At the end of life, let Grandma eat what she wants (with some caveats)

By Mary Bartlett
The Oregonian
www.oregonlive.com

After a bad fall, my 92-year old mother, Lois Bartlett, was convalescing at a hospital in her hometown, Tulsa, Okla. Despite her many ailments, she is sharp mentally and interested in getting better. It's her appetite that's gone.

A slim and tall woman, she has always eaten just about everything enthusiastically and, until now, has done her own cooking and shopping.

"The food is awful here!" she wailed. I had to agree that the overdone purées and tough slabs of meat were nearly inedible.

A few days later, my mother said she had a solution. "Christina is bringing me food." Christina Minielly has known my mother for over 30 years and, most recently, has been a caregiver and lunch provider.

I asked what her friend was bringing, imagining some nutritious soup or perhaps some vegetables or fish.

"Sandwiches and potato chips," she said. "And usually there's enough for my dinner too."

A 10-year-old probably shouldn't have a steady diet of sandwiches and potato chips, but for a 92-year-old it's worked well. My mother is back to eating and in fact, that sandwich probably has everything she needs, as least for now.

Better use of time

About 20 years ago my father was dying of lung cancer. I was appalled by his diet of canned soups and frozen food and wanted to make sure that he was eating "correctly." Maybe I thought I could cure him. I tried to tempt him by cooking various dishes with delicate sauces and special vegetables. Sometimes, he'd say, "Don't bother too much with lunch. Isn't there some Campbell's soup on the shelf?"

But I insisted. Nothing like that for my dad! Everything I served him would be made from scratch.

But on another occasion he was more forthright. "I'd really like some Stouffer's turkey tetrazzini," he said. Suddenly I was caught short. Why wasn't I feeding him what he wanted? At that point, his life was really down to just weeks. Shopping and cooking was eating into some nice time that we could be spending together, sitting and reading or reminiscing.

So I learned a lesson. Throughout your life, eating well is important for many reasons and health is only one of them. But at the end of life, the constraints of a healthy diet are not so important. If my mother wants potato chips, she should have them. When she's stronger, maybe she'll go for that nutritious soup I'd like to make her, but I can wait.

Kathy Hefflinger, registered dietitian and certified diabetes educator at Legacy Good Samaritan Medical Center, endorses the approach of lifting dietary restrictions when someone's days are numbered.

"All calories can be seen as good calories when appetites are substantially diminished," she said. "Under those circumstances, foods with concentrated calories are quite useful. It is also true that the sweet and salty taste buds are the last to go, so those foods can be especially appealing."

As a caveat, however, Hefflinger noted that with certain conditions, such as end-stage heart disease, an overload of sugar or salt could contribute to very high blood sugars or weight gain. "Both of those issues would add to physical discomfort," she said.

Tastes and smells

If you're cooking for a sick friend, bear in mind that many foods that smell and taste good when you're well might have the opposite effect when you're sick. Spicy or rich foods, dairy (especially cheese and cream), strong tasting fish or meat are likely culprits. Also, the texture of certain foods, such as steak, can be hard to handle. Salads and salad dressing can taste much more acidic when you're not feeling up to par.

Rylen Feeny, director of education at the Wellspring School for Healing Arts in Portland and a whole foods nutritionist, said there are many factors that can cause appetite to diminish in the elderly:

Pain: Makes it difficult to prepare food.

Poor dental hygiene: Makes it hurt to chew.

Lack of taste: Caused by medications and other reasons.

Mental factors: Loneliness, depression, forgetfulness can all result in a lack of appetite.

Digestive concerns: Often what one considers healthful can be nearly impossible for older people to digest.

"I often ask students which is healthier for an elder person to live on for a week, ice cream, or rice with veggies. Ice cream is actually the better choice, as it will provide more protein, calcium and fat," Feeny said. "Not that I am suggesting that we provide a diet of ice cream. But many elders need fat and protein."

So what are some good choices? Soup is a good bet with clear broth and some vegetables, a bit of rice and a little chicken. Some like rice pudding or applesauce. Using a mild cheese, a warm grilled cheese sandwich can be tempting. Feeny suggests pot pies, stews and purées of well-cooked foods rich in protein as perfect elder foods.

My mother's artist friend Rhonda Davis often brings her tasty treats. "You know this stuff, hummus, is really good," my mother commented one day, fishing around for more pita bread. Bear in mind that your older friend won't eat much, and heavy pots or bowls will be hard for a frail person to handle. A pint of soup, a small container of stew, or a slice of pie will be just right.

My husband's mother, Mary Allman, had a poor appetite in her last weeks. One day I made her a simple egg custard. It was plain and digestible and she ate some of it. It sparked some memories of her childhood, which she recounted with quiet pleasure. I enjoyed the stories and was glad that the custard coaxed them out and had given her a little energy.

-- Mary Bartlett is a Portland writer and the author of "Throw a Great Party: Inspired by Evenings in Paris With Jim Haynes." 

http://www.oregonlive.com/health/index.ssf/2013/05/just_let_grandma_eat.html