Aug 21, 2011

Problems with Taking Medicine and with Eating: Question and Answer

By Carole B. Larkin
Alzheimer's Reading Room

Our reader Kathryn asked this question under the article, How the Loss of Memory Works in Alzheimer’s Disease, and How Understanding This Could Help You.

Problems with Taking Medicine and with Eating
Any ideas as how I can get my mother to eat?

Every time we say were going to make her something to eat she says she already eaten. I've told my family she will always say she had a sandwich which she hasn't.

So I wait awhile and tell her I'm going to make her something and she hardly eats it. I've found that if I cut up everything sometimes she'll eat a little more but most of the time I'm worried she not getting enough.

I’ve tried Boost but she doesn't like cold drinks. Also she hides her Donezepil which I find around the house. Can I crush it up and put it in her coffee?

Any help would be appreciated. My father did a lot of her care however, he just passed away, so we are just trying to figure this all out. I've found this site to be very helpful. Thank you.

Carole Larkin responded:

In relation to your mom’s overall health, it is as important as eating for her to be taking the proper dosage of her prescribed medicine at the proper times of the day. If she's not taking her Donezepil, then the chances are very high that she is not taking any of her medicines correctly.

Her medication taking needs to be closely monitored. You need to develop a system that ensures she takes it and then verifies she takes it. Taking pills out of the bottle and giving them to her is not a system, so best to use a system.

You could try an automatic pill dispenser if you can afford the service. The pill dispenser should have an alarm that notifies you or another family member when mom has not taken her pills. If the automatic pill dispenser is not affordable for the family, then use the one week or two week pillboxes you can buy at the drugstore.

If you can, you might have someone go over there and put the pills in the pillboxes every week or two. Someone should watch the pill taking each day. That’s what is called “best practice”.

If this is not doable  have someone go over to her house at some point in time every day and open the pill box, check if that days slot is empty, and then check throughout the household to see if or where mom hides the pills she’s not taking.

If you mother is hiding pills, the best and most simple solution is to put the medication in a place where she  can not access it, and then have someone administer each dose.

As for crushing the Donepezil, the manufacturer of Aricept says that it should not be crushed. There is an Aricept that will dissolve on the tongue called Aricept ODT Oral. You will need to talk with mom’s doctor to see if he will allow her to take Aricept ODT Oral.

Your doctor may not know that Donepezil comes in an Oral form that dissolves. At any rate before you do anything please check with the doctor.

As for the problems with mom not eating; unfortunately not eating is common during a number of stages in these diseases.

People’s senses of smell and taste diminish as they get older, and these diseases seem to accelerate those sensory losses.

If possible, I suggest you try 6 small meals a day, otherwise known as “grazing”. Maybe there's too much food on her plate when it is presented to her.

Perhaps the choices between foods on the plate seem overwhelming to her and she freezes up.

Try serving her in courses, putting one food item on the plate, using a small portion. Maybe she can't distinguish the food on her plate from the plate itself (mashed potatoes on a white plate). Try using colored plates; red plates tested out particularly well.

If she's a pacer (is constantly walking around the house) give her something to eat and drink while she paces.

Boost doesn't have to be served cold. When you buy it, it is not refrigerated. It only needs to be refrigerated after you open the bottle. See if you have a better result serving it at room temperature. If she'll drink it heated- heat it.

If all else fails there are medicines that increase appetite, but that option needs to be the last resort, not the first one. It is just one more medicine to take; adding a higher risk of side effects from that medicine and may clash with the other medications currently being taken.

Additionally check her current medications to see if any she uses have an appetite suppressant effect.

The best thing is to have someone there with her to cook, clean, watch her take her meds, and generally keep her safe and ENGAGED.

Everyone needs a purpose for their day. Give your mom one.
Carole Larkin MA,CMC,CAEd,QDCS,EICS,
is a Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

More Insight and Advice for Caregivers

Original content Carole Larkin, the Alzheimer's Reading Room