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An elder refuses to eat: what should a caregiver do?

by Isabel Fawcett, SPHR

Family members and healthcare personnel sometimes agree to disagree on what needs to be done when an elder refuses to eat. Among caregivers, the answers to this question vary. However, the answers may not be mutually exclusive.

First, Do No Harm

One need not be a doctor to adhere to the ""first do no harm"" clause of the Hippocratic Oath. It would be negligent, irresponsible, and may have criminal implications, if a caregiver were to allow a family member to starve to death. Therefore, the short and simplest answer to the question often posed by caregivers is that there is a point where elders who refuse to eat need prompt medical intervention. Seek medical intervention long before the situation gets out of hand.

The Recurring Million Dollar Caregiver's Question

Few care circumstances are black and white, or even extreme. So, what needs to happen on those on-again, off-again days where elders refuse to eat, or constantly spit-out food? My practice is, if at first I don't succeed, I'll try, try again.

Without forcing your loved one to eat, or making meal times unpleasant by nagging, there are a few things you may want to consider short of waving the white flag of caregiver surrender.

  • Serve smaller meal portions on smaller plates, including your own.
  • Make sure the food is soft enough to comfortably eat, chew and swallow. Now is not the time for fried chicken or stringy asparagus stalks. Try polenta with a large flake of broiled salmon on top. Forget the salmon fillet service!
  • Skip herbal garnishes that may look like tiny insects crawling in food.
  • Sometimes a light and smooth sauce or greater moisture in meals helps elders to better eat, chew, swallow and enjoy foods that might otherwise be too dry for them to handle comfortably.
  • Verbally recognize and celebrate any food portions eaten with praise. I often remind my mother that we eat to live, not live to eat. ""I'm proud of you for eating a little something, Mom!"" She is visibly relieved whenever I make that comment.
  • Remove plates and uneaten food as soon as it becomes clear that your loved one has eaten as much as he or she can at that meal serving. Leftover food that remains visible may inadvertently reinforce not eating, guilty feelings, unappetizing meals, and may contribute to feelings of nausea for chronically ill individuals.
  • Before the next meal serving, casually serve a light snack like chilled or frozen grapes, biscotti for dunking in a hot cup of tea, a small cup of applesauce, or yogurt with rolled oats mixed-in.
  • Ask, before preparing and serving meals, whether your elder is hungry or not. Get a feel for what your elder's answers really mean. Sometimes it helps to go five to ten or more minutes past regularly scheduled meal-serving times to ensure that some food will be eaten. Allowing an elder to own his or her meal service schedule is more effective than rigid clockwork meals with no flexibility for normal individual appetite quirks.
  • Refusal to eat one meal does not a disaster make - not necessarily, that is. Hang loose to see what happens at the next meal. Sometimes, by the time the next meal is served some hunger pangs will have kicked-in. Other times, real appetite picks back up no later than the following morning when it's time to break the night's fast (breakfast). Late night hunger also may be part of the bigger care picture. Have something light to snack on for those wee hours of the morning hunger pangs.
  • Many individuals have a favorite meal of the day. Elders are no different. If you can determine which meal is your elder's favorite, try to pack the day's best nutritional punch into that one meal. It may be your best - sometimes only - shot at balancing your elder's nutrition for the entire day. My mother loves her first meal of the day, thankfully.
  • Be sure to track elder snacking throughout the day. Some elders sneak snacks in between meals that diminish their appetite when regular meals are served.

The more you can go with your elder's appetite flow, the more successful you may be at riding out normal appetite doldrums. Just be sure you know when to call the doctor, or whether emergency medical care is needed. Other than such times, chalk it up to your elders' finicky eating habits.

I know how that goes. As a child, all I ever wanted to eat was spaghetti and meatballs. My pediatrician helped Mom not lose sleep over that little appetite quirk of mine. ""When she's hungry, she'll eat, Mrs. Fawcett,"" he said. I've always remembered the relief I felt when my then-pediatrician enlightened Mom. His wisdom holds true for mature adults as well.