Mailbox Response

The question was submitted 16/10/2008

Subject: end stage dementia

why the patients with end stage dementia stop eating; is it because of depression,bad teeth ,thinking of suisied, or no energy to eator to keep their deginity....etc

Answer from DementiaNet

As dementia progresses a number of things occur which result in reduced intake of food.

These include impaired swallowing mechanisms and reduced awareness of hunger.

It is rarely as a result of poor oral hygiene , depression or suicide thoughts.

As dementia progresses there is a need to change the form the food is presented in order for the person to be able to swallow. It needs to be more vitamised to allow for easier swallowing but if too soft or liquid there is a risk of the food “going down the wrong way” and causing pneumonia. We call this aspiration pneumonia. Obviously the food is lees appetising in this form but that is the balance we have to accept in order to get adequate nutrition. Also it requires others to assist with the feeding , be it staff or family, and this can take quite a long time for each meal to complete.

If the person is unable to swallow safely then we consider, in conjunction with the family, whether it would be appropriate to place a feeding tube directly into the stomach through the abdomen.  This overcomes the need to take anything in by mouth but is not an ideal solution in a person with advanced dementia.

It is not surprising therefore that many residents in the very advanced stage of their life lose weight but they do not seem distressed by this as their hunger mechanism is adjusted accordingly.

The answer was published on DementiaNet 23/10/2008