How can we help my Dad eat?
March 13, 2018 12:00 PM   Subscribe

My Dad has been sick for a long time but right now he is doing okay except that he won't eat. We are heartbroken and running out of ideas.

He has a long (10+ year) history of ups and downs but now he has lost 40 pounds (160->120) in 2 months. My Mom constantly tries to get him to take Ensure, ice cream, anything he wants but he's eating less than ever. He finally started getting confused and paranoid but he refuses medical attention so I came up to see if I could help.

We finally got him taken by ambulance to the ER where a superhuman PA managed to get him admitted; his blood sugar was low but with no other problems they couldn't keep him more than one night. Main diagnosis was most likely depression. He easily clears the line of competence (once we got his blood sugar up) but doesn't want to get help or go to appointments. He's still not taking enough food to stay alive; I guess it might fall under failure to thrive. The PA says that he can go weeks or months like this but certainly not forever. He can walk 100+ feet at a time but mostly lies in bed (takes himself to bathroom though).

He is in a weird in-between place; he can't get hospice (no diagnosis); he can't be committed (he's too competent); he vocalized that he does not want to die right now; but he is not taking food or allowing us to take him to a PCP or psych appointment, so he can't get psych drugs or therapy. He is basically healthy and just will not take food. He is 100% VA disability and eligible for VA services but wont consent to be taken to VA and seen.

If he said he was ready to die I could make my peace with that but he said he does not want to die, but when I tell him he needs to eat, he says that he's fine and that he doesn't think he's too skinny.

We are running low on ideas. Bargaining, tough love, non-tough love, everything in between. We are going to get him some edibles ASAP and see if that helps. It's a bit of an untenable situation but I was wondering if anyone had any ideas on how to get him to eat and/or break him out of his rut. Longshots welcomed. Thank you in advance.
posted by ftm to Health & Fitness (25 answers total) 4 users marked this as a favorite
My competent and not ready to die yet grandmother also eats very poorly and (almost certainly, I'd bet my life on it, but not formally diagnosed) is depressed. She will sometimes drink a Boost, but not of her own volition, because they're "too expensive" (someone else always buys them for her, she just doesn't think she's worth the $1.06 or whatever it is they cost). She is very old and I totally get that preparing food is hard, but she also will sit with a fridge full of prepared food people bring her and instead eat a couple saltines for dinner, which isn't enough.

Things have gotten better in the last year, though, and the biggest change is that we've hired someone (not an official home care worker, but a younger-than-her elderly retired widow to come by a few days a week. She helps my grandma with some basic life stuff, but the best thing she does is sit down and eat meals with her. She makes food, prepares two plates, and sits down with my grandma and starts eating. My grandma will eat something at least when another person is eating it with her. She still picks and doesn't eat much, but it's the only situation in which my grandma will eat an actual meal: someone is eating it with her.

Is this something you've tried with your dad? I know it sounds simple. But dining at the table together and putting food in front of him, no pressure but obviously you've put it there because you expect him to eat it. It works for my grandma, maybe it'll help for your dad, too.
posted by phunniemee at 12:14 PM on March 13 [7 favorites]

(Apologies - I'm going to be sitting this thread more than I usually would.)

Thank you for the ideas! He spends most of his time in bed watching TV and getting him to a table would be a bridge too far right now; but we have tried making 3 of the same thing and going in there and sitting with him. We definitely put the food in front of him and tried both badgering him to eat it and not badgering him to eat it.

To fill in some details, my Mom lives with him and is 100% able and waits on him hand and foot, and was preparing hot food for him for as long as he wanted it (until a couple months ago - the change came rather rapidly but it's not connectable to anything we can find).

My Mom has access to paid and non-medical home health helpers and will be calling them in for this kind of help.

At the same time it is somewhat of a relief to hear of another person that maybe seeming ate way too little, but hung on for a long time. The more breathing room we have to figure this out the more we can be calm.
posted by ftm at 12:22 PM on March 13

6 Ways to Get Seniors with No Appetite to Eat. Also, the Google search results for "no will to eat" may have some useful tidbits tucked away here and there.
posted by WCityMike at 12:29 PM on March 13

It sounds like you have some money to throw at the problem. Since he won't go to the doctor can you pay for a home visit? Or else have him re-assessed and medical authority signed over to his wife who can then authorise an IV. Another alternative is to really be tough love and tell him his wife can no longer care for him (which is true, his needs outstrip her capabilities) and pay for him to go into the best assisted living facility for the short term to get him assessed by a team of professionals. I'm sorry. This situation is heartbreaking.
posted by saucysault at 12:29 PM on March 13

Could you find a physician who would make a house call? This sounds like exactly the right situation for that. Or use one of those services where you can video chat with a physician.

As for getting him to eat, is there anything he will eat? Can you just give him tons of whatever that is? How is his sense of smell? Will something aromatic like frying bacon pique his appetite? Will he drink anything? Smoothies can be bulked up with lots of protein powder, but maybe even something like bulletproof coffee could help if he likes coffee? Best wishes to you.
posted by CiaoMela at 12:31 PM on March 13

Did they check him for a UTI? UTI's can be a big cause of mental fogginess for seniors. (But I imagine they'd check for it at the hospital, just mentioning it in case they didn't.)
posted by LobsterMitten at 12:32 PM on March 13 [5 favorites]

I guess I'm the cannabis guy on AskMe today, but cannabis. Like, this is one of the most classic medical uses for it. If you have access to it, I'd recommend giving it a try if he'll let you. He doesn't necessarily have to smoke or eat it, depending on where you live you may have access to drinks, topical ointments, tinctures, and other such things. It's a really good appetite stimulant and he may find it pleasant enough to want to do it regularly. If you can and he's willing, give it a shot.
posted by Anticipation Of A New Lover's Arrival, The at 12:33 PM on March 13 [18 favorites]

It sounds like you have some money to throw at the problem.

We do! The problem is, no skilled health workers can offer him anything because his physical health is fine (such as it is). They actually have all expressed bewilderment at what we thought they could do, which I didn't find particularly helpful in the moment, but what are you gonna do.

This is totally, totally too much for my mom or even me + my mom to handle but he's not consenting to go into assisted living right now and in fact he became very agitated and scared during his ER stay. That was hard to watch and he calmed down a lot when he got home. It would be ideal to keep him at home, and the VA can get him home care, but only if he goes once (we're going to try).

Thank you so much for your kind help and thoughts.
posted by ftm at 12:36 PM on March 13

Did they check him for a UTI?
Thank you! But it turns out they did - no problems.

I guess I'm the cannabis guy on AskMe today, but cannabis.
We've got some indica or indica mix brownies inbound. A different doc told me that sometimes not eating begets not eating and that if we can get him to eat for a while it will self fix, so I'm hoping that helps. (He doesn't have a card yet but we are in a medical state.)
posted by ftm at 12:41 PM on March 13 [4 favorites]

My grandfather was prescribed folic acid for appetite stimulation.

He had Alzheimer's. I thought they gave him the folic acid to improve brain functioning, so I starting taking it. After gaining like 10-15lbs, my father mentioned it was for *appetite stimulation* not brain function. Ooops.
posted by slipthought at 12:47 PM on March 13 [4 favorites]

You are in a terrible situation, and I know because so am I with my mum. Just today, I had to leave her house because I became so depressed, and then my sister went there and ended up screaming at her (she lives alone).

I think your best bet would be to seek assistance for your mother, who must be so stressed and overworked. I gather she is covered by the VA as well? The research into how to help your mum will point the dial at your dad, and may move the process ahead.
The thing is, your mum is inadvertently a barrier between him and the healthcare system. She's keeping him from becoming very ill — of course — but at the same time it's a huge burden on her.

My mum was just released from hospital yesterday after a really serious bout with sepsis, which was again caused by her refusal to move out of bed, even to bathe (and some more stuff, obviously). Over the last year, we've been struggling to keep her overboard, but I admit that during the last month or so I've been slacking a bit and let my aunt take over. And then it all went off. The good thing was that she was so helpless that we could overrule her for some days and get the healthcare system to engage. She has spent today trying to throw nurses and carers out of her house, which is why my sister and I became desperate, but at least now they are onto her case and they aren't giving up just yet. If she doesn't take their help, and eat the food they bring, she'll be back in hospital very soon, and she doesn't want that either.
posted by mumimor at 12:58 PM on March 13 [3 favorites]

Has he actually had the kind of medical investigation that would uncover a cancer diagnosis? I'm talking CT scans and other medically indicated testing. 40 lbs in 2 months is a tremendous amount of weight, and is the kind of weight loss that would automatically prompt a thorough work-up. This is not generally done in the ER unless there is some symptom that suggests a specific test, like abdominal pain. The ER is just not set up for that kind of medical interaction. The depression might be a confounder rather than the responsible diagnosis, and there is some evidence that having cancer itself may cause depression. Having a cancer diagnosis can cause depression, logically enough, but the researchers believe there may be an independent biological reason as well.

I would not be comfortable assuming that depression or a lack of appetite in old age was the basis of this profound weight loss without assurance from competent medical professionals that there is no underlying cancer diagnosis.

I know he's refusing medical attention, and perhaps he's afraid himself of what might be going on. I hope you and his wife can persuade him to see a physician to get to the bottom of the issues he is experiencing.
posted by citygirl at 1:07 PM on March 13 [4 favorites]

When I was actively anorexic and starting recovery, eating made me feel sick. Not in a psychological fashion, but physically ill to the point of pain and nausea. It turns out that prolonged periods of fasting cause the stomach and intestines to empty more slowly when you do eat, leading to discomfort which can lead to further food avoidance. Also, when nothing is flowing through your gut, a lot of your gut bacteria die off, which can cause discomfort when eating again. And, weirdly, not eating can lead to a feeling of euphoria that's difficult to give up.

The solution to this in treatment was to eat a lot of small, nutritionally dense snacks throughout the day rather than typical full meals. Peanut butter on saltines was my go-to, because I could stuff in a lot of calories without having to eat a lot of volume. I was also required to drink plenty of water in between meals to get my stomach used to having volume in it. In developing countries with malnutrition programs they hand out this stuff called "plumpy'nut" that is basically peanut butter, vitamins, and sugar for similar reasons.

Actually getting him to eat just a little more often is a hard problem to solve, but hopefully some understanding of the physical side effects of fasting and refeeding might help you think about the situation a bit differently and maybe come up with a solution. I ended up eating actual food to avoid getting an NG tube, but the threats you use on 14 year-olds are probably ill-advised for elderly patients.
posted by xyzzy at 1:12 PM on March 13 [6 favorites]

I don't know how clear he can be in a conversation, but there's some difference between having no appetite and being nauseous or feeling uncomfortable after eating. (Discomfort swallowing is also a possibility.)

I feel you. My dad (mid eighties) has always been quite skinny, and now his pants are two and a half sizes too large (it seems). Also, a close friend went through this with her mother, just a few months before her mom actually died.

Smoothies or full-fat flavored yogurt or his favorite foods, maybe just a little on a small plate? I hope something works, but pressure can backfire.
posted by puddledork at 1:24 PM on March 13

I came in to advise that you watch out for "refeeding syndrome," which can accompany the reintroduction of food to someone who has become malnourished for whatever reason.

Since your father is living mostly indoors, he may have developed a Vitamin D deficiency which can suppress appetite. Supplements (avoid megadoses, which also lead to problems) and more time in sunlights will help.

Does he have a wheelchair? Maybe also try to get him outside, into the kitchen while people cook, etc. so he's more of a participant in life.
posted by carmicha at 1:42 PM on March 13 [1 favorite]

Is he drinking fluids? I know ensure is the go to in situations like this. But does he drink fluids regularly, you say he takes himself to the bathroom so I figure something is going in. Dehydration can make you feel depressed & not hungry. Getting him to drink water might be easier than food or ensure. If you can get him to drink anything even fruit juice, sweet tea, lemonade even etc, that will re hydrate him & get his blood sugar up which will help the lack of hunger pangs that come from low blood sugar as well.

Getting peoples metabolism to kick in again after not eating is hard. Dehydration & low blood sugar self defeatingly make you less hungry and as mentioned before the longer you go without eating the harder it is to get your body kicked into gear to want to eat again.
posted by wwax at 1:51 PM on March 13 [1 favorite]

I'm so sorry you're going through this, it's in a lot of ways worse than an abrupt identifiable change in circumstances. This is going to be incredibly difficult advice but:

he's not consenting to go into assisted living right now and in fact he became very agitated and scared during his ER stay. That was hard to watch and he calmed down a lot when he got home.

That agitation is the symptom of the cognitive deficit. He's just covering very very well until he can't. If you ever get another chance, you're going to have to let him suffer this way for long enough to be assessable by a professional. You'll have to let him be scared a while.

And if he's competent, he needs a good scare anyway. This is where I would truly employ the tough love and explain he can do this easy or he can do it hard, and if he chooses hard you're going to turn your energies to saving your mother from his abuse - because if he's competent, this is abusive - and not letting him take her out with him. Tell him the next time he decompensates from not taking care of himself, y'all won't take his ass to the ER until he's so bad that they won't let him leave. Tell him he's a big boy and can make his own decisions, and if those decisions are not eating and not engaging in even basic medical treatment the clock is ticking very fast toward the time where his ability to make decisions will not be a factor anymore. I would deliberately scare the fuck out of him with all the ways his control over this situation can evaporate and how cruel it is to play roulette with you and your mother's stress levels and well-being that way. But if he doesn't care about that, he'll probably at least be real scared of losing his agency.

All he has to do, if he wants to regain some control over this situation, is go to the fucking doctors. If he's so sure he's fine, why not let them confirm that, and if he's not they can help make it not be so horrible or hard on your mother. Any other choice is a choice to make this horrible and hard.

Unless he's not actually competent, in which case this whole situation will probably come to a head pretty quickly as long as you and your mom stop helping him coast. This is incredibly hard to stand by and watch, but it's the only way to get at the truth of what's going on if he won't cooperate.
posted by Lyn Never at 2:18 PM on March 13 [9 favorites]

Are his teeth okay? Dental problems, including pain and ill-fitting bridges and dentures, can make eating unappealing, but a lot of people with this problem don't like to discuss it.

Agreeing there might be a vitamin deficiency (D, B-12, folic acid).

He spends most of his time in bed watching TV That TV should stop working properly, in hopes of luring him to a different room for watching and then to the dining table at mealtime since he's out of bed anyway.
posted by Iris Gambol at 3:11 PM on March 13 [2 favorites]

State laws vary, but in NY state if you brought him to a psychiatric emergency room he might be involuntarily hospitalized for being a danger to himself. Self neglect due to depression is considered a danger like suicidal ideation.
posted by Waiting for Pierce Inverarity at 3:36 PM on March 13 [2 favorites]

It's a very, very small thing, but a straw can really help encourage drinking fluids (water, ensure, juice) if they are able to use one.
posted by windykites at 3:37 PM on March 13 [4 favorites]

It sounds like maybe he doesn't have much of a social life outside the family? Which can be true and rough for a lot of men his age. Was he formerly active in veterans' associations? I'm just wondering if it might be beneficial for him to have someone besides family and medical workers to talk to.
posted by The Underpants Monster at 3:57 PM on March 13

I know he won't get care, but if he does, my mom was given an antidepressant when she had late-stage Parkinson's that was specifically used to help get depressed elderly people to eat. I, of course, don't know what it was called. But it helped.

But what I really came to suggest was Soylent. They sell it in premade bottles now with flavors like Chai and Coffee and Chocolate and it's 100 better than Ensure.
posted by orsonet at 4:24 PM on March 13

This is one of the standard on-label prescription uses for cannabis, in the 29 states (plus DC) where it’s legal. Ask your doctor about it if you are in one of them, and if not I hereby empower you to ask the nearest college student to procure you some.

(If you aren’t up to date on the latest, there is a) no need to smoke it and many healthier ways to consume; b) if in a medical-legal state, there are CBD formulations with very few psychological effects - more physical like relaxation, sleep-inducing, pain-relief, anxiety-relief...and appetite-inducing.)
posted by amaire at 9:28 AM on March 14

Nthing the possibility of major dental issues. My father lost a dangerous lot of weight trying to hide major dental issues which basically prohibited chewing and made eating painful and embarrassing for more than a year at least.
He hid it so successful ly that not even his then new second wife realised the extent.
In his case it was both massive fear of dentists combined with money issues he also covered up.
Not sure how you would find, we only did when he hospitalized and required intubation.
posted by 15L06 at 10:59 AM on March 14 [1 favorite]

I'd like to follow up on my former comment. It seems like my aunt also blew up on my mum yesterday. So everyone caring for her in each her way set a boundary. And today when I called her (I couldn't face a visit), she was apologetic, told me she would accept the nurses, and that she had eaten her dinner yesterday and lunch today. She may well be lying, but I felt there was some truth to it. I won't be able to check it before Friday, but I think the nurse would call me if she was worried.
I experienced something similar when caring for my gran. Because my gran was a really complicated person, the main carers were my cousin and myself, and our oldest children. After a while we learnt to coordinate everything, so she couldn't blame any of us for anything. My cousin and I loved our gran dearly and she loved and cared for us, but she was also manipulative, there was a reason my mum and my aunt weren't there for her.
My conclusion is that if you can all agree to a decision, and stick with it, you may create change. Obviously this is hardest for your mother who is living with him. Maybe she needs a holiday — does she have an out-of-town friend?
posted by mumimor at 1:46 PM on March 14 [3 favorites]

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