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My 94 year old MIL recently came to live with us after fracturing her hip. She had surgery and rehab. Until recently she actually lived on her own. She's been doing fine - going to the bathroom on her own, I helped her shower just last night, and she's been sitting in the living room with us watching TV and joining in conversation.


She eats little to begin with, but I've noticed yesterday and today so far she seems weaker and has refused food, although she had some tea. (My husband is currently out of town so I am with her while I work from home.)


My question is should I, for lack of a better word, "allow" her to refuse food? I'm not sure how I could force her to eat, but should I try to spoon feed her? I have some really good soup that I think she would like, but when I ask her if she's hungry she almost gets angry and tells me no. She hasn't eaten since lunch yesterday. Currently, it is after 10:00 a.m. the next day. And she went to bed at 7:30 last night and so far has only gotten up to go to the bathroom. (My office is also the guest room that she is in so I am sitting with her.)


To be honest, I have a weird feeling inside. I wouldn't have been surprised to see that she had passed overnight. This is all new to me, any advice would be appreciated.

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Tell her if she won't eat, then she'll end up in the hospital and no one will have choices anymore.
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PenelopePitstop Jan 2022
Actually, when she was in the hospital she wasn't eating much there either and they didn't do anything like tube her. She's also very picky and they tried everything and even brought her those Ensure drinks, which of course she hated. But no, even there, they didn't force her. My husband said she was "playing games" and told her if she didn't eat, she wouldn't be allowed to come home, so she finally started eating! But now she's home and starting that again.
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No, at 94 I would think we have still at least the choice whether we eat or do not eat. And I would never hospitalize nor put in feeding tubes. So my question now is what understanding is there with MIL and with family as to what her end of life wishes are. Firstly, you would be utterly amazed at how little it takes to keep one alive at a certain point. Those who purposely stop eating in order to pass with hospice support and doctor's knowledge, if taking minimal sips to hydrate, can live well over a month.
You surely should OFFER anything you know she loves, perhaps easy to take puree, high protein puddings, and etc. You surely may think now to contact the MD and discuss palliative care and Hospice support if you wish.
But no, I would NEVER under any circumstances, force anyone to eat, against their own will. And at minimum, you could be looking at choking food into the lung and death due to aspiration pneumonia.
It is time to have discussions about end of life with your MIL, your family, her doctor.
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PenelopePitstop Jan 2022
Thank you. Other than sleeping a lot and not eating much, she's doing ok (considering). I see no reason to put her in the hospital, nor would we ever dream of putting a tube in her. I do kind of feel like she is in hospice at our house. :(
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No. While caring for my mother I made a vow to never force food on anyone. Encourage, wheedle and beg....
I worked hard making this dish for you, please try just a little
OR
if you don't eat you'll get weaker and I'm not sure we'll be able to care for you here

Offer tiny portions of the foods she is willing to eat often throughout the day

Concentrate on boosting the calories and value of foods - add healthy oils, cream, butter, cheese, nut butters, Greek yogurt

Supplements like ensure drinks and puddings were invented for this

And finally, do you have any idea why she isn't eating? It could be that she is having problems with her teeth or upset stomach or constipation (especially if she is on opiate pain killers). Or she may be having difficulty swallowing her food (dysphagia) and would do better on a modified diet.

I'm linking some articles for you

https://www.agingcare.com/articles/reasons-why-your-aging-parent-may-not-be-eating-properly-and-what-you-can-do-about-it-133239.htm

https://www.agingcare.com/articles/high-calorie-foods-for-seniors-168493.htm

https://www.agingcare.com/articles/dysphagia-how-to-help-a-loved-one-eat-and-drink-safely-187010.htm
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PenelopePitstop Jan 2022
There's nothing physically wrong with her to cause her to not want to eat. My husband thinks it's in her mind. This is really awful, but the other night she apparently had an accident. She changed herself and threw away the pants she was wearing. We later found the evidence (because she put them in the recycle bin and not the trash). I was impressed she could be that sneaky in her condition (ha ha). He asked her about it and of course she was embarrassed and started saying that she's not going to eat again because we think she's dirty. That is absolutely not true of course. Then she said she threw the pants away because they were too tight, which is also not true. So basically, she's starving herself because she doesn't want to go #2 - or at least that's what my husband thinks.

I know it sounds like she has dementia or something, but she does not. This is just how she is. On top of that, she is super picky with food. She is Persian and likes hardly any kind of American food. Before all this happened, we arranged Meals on Wheels for her. She hated all the food and threw it out "to the birds" so we cancelled it! I have never met anyone so weird about food!

My husband is out of town right now. I called him to let him know she hasn't been eating so he talked to her. She actually told him she wanted to go to a nursing home! So... that's why he thinks she's just playing games, but I don't understand why. I know she has to be hungry.

I've also tried giving her small amounts of what she does like and she either wastes it or sneaks it to the dogs. I don't know what else to do at this point.

I'm sorry to ramble on so much. Thank you for your suggestions.
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Absolutely no force feeding.

You might consider getting a referral to her doctor for hospice care, because I'd say she might be heading toward death.
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PenelopePitstop Jan 2022
I read that not eating is one of the early signs. She was very lethargic this morning, but has since pepped up a bit. Still not eating, but asked me for a glass of water and now she's busy talking on the phone so I don't think she's that close (although this morning I might have said the opposite). Sorry, I'm not trying to joke or make light of the situation, but it's the truth!
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As hard as this is--don't push food. Liquids, yes, as much as they want, which may be a very small amount.

As the body shuts down, it's actually painful to eat. My dad quit eating after he was vomiting back up everything he ate. Liquids, he could keep down. But I'm talking popsicles and fruit ices. Not much nutrition.

I'd be talking to a dr about EOL expectations. If she is in pain or discomfort, there are drugs used in Hospice that make the passage of all this so much more calm and peaceful.
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Definitely do not force or try to force your MIL to eat; it's her prerogative, after all! A person can live for quite a long time without food; it's water the body needs to survive, in reality. I wouldn't threaten her with PEG tubes or trips to the hospital either, what for? I always look at it as how would I like to be treated?

Your MIL doesn't have to be looking & acting half dead in order to actually BE approaching the end of her life, in reality. Death is not a linear thing; in other words, she'll have lucid moments where she's spry and active, while there will be other moments where she's exhausted, lethargic and refusing to get out of bed. The fact that she's refusing food almost entirely is a sign that her body is getting ready to transition, even though that may take months to actually happen.

Hospice accepts patients they feel have 6 months or less to live. Get MILs doctor to write a referral to hospice and then she will be evaluated by the hospice team. If she needs comfort meds, they will be dispersed; if not, they won't be. Hospice does not 'kill' people; they provide extra support, supplies and services to them as they approach the end of their lives. They help YOU, too, as you try to navigate a difficult part of this journey. If your MIL needs a hospital bed, oxygen, adult briefs, etc, hospice will supply them at no cost as their services are paid for entirely by Medicare. Also, your MIL will be spared the pain & suffering of going back & forth to the hospital for unnecessary poking, prodding, testing and life extending measures that only prolong pain & suffering. My 95 y/o mother has been on hospice since 12/21 and I can't tell you how wonderful their services have been in this short time already.

Wishing you the best of luck during a difficult time.
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OFFER food and drink but do not force or push food.
As a person declines and their body begins the dying process the need for food lessens. If you force food or try "tube feeding" often the food remain in the stomach or gut and create more problems.
I think it might be time to consult with Hospice and heave her evaluated for their care.

If you wish try this...
Make the soup, heat it up and bring it to her and just offer a spoonful of it.
(If it is not pureed I would do that before offering it to her)
Place the spoon to the lip and often the mouth will open. But if it doesn't and she turns her head just tell her that it's ok.
Do offer fluids though and if she take that try the liquid protein drinks like Boost, Ensure Premier Protein and others like that.
🙏
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As a retired nutrition clinical staff member {27 yrs in Geriatrics} I would try offering home made milkshakes {add skim milk powder for extra protein and fruit like bananas}, Ensure if affordable, puddings, cream soups with added skim milk powder for protein, custard and any food she really likes. Yes..A decreased food intake will cause weakness. I would assess how much pain she is in. Pain can cause a decrease in intake. Her MD needs to know she is eating poorly. Also watch her weight loss…a 5% weight loss in 30 days is a sign that needs reporting to her doctor. You can not force someone to eat. Aging people begin to decrease their intake. Some people do not bounce back after a hip fracture..good luck..
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Talk to her doctor about her lack of appetite and other symptoms. At the least, there are medications that will increase her appetite.
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Always have available within reach small plate of food, a cup with a cover and a thermos of ice to add to the drink as needed. Bottled resealable drinks. During the day pour only a small amount in a clear plastic cup and the casual “how about finishing that one up so I can take it away”. Or, pour drink into a large ice filled styrofoam cup with a lid and straw so she can sip on it throughout the day. If she does not have swallowing issues, packs of crackers, small cluster of fresh grapes.
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Is your MIL getting therapy for her hip? Perhaps ask her doctor to order home therapy and the exercise might improve her appetite. It could help break the cycle she is establishing. Is she using a cane or walker? Do you have a transport wheelchair?

I wouldn’t hover. Where do you serve her? In her room or at a table?
Perhaps serve both your dinners and ask her to join you.

Does she have enough time to herself? It’s a big adjustment going from her own home to having her bed in her DIL office.

It might scare her to realize that she is getting weaker. It can happen fairly soon for the frail elderly.

Also it might be time for depends. If not eating is to avoid bowel movements, the depends can give her backup when she needs more time to get to the bathroom.

Hopefully she will perk up when her son returns.
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My mom turns down food when you ask if she wants some and while capable she would go for days without eating a meal if left to herself but put something in front of her and she devours it while maintaining she isn’t hungry. The more of an investment we have in her eating the more she will resist too. I would put the soup in front of her while having some yourself, if she resists ask her to taste it for you and let you know if it’s something your husband would like or if you should make it again when she is hungry…just get her to pick up the spoon and start, if she doesn’t keep eating so be it try a sandwich next time or something you know she likes, give milkshakes or some sort of liquid nourishment made for just this issue a try. I wouldn’t attempt “forcing” or even feeding her by hand while she can think and eat for herself, it is likely to create far more problems than benefit and end up unsuccessful anyway. If the issue continues and is concerning to you consult with her doctor and include your husband, it may require a “follow up” visit with the doctor where he or she goes over the importance of nourishment and options for getting that. The last thing I want to mention is the importance of fluids, if she isn’t taking in plenty of fluids either that is an even bigger, more immediate problem and can quickly get the point where an ER trip is required.
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Sounds like she is Tired . Do you have a visiting Nurse coming in to check on her after her hip Fracture ? She may have a infection which would be cause for lack of appetite . I would do a telemedicine call with her Physician or Nurse assistant and get a Visiting nurse to come in . You May want to get hospice Involved if your concerned about her passing in the night .
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Broken hips are very serious in the elderly. Some just don't bounce back. The anesthesia does a number on them too. I think you need to call her doctor and run this by him. It ma6y be depression.
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Have you mentioned this to her doctor? If it continues, talk to the local hospice care folks. Maybe she will come out of it, but losing the need to eat is one of the signs that the body is shutting down and its no longer in need of food.
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My own mother made this choice. She was tired of living at 86. Tired of not being able to do anything. In the span of about 4 months she went from walking in the house but with difficulty, on her own to being to weak to get out of bed or walk. She refused seeing a doctor. I was advised to call 911 by the hospital when I called for advice. To document her refusal to seek medical help and document that it was self neglect not us neglecting her care. That went way better than expected when the ambulance arrived. The EMTs were so kind and sweet with her. We had called 911 and explained the situation. She refused to go to hospital. Papers were signed stating that. My dad was there but ccouldn't make the call without feeling he was betraying her but wanted us to do it. When she started refusing food I would offer food and spoon feed if she was willing but would only eat a little bit. Once she stopped anything but water she lasted 4 days. Slept mostly. I almost waited too long to call hospice. A hospice volunteer met me at Mom's house, saw her, then we talked. Mom didnt want to be in on it, waved her away. The volunteer, a retired nurse, urged the local medical person who would be the "doctor in charge" so to speak as she had no doctor really, to come to the house that night. Thankfully She did. Mom died peacefully in her sleep that night. Had we not had Hospice papers signed it would have meant a full investigation of her death which I've been told can be horendous. I may be wrong in your case but I would urge you to call hospice for that purpose at least. My dad and I were her caretakers. We never used hospice for her physical care. Its a hard decision making time. May her time with you go easy as you continue to care for her.
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This refusal to eat sounds like a change.

Try to get her to take down anything. Boost, yogurt, dry toast. Maybe she has a virus. Maybe she is depressed because her son is out of town. Anorexia frequently is treated with antidepressants.

A bite of this and a bite of that - each bite counts. If she is only able to take a bite or two, strive to make those bites caloric, to sustain her.

My mother refused to eat and was “written off” by her medical team.

We got her eating again, one bite at a time. The process took patience, innovation, distraction, praise and creativity.
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Can you talk to her doctor? Maybe need to consider Hospice?
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My mother is in a memory care facility, with hospice type care, and they never force her to eat. They do feed her, because she is incapable of feeding herself. She accepts food when they feed her. Some people have difficulty chewing and swallowing as they age. If there is difficulty swallowing, the facility gives them thickened liquids. Try tempting her with soft easy to eat foods, like ice cream, pudding, scrambled eggs, yogurt. Do you know what her medical wishes are? Would she want feeding tubes and the like? Many people do not want that, and I spoke with a woman who put into her medical directives that if she could not feed herself she did not want to be fed.
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Refusing food is the first sign that she may be transitioning. I think a hospice nurse should come and see/talk to her. And you separately. Might want to call your husband home. Maybe she will respond in his presence. Or maybe she is waiting for his return. She is at an age that even you can ask her why she won’t eat.
Both my sister and I (separately) asked her if she was afraid of dying and to me she “no, not anymore” which spoke volumes. Both sis and I believe there is an afterlife. My sis told her to come back and give us a sign, she did. Same day we were all (my niece too) visited by a small wild bird.. Brothers aren’t believer so she let them alone. When she left me, still in her house she flew directly into a wall. Turned and looked at me and flew away (still learning to fly)
Dont force her. She needs calm and love and reassurance right now
love and light
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Agree with Patience's answer. I was very sad/upset when our mother started refusing food middle of October-I went to visit her and nobody could get her to eat-nurses, I, my brother. She passed in early December....It is very likely this is the beginning of the transition and you are wise to recognize it. It is a sad and sometimes frustrating time but hopefully you will have some nice moments with her during this time which can comfort you later (true for me).
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Already great replies with regard to transition to next stage. If you so discern, doctors can provide an appetite stimulant for a short time to help with weight gain.

Blessings as you discern the most holy path.
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It is normal as people age and become weaker and ill, their appetites go way down. This is the body's way of saying to prepare for what is coming. Don't force her and make her miserable or sicker - let her decide what her body wants and needs. Be at peace - it is part of the 'process'.
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She’s making a choice.
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You might want to buy her a package of Depends which she can wear and then throw away if they get soiled.
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My mom will say she’s not hungry but then eat if I just put some food near her & don’t say much about it.
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Do you give her Ensure shakes? She might like that. Lots of elderly folks don't want to eat but they still enjoy milkshakes, ice cream, pudding, Jell-O, and other sweets.
She if she'll take a pudding cup or a protein shake. She likely will.
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PenelopePitstop: Imho, perhaps you should contact her primary care physician in regard to the issue that you've posted here.
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Have you offered her something sweet? The taste for sweet foods is the last taste to go. Offer ice cream, or a favorite sweet - but if she doesn’t want it, let it be.
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I'm late to the party, but I want to offer encouragement. Please don't force your mil to eat. Her body may shutting down, and her time may be drawing near.
Honor her wishes, because she may be listening to her body, and if her bodily systems are shutting down, then she will have zero inclination to eat.
I pray she is saved by Christ the Lord so she will spend eternity in Heaven, not Hell. John 3:16 is key here! That's all that really matters, and especially as we near the end of life here on earth.
May the grace of our beautiful Creator be with your spirits. Shalom! 💜🕊💜
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