Lillian Hung recalls the confusion that ensued when dining staff at her long-term-care home served mushroom soup to patientsÌý— only for many to return their bowls, still full and untouched.
It wasn’t that her patients had suddenly developed an aversion to mushrooms, Hung, the 91Ô´´ Research Chair in senior care and a professor of nursing at the University of British Columbia, told the Star.
Rather, the answer lay in the tableware.
“It was served in a white bowl, and it was a white soup,” she explained.Ìý“And people simply couldn’t see the mushroom soup in there.”
“We were asking the patients, ‘Why didn’t you finish your soup?’ And they were saying, ‘What do you mean, there’s nothing in the bowl?’”
Alzheimer’s disease and dementia can have dramatic impacts on our ability to feed ourselves, a facet that is often overlooked. Yet the behaviour is “very, very common” in those experiencing cognitive decline, according to Hung and other expertsÌý— and can range from forgetting to eat meals to being unable to identify what is edible.
“The person living with the condition may not understand themselves that they have these changesÌý—Ìýbut their family, loved ones, care partners may report it,” said Dr. Roger Wong, a clinical professor of geriatric medicine at UBC.
The experts say sudden dietary changes can be an important warning sign of dementia. Here are some signs to look out for.
Dementia and forgetting to eat
According to Wong, the many diseases responsible for driving cognitive declineÌý— collectively known as dementiaÌý— usually start changing our eating habits by way of forgetfulness.
“Because of a loss of memory, very commonly, family and care partners may report that the person living with dementia may forget to eat … And that could be problematic because it can lead to involuntary weight loss, it could lead to malnutrition,” he explained
People may also forget that they’ve already eaten, and continue to snack or eat meals past the point of fullness.
“For example, they may get up in the middle of the night and try to get food,” Wong said. ” … Obviously, this is going to be a concern (especially for) individuals, for example, who have other long-standing health conditions such as diabetes.”
Hung warns this behaviour could spark tensions with caregivers, especially as dementia could lead to emotional changes making one more argumentative.
“Sometimes it causes family conflict. Your family will say ‘wait, you just had your lunch.’ And then you’ll get in an argument … It’s very common,” she said, urging patience and flexibility in family membersÌý— it’s all right to seek help if needed.Ìý
“I’ve heard of women caregivers getting very afraid (during meal time),Ìýbecause sometimes they’ll get hit by their (dementia-stricken) husband.”
Forgetting old dining habits
Memory loss can lead one to revert on old habitsÌý— Wong gave the example of a lactose-intolerant man suddenly drinking milk despite avoiding dairy for years. He may have forgotten about his condition.
Then again, this could be related to aging-relatedÌýchanges in smell and taste, and have nothing to do with dementia, he continued: “There is no clear evidence to suggest that people living with dementia are more prone to developing aging-related changes to smell and taste.”
Look for other warning signs of dementia, he warned,Ìýbefore assuming your grandpa has Alzheimer’s disease because he suddenly became fond of picklesÌý— or figured a cheese pizza was worth the bowel pain.
Dementia and not recognizing food
If you find yourself unable to recognize what you’re seeing, smelling or hearing, despite feeling like you should and your senses otherwise working fine, you may be experiencing agnosia.
Known as one of the cardinal features of Alzheimer’s disease, agnosia is not caused by memory loss, Hung explained. Patients become unable to identify objects or people with their sensesÌý— leading one person she knew to brush her hair with a fork, for example.
“They may see salads, vegetables, and they don’t know what it is,” she said. “They might be vegetarians, and then they start eating, like, a steak”
This becomes especially problematic when people eat objects that are not edible. “I have seen patients, during Christmas time, who would eat Christmas ornaments,” Hung said. “It can be pretty risky.”
While agnosia is rare in the early stages of the disease, families and loved ones may not realize one has dementia until it has already progressed to that point, Wong added. But again, look for more signs before leaping to conclusions after a dietary change.
Interestingly, cultural foods agnosia patients grew up with can often spark recognition. Hung recalled a patient who would refuse to eat any food the hospital gave her. But when her daughter snuck her a Tupperware of steamed chicken feetÌý— a difficult-to-eat traditional dish with many little bonesÌý— the woman regained her appetite for the first time in weeks and spat out every tiny bone.
“I went into long term care homes and asked people what they’re eating,” Hung said. “The majority of people, they had no idea what they’re eating.”
Dementia and motor difficulties
Around the mid-stages of cognitive decline, patients may develop apraxiaÌý— the inability to carry out a learned motor act, despite being physically able, Wong explained.
“People living with dementia may have difficulty using cutlery, for example, or use other means of eating. So in Asians, they use chopsticksÌý—Ìýso they may be more likely to use their fingers” once they’re no longer able to hold chopsticks, he said.
It may also impact one’s ability to prepare food for themselves, and lead to significant safety risks if they’re living alone, Wong continued. “For example, they mayÌýleave the burner on causing a fire hazard.”
When it gets to this stage, Hung recommends caregivers feed people with dementia snack-sized finger foods throughout the day, rather than having them sit down for a full meal.
“You just have to adapt as the person changes. It’s really important to understand the disease,” she said. “The needs of the person changes according to how the disease progresses.”
Inability to feed self
In the very last stages of dementia, “usually when a person is on their way out,” patients may find it difficult or impossible to feed themselves, Wong said.
“By the time someone cannot feed themselves, and this is clearly related to eating, that is considered to be a very late stage change,” he continued, describing it as one of the last functions to go.Ìý
Patients with advanced dementia may not eat or drink, and can develop dysphagia, a condition that prevents swallowing.
“If someone is not able to feed themselves, then there needs to be a very a careful assessment of how feeding can continue to take place,” he said. “Feeding is important not only because it is about ingestion of nutrients, but it’s also a social experience. There is enjoyment in the mouth.”
In the end, dementia is a very complex group of disorders that can affect people in dramatically different ways. There is no one warning sign of the illness, Wong said.
Where there is one sign, there are likely others. Dementia can go undetected for years, he continuedÌý— if you notice something wrong in a loved one, it may be time to pay them more mind.
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