We are two daughters responsible for the care of our 77-year-old mother, who has mid-stage AD and is in the memory-loss unit of an assisted-living facility. (One daughter is local, one is out of town.) Up until now our care-related stresses have been pretty minor, and we are very grateful for how lucky we've been. By and large she's been docile and agreeable as long as everything's familiar.

The biggest problem we have is our mother's reluctance to eat or drink. (She eats very little besides breakfast and desserts, but has put on weight since she arrived there two years ago. She's not on any appetite stimulants, but is on Aricept, Nemenda, Zocor and a blood-pressure medication.) A year ago she was diagnosed with a UTI and put in the hospital for intravenous antibiotics, not a good experience for either her or her daughters, one of whom had to sit with her every minute or she would become predictably agitated. Since then we've tried hard to keep her hydrated, but if we're not around the chances that the ALF staff will push for this are pretty small.

Three weeks ago she was diagnosed with gout and had colchicine prescribed, with NO warning that it should be discontinued if diarrhea occurred. The foot pain subsided quickly but the nurse at the ALF recommended keeping her on the colchicine for the entire two-week course even though she was experiencing constant diarrhea. Lo and behold, by the end of the week she was severely dehydrated, her blood pressure was acutely low and she was starting to to into renal failure. Ambulance trip to the hospital,two days on IV fluids and as much fluid by mouth as we could get into her, and then she was deemed sufficiently hydrated to go home.

Since her return home three days ago, however, she has been adamant in her refusal of food, although we have been able to get some fluid into her. She says she's not hungry and everything tastes like sawdust (which we understand is normal), although she does acknowledge feeling thirsty. She complains of not feeling well but can't articulate specific ailments, frequently complains of feeling dizzy (which we know is common with dehydration), is very reluctant even to get out of bed in the mornings, and has just in the last three days become verbally abusive to the staff and to some degree to us when we try to encourage her.

THIS IS A HUGE AND SUDDEN CHANGE in her personality from even two weeks ago, and it is completely new. Our question: Is it more likely that the trauma of two days in the hospital entirely responsible for this change, and it will subside once she re-accustoms herself to her regular surroundings, or is it more likely that we are in for a permanent personality change and need to address it accordingly?

Thanks for whatever advice you can offer.

Dear Laine & Susie,

Hello, and thank you for using the Alzheimer’s Association Online Community. Proper nutrition is very important in keeping the body strong and healthy. Regular nutritious meals may become a challenge for those with dementia. People who are in the stages of Alzheimer’s may begin having problems eating due to many factors. These factors include loss of appetite, non-recognizable hunger cues, becoming overwhelmed by the eating environment or food choices, or forgetting the purpose of eating or how to use eating utensils.


The stressors/trauma of being in a hospital can serve as possible factors for changes in appetite. To encourage your mother to eat, try some of the following suggestions. Try serving her meals in a quiet environment away from a television or other distractions. Keep the table setting simple with only the utensils needed for eating. Other objects on the table may be distracting or confusing. Only offer one food item at a time. An example of this could be first serve mashed potatoes, then cooked meat. Too many food choices may be overwhelming for her. You can provide visual cues/or verbal directions, prompting her to eat by taking a utensil, placing food on it, and raising it to your mouth; this may mirror eating behavior. Always serve foods that she may prefer, and if at all possible, serve finger foods, or smaller bite-sized food items that may be easier to pick up and eat. Nutritional supplements, such as Ensure or Boost are good for dehydration, and you may also try offering nutritious milk shakes, “smoothies” or eggnog as a means for hydration. Talk with your doctor or pharmacist about vitamins as an adjunct, and low calorie snacks such as apples and carrots are all possible.

If you have any questions, please feel free to contact us 24 hours a day/7 days a week at (800) 272-3900. Thank you for using the Alzheimer’s Association Online Community.



Sincerely,

Dear Laine and Susie: I had responded and suddenly, the post disappeared, so here I am again.

Was your mother catheterized while recently in the hospital?

With the abrupt onset of changes in her personality and behavior, I would suspect the possibility of a, "silent UTI."

This is quite common in the very elderly, especially women. My mother gets about a half dozen of these per year. No pain, no burning, no frequency, no change in color. She just starts to get those personality and behavioral changes, and 9.9 times out of 10, she is positive for a UTI.

If your mother was cath'd while in the ER or hospital, she was placed at increased risk for UTI with the invasive procedure and this may be what you are dealing with.

I also wanted to tell you, that when your mother was treated with IV abx a year ago and she had such behavioral issues; was she ever treated with that particular IV ab before? If so, did she have the same behavioral issues?

The reason I ask, is that my mother was treated twice with IV Levoquan and each time she went completely off the scale with behaviors and loss of cognition. She was accidentally treated with the same drug a third time with the same result. It was absolutely bizarre. She didn't even know who she was or who I was.

Once the Levoquan was stopped, she recovered very quickly. Levoquan is a wonderful ab, but it is now on my mother's allergy list - it just takes her to an alternate universe.

Other antibiotics can also cause the same reaction, so I just thought I would ask if she had ever experienced that ab before.

Interestingly, I am sensitive to Zithromax and felt myself going over the top, called my doctor and he dc'd it immediately. He told me about a patient that got that drug in the hospital and became so bizarre they initially thought he was having a psychotic break until they realized it was the drug.

My husband and adult children can take Zithromax without any difficulty, but it's one I cannot take again.

Funny how that happens. Best of wishes to you, you are excellent advocates for your mother. She is blessed to have you in her corner.