I believe my client is anorexic. She is 88 years old and refuses to eat. She says she doesn't want to get fat. In the last two years she has gone from 98 to 85 pounds. She has gotten so weak she has been hospitalized twice. She only takes in around 600 calories a day and most of them are empty calories. She refuses protein. I am at my wit
s end.
The doctors give her potassium and hemoglobin. But they are not talking to her about the need to eat. Should I be trying to get her counseling or should I just do the best I can? I feel like the people around her just think she is too old to help.
I was going to ask about painkillers - Tramadol is the culprit I had in mind which can cause anorexia - but if your client is managing even 600 calories' worth of food daily she's not technically anorexic. Anorexics literally cannot bring themselves to eat: once seen, never forgotten.
I totally agree! Very true. It's exactly what I have observed with my mom.
This is exactly what I have been going through with my grandmother. She has never weighed more than 100 lbs her whole life, has a 24-in waist & thinks she's fat. Everyone tells me to let her eat only what she wants but I am concerned with her getting so much protien in her diet too. This is probably not a probable expectation for you but it literally took me sometimes 5 hours each day for her to eat a small balanced meal with all her restrictions on flavor. They were tiny bites of food & frequent breaks. I fed her first to not let her see how much food I was giving her. I let her finish each meal on her own when I could say "it's only a few more bites!" She is almost 100 yrs old, on no meds & can still walk on her own but she weighs 64 lbs. Her PCP said her body has adapted on so little food her whole life. When she first declined & I took over her care, she gained 30 lbs but she has since lost it & then some. It may be a losing battle.
To help you out, your patient is probably on a drink like Ensure Plus. For a while, my grandmother couldn't stand the tastes of it. Her PCP suggested Carnation Instant Breakfast. I would mix it w/ warm (her preference) vitamin D milk, melted ice cream & add chocolate or caramel syrup. Because I had to go through all that, she drank 16 oz instead of 8. Just like JoAnn29 said about taste buds failing, sweets are what elderly can taste. It's true. My GMA never ate sweets until now. She loves chocolates & wants Godiva or Lindt, not Hershey's. She knows the difference. Can you find foods that your client really likes & really encourage it because it may be all you will be able to get down. I sometimes tell my GMA that she can have all (the sweets she wants) but it is really important to eat other foods if (her goal) is to make it to 100.
I would stay away from protein powders like whey because it is geared towards athletes & individuals that train for high physical activity-it helps with pre-workout & muscle recovery after. I thought the same thing too because I use the product for my training. I was told it will cause dehydration in the elderly because they are not drinking lots of water. Will your client eat yogurt, especially Greek? It is high in protein. Basically, anything promoted as "protein" is junk unless it has at least 10 grams -something to keep in mind. Nut butters (sunflower, almond, cashew & peanut) are a good source of protein along with eggs, cheese, lean chicken, tuna, salmon, halibut, lentils, tofu. You could point out that this is clean eating & not fattening foods.
Since you are around at meal time, it takes positive reinforcement. You may sound like a broken record but something will click & take advantage when you can. Counseling will not help because at 88 years old, your client is set in her ways. You will have the greatest impact because of your role in your client's life. Good Luck!
Thanks for asking the question Walksmile. I will try the above suggestions too.
I don't know if this is the case with your client, but a lot of times the elderly can't be bothered with making food but they will eat if the things they enjoy are just placed in front of them. I agree with terryjack; find out what foods she enjoys or used to enjoy and just put them in front of her. Don't talk about it a lot just make the food easily available.
A lot of foods have surprising amounts of protein...wheat breads, vegetables, grains...so I wouldn't worry too much about protein specifically as long as she is getting some decent, wholesome foods.
I wonder if your client would allow you to make smoothies for her. You could use protein powder and add berries or other fruits. There are many options if you do an internet search for recipes. That might replace some of the empty calories. She might benefit from some dietary counseling if she's able to understand and follow the guidelines. Psychiatric counseling might help with the dysmorphia, I don't know how it would work with an elder. What do her family members think? Are they concerned? Good luck, I think you are right to be concerned, especially since she has been hospitalized already.