how possible it would be for him to eat real food. There has to be some alternative to sugar cookies and sugary milk (=Ensure!) 3x daily. He constantly clears his throat of phlegm. It is disturbing and saddening.

My dad refuses to start eating real food again, minus some soup at restaurants. He's a brilliant man, but was so emotionally unfulfilled as a child and damaged by war that he apparently feels no drive to take care of himself, despite his loving family. I'm sure it will be difficult for my mother--a wonderfully fun-loving, compassionate person and devoted wife--to care for him during his inevitable decline.

What can you do if your loved one refuses to help himself? How do you worry less about it? Looking for advice from anyone who has been in a similar position with a family member.
posted by anonymous to Health & Fitness (33 answers total) 5 users marked this as a favorite
Is your dad getting help for his PTSD at a VA Hospital? He is entitled to treatment.
posted by jabes at 7:13 AM on March 8, 2013 [4 favorites]

He is a grown man being lectured about his eating habits by his own child. How would that make you feel?

I went through something similar with my mom. She is morbidly obese and flatly refuses to even discuss it, or to do anything at all about it. She will not exercise, she will not modify her diet, she will not stop going to horrid Chinese buffet restaurants for dinner. No home-cooked meals are ever prepared in her house except when I visit, and if there are leftovers they are thrown away unconsumed after I leave. What I realized after many yelling matches is that mom is an adult, and the reason she doesn't help herself is because she doesn't want to. She is tired, she is old, and she especially doesn't want to justify herself to me. I'm not happy about it, and I wish she would change, but her life belongs to her. She understands the consequences and prefers to be obese.
posted by 1adam12 at 7:18 AM on March 8, 2013 [48 favorites]

Why are you hectoring your dad about this? Don't you think that at 70 years old, a veteran with PTSD and a mutilated tongue deserves whatever physical comfort and pleasure he can find in this world?

Your dad served for 30 years. He's not a lazy fool. He's doing what he can. Leave him alone. Bring him some cookies.
posted by fingersandtoes at 7:23 AM on March 8, 2013 [40 favorites]

There isn't a lot you can do. Concentrate on appreciating your dad as he is. He's grown, if he wants to subsist on garbage, that's his prerogative.

He may be depressed (there's that bugaboo again) so it's in his interest for you and your mom to go with him to the VA or his doctor to discuss some strategies with him/her. A GP with a large geriatric practice is probably someone you should find and see, as they are more attuned to issues of those of us who are older. (I see one and it's AWESOME!)

When he visits the doctor, you and your mom should accompany him in, so you can take notes, and listen to what the doctor has to say.

It may be that an anti-depressant might be very helpful at getting your dad back on track.

Another stop might be the dentist to have the dentures adjusted.

You need to make your peace with this though. Your dad has been through a lot, and he may just not be in a frame of mind to do more than what he's doing.

It sucks, but there it is.

My Dad is a 76 year old diabetic. He gets 1/2 cup of ice cream every night. So he takes the 1/2 cup measure and PILES as much ice cream as he can into it, on top of it, and on the spoon he's going to use to eat it. At this point, what am I going to say that he's already not totally aware of?
posted by Ruthless Bunny at 7:29 AM on March 8, 2013 [5 favorites]

One way to approach this may be in bringing him some things he may like, that are more nutritious.

Soups are a great start. Make or buy some in the flavors he likes. Get excited about the new recipe you tried and bring him a pot full. Have dinner with him.

If he's already drinking Ensure, then maybe you can get all enthused over smoothies. Make them for yourself and have him over to your place, where you say, "I'm going to make myself a kale/banana/apple smoothie...sounds crazy, but you should try it! So good!"

The point is not to point out what he's doing wrong, but to encourage him without lecturing. Nothing turns other people on to new food like someone who is enthusiastic about the food themselves.
posted by xingcat at 7:30 AM on March 8, 2013 [6 favorites]

I've dealt with similar things with my grandfather (also a veteran) and, honestly, let the man do what he wants. He's five years short of the American life expectancy for men, still smoking, a recovering alcoholic (based on your tags), has had cancer, and suffers from mental health issues. You and your mother should concentrate on making whatever time he has left comfortable, and if leaving him alone about his dietary habits is going to make him more comfortable, then let him be. Maybe you can make him some soup once in a while.
posted by griphus at 7:31 AM on March 8, 2013 [10 favorites]

I've had to adjust to a similar situation with my mom (85), who is (in my opinion) killing herself as primary caregiver to my dad (86) who has advanced dementia, despite having hundreds of thousands of dollars in in-home care insurance and a year of available inpatient care. She is convinced she "can't afford" to put him in inpatient care because they share the insurance policy and anything she uses for him will no longer be available for her if she should need it.

It's been a long road to arrive at where I am, which is to accept that she's an adult, she loves my dad, and she's fully capable mentally of making these types of decisions. If she decides to kill herself caring for him, it's her decision to make. I've decided to just love and enjoy her for as long as we have her, to help her as much as I can in caring for Dad. Anything else just adds to her stress.

This is not an easy road - my thoughts and prayers are with you as you travel it wisely.
posted by summerstorm at 7:36 AM on March 8, 2013 [2 favorites]

About the only thing I can suggest is that you and your mom make a point of making available to him the kinds of foods he can eat -- which seem to pretty much be very soft things like soup -- and then let him decide whether he wishes to eat it.

The treatment for tongue cancer can radically alter the way things taste to a person, so it may be that most salty foods suddenly taste way too salty or something like that.

If he likes soft, sweet things, perhaps he'd like smoothies? The coldness of them may be uncomfortable for him, though, so you might want to aim at more of a room temperature smoothy using yogurt rather than a cold one using ice.
posted by jacquilynne at 7:49 AM on March 8, 2013 [6 favorites]

I agree that there's probably very little you can do. But based on my experience (not the same, but similar in many ways) I'd suggest attempting to introduce him to slightly healthier versions of these foods. Maybe there's a less sugary cookie with a similar texture, or a meal replacement shake with actual fruit in it, or something? Don't present these things as healthier per se, just as stuff you found that you think he might like.

Also if he takes any pills, see if you can get him to add some vitamins. (After figuring out, preferably with his Dr's, what he's missing.) It doesn't really take any work to add a few pills to one's other pills, and maybe he'd do it just to humor you.

And try to remember that sadly, as diets go it could be much worse; I'm sure there are people who live for years on, like, Coke and Doritos.
posted by DestinationUnknown at 7:51 AM on March 8, 2013 [1 favorite]

Ensure is not just sugary milk. It has vitamins, minerals and other nutrients on top of normal milk contents. It (and it's equivalents made by other manufacturers) are intended as a substitute for people who for whatever reason can't eat a normal diet. It's used in hospitals to feed seriously ill patients.

It's not miraculous. It's not as good as a good balanced diet with lots of fresh vegetables, but realistically it doesn't sound like that's likely to be achievable. It may be hard for you to watch but I'm not sure this is a great battle to pick in terms of your dad's quality of life.
posted by *becca* at 7:52 AM on March 8, 2013 [15 favorites]

Daughter of stubborn elderly mom here. You can make suggestions but that's about it. And if your loved one doesn't want to listen to suggestions, you can stop making them completely, and when complaining about the results of the undesirable behavior starts, you can say, "I've got something on the stove, gotta run." Sounds like your dad isn't complaining, though.

I'm not sure what there is in our culture that tells us that we do (or should have) control over the behavior of our elderly parents but it sure seems to be widespread. I'm not faulting you at all but I see a lot of questions like this on the green and it's sad, because it exposes the middle-aged kids to a lot of guilt (and leads them to try to intrude needlessly in their parents' affairs) when they could just be trying to enjoy the remaining time with their parents.
posted by Currer Belfry at 7:54 AM on March 8, 2013 [4 favorites]

When my uncle destroyed his jaw in an accident, during the reconstruction he couldn't chew solid food.

After a few weeks of health shakes and the like, he'd had enough. So, in a fit one day, he took the left over speghetti and meatballs my grandmother had made and threw them in the blender. To this day, he says it was the best meal he's ever had.

After that, everything went in the blender - meatloaf and potatoes, pot roast, minnesota hot dish, eggs pancakes and bacon - everything. Some of it worked OK, and some didn't, but being able to eat "real food" really did help him get through that whole ordeal. This might work for your dad, maybe.

You father is old, and ill, and he's never going to get better. I'm watching my father start that slow unwinding, and it's hard. At the same time, he's a grown adult and he could choose differently. I've just resolved to keep offering to help him make different choices, and accepting that it is his life to live.

But I'm not going to fight with him - there will be plenty of time to be angry after he is gone.
posted by Pogo_Fuzzybutt at 7:55 AM on March 8, 2013 [2 favorites]

This sounds like my husband's late grandfather. He too was eating cookies and junk all the time. His PTSD went untreated for years and years; so too did his diabetes. The untreated diabetes also caused additional moodiness. I know two much younger men, both diabetics, who become very difficult and unreasonable when not managing their blood sugar. His stubbornness might be a facet of that. Alcohol abuse has a significant tie to type II diabetes, and so does older age. Is he taking anything to manage blood sugar? Has he been tested for it?

If he's not getting help at the VA for the PTSD, and for nutrition, see if that can be arranged. Even just a support group might help with the underlying PTSD. I know several vets with PTSD; you can't completely eliminate it, but you can develop better coping strategies and let it impact your life a lot less.

Perhaps he would accept suggestions and changes from a medical doctor or social worker, rather than his child.

If no, then I would go with the majority of the advice here, to enjoy the time you have with him, not badger him, and not waste your breath.
posted by mitschlag at 8:01 AM on March 8, 2013 [2 favorites]

Your Dad went through oral cancer, lost part of his tongue and lost his teeth due to radiation. Of course he doesn't want to eat solid food after that!

You seem to have more of a concern with the Ensure than the cookies, strangely, and you don't tell us if either is excessive. Ensure is 14% protein, 22% fat, 33% sugar and 31% other carbohydrate, and contains substantial vitamin supplements. It's a little sugary to make it palatable, but it's made specifically to provide full nutrition for people who have can no longer eat solid food comfortably long term. As long as he's not losing or gaining any substantial amount of weight, and he's got his senses about him, your dad really is taking care of himself with his slightly goofy but functional diet.

If he has come to a place where he accepts the Ensure and can keep his weight and health stable, and finds eating food uncomfortable, he may not like being reminded of solid food. Your concern about his diet may come off to him as a lack of concern for his pain or what he's been through. I would consider asking him directly whether he avoids solid food because he doesn't like the pain, and whether he would be interested in exploring treatments or denture adjustments for that pain. If he responds that he doesn't like the pain and is interested in treatment or adjustments, he has opened the door to your help. If he says he doesn't want to talk about it or rebuffs you, you should probably respect that.

As long as there has been no tangible impact on his health from his diet - and you don't mention any - there's just no harm in allowing your Dad to subsist on Ensure. And if that's the case, your concern is more about your personal judgement of his diet than about truly helping him get through these later years. Trying to repeatedly cajole him into eating something different is likely to make everyone involved miserable. Just let the man have his Ensure and cookies!
posted by I EAT TAPAS at 8:13 AM on March 8, 2013 [11 favorites]

Ok, well cook him some delicious homemade soup then.
posted by oceanjesse at 8:44 AM on March 8, 2013 [2 favorites]

Well, for my parents I just do my best to offer food. Instead of Ensure (which her doctor suggested) I made my own smoothies. Full fat vanilla yogurt, a little vanilla ice cream, fruit (bananas work well). They are great and better than the alternative. I make bake goods that are as healthy as possible. I make peanut butter cookies with less sugar, no white flour and extra eggs. A healthy custard.

Instead of saying don't eat that, I offer alternatives that I think would be better for them.
posted by beccaj at 8:45 AM on March 8, 2013 [2 favorites]

I think you should take a gentle approach to this. I've struggled with trauma. It can be really hard to take care of yourself. The cookies provide some comfort. What if you started making sweet potato shortbread or pumpkin shortbread? Peanut butter shortbread. And you could make smoothies and soups. If that's too hard, maybe go to a good bakery and ask if they could make them for you. You'd at least be getting something into him.
posted by Chaussette and the Pussy Cats at 8:56 AM on March 8, 2013 [1 favorite]

You're probably going to have to admit defeat for the moment and prepare for the next step, which is likely going to be a serious illness or debilitation.

Do your parents have their legal affairs in order? Since it may be difficult to ask such a question, maybe seek out advice from your family accountant or a trusted lawyer about how these things play out.

The sad fact of life is that our parents will die. Some of them stay longer, some don't - my dad is 72 this year and is very healthy, hardly changed at all from when he was 50.

However, my grandmother put my parents through considerable stress during her final five years of life. Through a bit of luck and a bit of seat-of-the-pants planning, they were able to manage her affairs and prevent some legal and financial headaches.

Since your dad is already somewhat at risk for more illness in the near future (diet + smoking), it would be wise to look ahead and plan for what's around the corner.
posted by KokuRyu at 9:11 AM on March 8, 2013

There's probably some justified anxiety around chewing, and very little pleasure in eating at all. HUGE second to getting the dentures taken care of, which is a project in itself. They can be very difficult to fit - some labs/technicians are better than others, and the dentist is relying on feedback from your dad to finesse the fit. Get recommendations from other people who are happy with their dentures. Also, it would help if someone fluent in your father's responses (including non-verbal ones) could accompany him (as with other medical visits).

What kind of soups does he prefer at restaurants? Can someone make batches of similar recipes to store in single-serve containers? Otherwise, so long as basic nutritional requirements are largely met, it's more harm than help to force changes around diet, at this stage. (That's from medical people who wanted to spare me stress around my wish for my dad to get his 5-a-day.)

I found the book Coping With Your Difficult Older Parent helpful in working through boundaries and feelings around, well, coping with my difficult older parent.
posted by nelljie at 9:12 AM on March 8, 2013 [2 favorites]

Tell him you love him, ask him what he needs, and listen to him. Treat him like an adult.
posted by disconnect at 9:13 AM on March 8, 2013 [3 favorites]

My MIL did this toward the end of her life, sustaining herself primarily with Ensure and Fudgesicles and maybe a banana here or there. We spoke with her doctor about it, and he pointed out that older people tend to eat less; her stomach has shrunken accordingly; and that her body has learned to survive on what she consumes. He also mentioned that if she suddenly started to consume a variety of foods in more quantity, she'd likely suffer some discomfort and other associated problems. We knew that she had anorexic tendencies throughout her whole life, and so in thinking of her in those terms, he was right and so we stopped bugging her. The only thing I did force the issue on was to get her off this Xoxai "Healthy Chocolate" stuff her friend was selling her that was making her jittery and sleepless by presenting the facts. True enough, she'd come to dinner where I'd make some nice grilled fish and a salad and vegetables, and she'd eat a good plate happily, with dessert -- but then her stomach would be upset for days.

What you want to do is kindhearted and wrong-headed. It's not how he'd like to be cared for, so please leave off it, even if it's coming from a loving place. I'll agree with the others - make yourself a healthy smoothie and some awesome shortbread while you're there, and offer him some. Then you'll feel you've done something, and he'll not feel criticized. How do you worry less? You realize that just as you want to make your own decisions and not feel parented at your age, he would like the same treatment from you. You will be caring for him by treating him as he wants to be treated. Best wishes to you - this is a hard enough road, and you don't want to spend this time in conflict.
posted by peagood at 9:18 AM on March 8, 2013 [12 favorites]

How do you worry less about it?

You might look for ways to replace the social meaning of food. So often, we use a nice meal together to mean "I love you" and "I want to take good care of you" and "it's great to be together -- let's celebrate" and so on. So I wonder if you'd feel better if you found other kind and loving gestures you could make between the two of you that would carry the same social meaning and emotional weight.
posted by Now there are two. There are two _______. at 9:59 AM on March 8, 2013 [2 favorites]

Yeah, Ensure is like baby formula for adults and as long as his doctor knows that's what he's doing, I think it's fine unless the doctor says it's not fine. But I just wanted to share that my grandmother's last year of life, she basically subsisted on sugar cookies and pink wine. She knew her time was coming, her stomach was frequently upset, there were few pleasures she could participate in any longer beyond spending time with her family and sugar cookies and pink wine. It's possible she may have lived a couple weeks longer if she'd eaten "real" food, but, dude, she spent the last year of her life subsisting on sugar cookies and pink wine. If you've ever thought, "Man, I wish I could eat nothing but mint chocolate chip ice cream every day" -- well, that's basically what my grandmother decided to do. It's kind-of bad-ass when you think about it.
posted by Eyebrows McGee at 10:02 AM on March 8, 2013 [32 favorites]

What your dad choses to put into his body is probably one of the few things in life he has control over. After all the difficulties you'v described he might feel pretty vulnerable and as if his dignity is threatened. I'd let him eat what he wants. Hang on to a little dignity.

If I were to make a suggestion like this to a parent in his situation, I might call them up when I'm cooking or shopping and say something like "Hey, I'm making X and I have some extra. Let me know if you'd like and I can bring some by for you."

If he says no, then just say "Ok dad, just wanted to check. I love you!" And let it go, but call him again next time. You might also just take one or two servings of something by the house and leave them in the fridge without any fuss. "I left some soup in the fridge just in case you want to try it. Hey, want's on TV?"

I would absolutely avoid taking a parent role or pressuring him. If this turns into a situation where you "lose" if he doesn't change his eating habits, and he "loses" if he does .. nobody wins.
posted by bunderful at 10:31 AM on March 8, 2013 [3 favorites]

In no way do I want to dismiss your concerns--I think they are understandable, for sure. However, it's true that, as others have said above, Ensure is actually used as a meal replacer for people who can't have solid food for one reason or another. Is it optimal? No. But it's better than, say, ONLY the shortbread cookies. Also, it is probably very beneficial for his health that he has quit drinking alcohol. One thing at a time.

To give you another potentially reassuring anecdote, I have an elderly relative who has subsisted for the last decade on shortbread cookies (based on a totally unscientific survey among my friends, shortbread seems to be a staple food for a lot of elderly relatives), deli cold cuts, and tea. It drives her closest caregiver nuts, but we all have to admit that she is over 90 years old and, well, it's been working for her so far. Like Eyebrows McGee said, forcing her to eat a better diet might lengthen her life a little, but it wouldn't be worth it to make her last couple of years so unhappy.

Good luck. I would feel frustrated in your place too, but hopefully you will feel more at peace after reading the suggestions and reassurance in this thread.
posted by hurdy gurdy girl at 11:24 AM on March 8, 2013 [1 favorite]

When my anxiety levels get extremely high this is exactly what I end up doing as a reflex, dialing back to one or two kinds of food that feel very safe and have an effect on my body that makes me feel less anxious. It has nothing to do with being a childish picky eater it is all about coping with anxiety. Given your dad has PTSD I would not be surprised if that was a factor for him. If that might be the case, and if it is giving him some kind of mental relief to eat that way, why not?
posted by cairdeas at 11:27 AM on March 8, 2013 [2 favorites]

I honestly think the best you can do is see if he has any interest in switching to Ensure Complete or taking some vitamins. If he doesn't, well, that's that because he is a gorwn-ass man. You can make soup but it sounds to me like if soup was a goer, your mom would have stocked the cupboards and fridge with... soup.

If it makes you feel any better, my father is subsisting on 3 bottles of Ensure each day, and one bite of a sandwich at lunch on a good day. This is what his (utterly amazing and compassionate) doctor has ordered to get nutrition into him since he's terminal and has zero interest in eating. He has actually gained a modest amount of weight on it, because even at 750 calories a day, the nutritional and caloric needs of the ageing are very different than the rest of the population. Yes it's a far cry from lovingly made, delicious home cooked meals, but it's also a far, far cry from a GI tube and liquid feeding.
posted by DarlingBri at 12:31 PM on March 8, 2013 [2 favorites]

Have you tried blending foods for him? My husband worked at a retirement home as a teen and said some residents would get things you would not associate with pureed food like steak blended for them. Sounds gross but worth investigating. Do you think he would try some baby food or pureed food at home?

I feel for you. It must be so difficult to see him continue to smoke even with the oral cancer. You could try checking with his oncologists or the VA for more resources and advice about feeding and smoking cessation.

Wishing you the best of luck with this issue.
posted by dottiechang at 12:56 PM on March 8, 2013

As others have noted, Ensure is nutritionally complete, designed to be so for people who can't or won't eat, so don't worry about that.

I must say that when I'm in the last stage of my life I plan to eat whatever the fuck I like - if that's fairy floss and popcorn with the occasional banana (because man, I love bananas) then so be it, and I expect my loved ones to let me do what I enjoy, because I enjoy it. Tell him you love him, and let him be.
posted by goo at 2:57 PM on March 8, 2013 [2 favorites]

I just wanted to say that while I agree that there's probably little you can do, I sympathize with your situation and your mother's situation in giving him care. Especially because poor diet and untreated diabetes can make someone quit difficult to deal with in personality. Your mother doesn't deserve the burden of someone who won't take care of themselves, but as long as she loves him this will probably be the way it is.
posted by stoneandstar at 6:55 PM on March 8, 2013

I would add that trying to replace Ensure with homemade smoothies and soups is probably not the best long term solution either - unless you get the balance right, it probably will be worse for him than the Ensure.
posted by geek anachronism at 8:29 PM on March 8, 2013 [1 favorite]

What can you do if your loved one refuses to help himself?

Very little, perhaps nothing.

In a short post you mention a whole lifetime of dad's painful experiences. The arguments are painful for you, your mom, and (if he's throwing tantrums) him. Back off and let him eat and smoke as he pleases in peace. At least it won't add another layer of distress to an already difficult situation.

How do you worry less about it?

If your mom is going be his primary caretaker, helping her get as well situated and cared for as possible might be the best way to help both of them. That will have concrete, direct and long term consequences for her stability and security. You can't help her by haranguing dad.

He's a brilliant man, but was so emotionally unfulfilled as a child and damaged by war that he apparently feels no drive to take care of himself, despite his loving family.

It's like that sentence is perched on top a raft of sugar cookies floating on a whole ocean of history and feelings. And that despite, it's like a 2000lb anchor pulling the whole thing down.

You could have asked your question without mentioning the drinking, his brilliance, the combat trauma, the bad childhood. This is not a criticism, it's my favorite thing about your post. It implies so much. Given all the rich stuff your posts suggests, it makes me wildly curious about the dramas are getting played out in this fixation on his diet.

So yeah. Back off. Help your mom prepare as much as you are able and willing. Pay attention to what your worry is telling you about your feelings about him and your relationship to him.
Best of Luck.
posted by space_cookie at 11:15 PM on March 8, 2013 [3 favorites]

If you live in an area where Medical Marijuana is used, I'd look into that. First talk to your father about it.
posted by QueerAngel28 at 12:28 PM on March 9, 2013

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