Dad won’t eat.

My 90-year-old dad has had dementia for close to five years and has been living at a dementia home. Up until now, his decline has been a relatively slow one. He forgets people and repeats himself a lot, but he seems “there” when I take him out for lunch. He’s never been a big eater—it would be a stretch to say we “share” a dish of ice cream, but lately he doesn’t eat at all. The staff at his facility tell me it’s normal in the later stages of dementia.

I guess I’m wondering if there are any tricks I can do to keep him eating, because if he doesn’t eat, he won’t be here long.

First, the tricks.

It’s not uncommon for folks with dementia to actually experience an insufficiency in energy absorption in the brain (sometimes called Type 3 diabetes). Their brains struggle to get enough glucose to function, and since nutrition is essential for survival; if Dad will eat at all, it’s important to find out what, when, and how much.

• Try different foods: Feeding adults with dementia can sometimes be like feeding toddlers. You never know why mashed potatoes are nothing but a toy and strained pumpkin is their current favorite. Keep rotating through different things to see if Dad will eat one of them. Then stick with that until he decides he doesn’t like it.

• Switch to dessert: Honestly, at this stage, we’re not really concerned about getting the US RDA of 8 essential vitamins and iron. Just getting ANY food into Dad is success. So if he wants ice cream and cookies, let him chow down on it. Bring more.

• Try a different time of day: If Dad will still eat the chocolates you bring him, get them out whenever you sense he might be willing to eat them. It doesn’t matter if it “spoils dinner” or if he eats with the other residents…as long as he eats.

• Eat with Dad. The companionship PLUS the social cues of seeing you eat and enjoy it may all help encourage Dad to do whatever you are doing.

• Try calorie-dense foods: This is where junk food rises to the challenge. Ice cream, cookies, chocolate, cheeseburgers, it doesn’t matter. Whatever he will eat.

• Try softer foods and smaller bites since Dad may not be able to chew or swallow normally.

• Try putting a little taste in Dad’s mouth. Make sure it’s just enough to taste. He may have trouble swallowing and you don’t want him to choke. If he swallows it, repeat the process.

• Try foods with a strong flavor appeal. Foods that smell good when cooking can help stimulate whatever appetite Dad has. Warm, savory foods that taste sweet, buttery or otherwise appealing might stimulate Dad’s appetite.

• Consider a potpourri that reminds Dad of food: cinnamon,vanilla, peppermint, etc.

• Take Dad on walks. Walking might help his appetite, especially right after walking.

• Pair Dad’s meals with other activities that he likes. It’s important that he actually LIKE the activities…if Dad doesn’t want to be in the same room with the “screamer” from room 4, bring take-out to Dad’s room and eat it there while you play cards. PRO TIP: don’t worry about the rules to the game. They’re not relevant…, so make something up!

• Consider appetite-enhancing medications. Ask Dad’s doctor (preferably his gerontologist!) if appetite-enhancing drugs like megestrol, dronabinol, marinol, or oxandrolone might be helpful. Some supplements might also have an effect at increasing appetite.

• Take a look at Dad’s existing meds: If any of them have appetite reduction as a side effect, ask his doctor to review his medications and make appropriate changes.

• Have Dad’s mouth checked: A dentist or doctor should be able to tell if there’s something physically wrong with Dad’s mouth that prevents him from eating. Keep in mind that Dad might not actually know how to tell you it’s painful.

When nothing works

The reality is that a loss of appetite can often be a sign that Dad’s dementia has taken a stronger hold.

If you’re his caregiver, it’s probably one of those moments you dread sharing with siblings or other relatives less connected with Dad’s health condition. Even if you’re not on talking terms, this is the time to be brave and let them know what’s actually going on. If it helps, you can share all the tricks you’ve tried.

Someone will probably suggest something they think you haven’t done. Try to take that as their concern for keeping Dad alive and not them second-guessing your caregiving. If their suggestion makes sense, try it. You never know what might work, and they’ll feel listened to. Regardless, it’s important that both you and your relatives understand that dementia is a progressive illness and that there’s no turning back to the way things used to be.

When elderly patients with dementia truly stop eating, their days are numbered. They may live anywhere from a few days to a couple of weeks. If your Dad gets more than that, consider yourself lucky. Encourage relatives to visit while they still can, and make it clear that there’s not much time left.

It’s a sad, sad, ending to a cherished life, and what makes it tolerable is a combination of saying the things to Dad you always intended to say, savoring the remaining days together, and keeping him comfortable.

Remember, you can’t stop time, you’re doing the best you can, and that’s good enough.