My 95-year-old mother-in-law lives with us, and was very independent until March. Then she started weakening, having trouble getting up from a chair and walking, started speaking word salad. Just in the past few weeks, she is sleeping all night and all day, with very little speech and eating less and less.
We got her a chair lift to gently raise her up, but after only a few capsules of CBD, she could stand again. I’m afraid that very hard plastic lifter, plus her increasing immobility, gave her pressure sores.
A week ago, her dentures became too loose to use, and the sole denturist in town isn’t available until August 11.
When I contacted public health about the pressure sores, they said “Boost! Ensure! She needs protein to help heal those sores.” Yikes, all that sugar and she is diabetic. She didn’t like the artificial sweeteners taste, grimaced after each sip. I figured, it is more important to get the protein in than keep the sugar out. I got Ensure “High protein,” 12 grams. Then I started looking around and saw Vega protein, 20 grams – that’s more like it! We’ll try that tonight.
Then I started reading about geriatric nutrition, “Correlation of Pressure Sores and Nutritional Status,” by Gayle D. Pinchcofsky et al, who confirm “One major problem is that of protein calorie malnutrition; another is the susceptibility of this [elderly] population to pressure sores.”
Another study, “Effects of enteral nutrition on patients with pressure lesions,” says, “Protein-energetic malnutrition (PEM) affects prognosis and mortality in elderly patients as an inadequate nutritional status is a risk factor for the development and worsening of pressure sores.”
Ok, so it is important to get that protein in, but exclaiming “Wake up! Take another sip!” for every single sip is not a relaxing mealtime atmosphere.
But there is another view of geriatric nutrition that seems more humane and respectful. “Nutrition Support at the End of Life: A Critical Decision,” says, “A comprehensive study of nursing home patients with dementia reported that the insertion of feeding tubes did not improve survival over those hand fed, did not lower the risk of aspiration pneumonia, and did not improve pressure ulcer healing, weight status, comfort, or functional status.”
This article tackles it head-on. In “Food – The four letter word in end of life care,” explains, “What a patient can eat and drink will become less. Eventually both eating and drinking will become zero. Stopping eating and drinking is natural to the dying process.” And, oh boy, “The atmosphere around eating is more important that what is ingested.” And finally, “Is he dying because he’s not eating? Translation… No, he is not eating because he is dying.”
In “End of Life Nutrition,” Katie Dodd says, “Interestingly, when it comes to reduced intake at end of life, it is the caregivers who experiences the greatest amount of distress and not the dying patient. An anonymous healthcare professional was quoted as saying: ‘I have had so many experiences of relatives and professional carers distressed because their loved one/service user hasn’t eaten properly. It would be great to be able to re-assure them from the strong position of empirical evidence that their relative is not distressed.’”
I hope the Vega is tasty enough to keep her awake and keep me from exclaiming, because, yes, I am distressed.
References
Dodd, K. (2020.) “End of Life Nutrition.”
From https://www.thegeriatricdietitian.com/embracing-hospice-end-of-life-nutrition/
Fuhrman, M. (2008.) “Nutrition Support at the End of Life: A Critical Decision.” From
https://www.todaysdietitian.com/newarchives/082508p68.shtml
Murray . K et al. (2011.) “Food – The four letter word in end of life care.” From https://www.alzheimer.mb.ca/handouts/Food%20the%20four%20letter%20word%20in%20end%20of%20life%20care.pdf
Pinchcofsky, G et al. (1986.) “Correlation of Pressure Sores and Nutritional Status.”
From https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.1986.tb03411.x
Straccci, G. et al (2020.) “Effects of enteral nutrition on patients with
pressure lesions: a single center, pilot study.” From https://www.europeanreview.org/wp/wp-content/uploads/1563-1570.pdf
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