This insightful seminar gave us an actual understanding of what it feels like to be old. We placed actual corns inside our shoes to mimic corns in our feet, wore glasses that mimicked glaucoma, had our fingers taped to mimic arthritis, put marshmallows inside our mouths so it was hard for us to be understood when we spoke. Then we were made to dress ourselves, go to the doctor's office, get our prescriptions, go to the bathroom, fall in line, and were herded to go places with no explanation. We felt a sense of powerlessness and frustration because no one understood us, and a sense of embarrassment, anger, and confusion. These experiences made us realize that we needed to understand the elderly rather than judge them because of their age.  It made us think about the root cause of the difficult behavior rather than relating it to age.  We learned the following:

 

• Difficult behaviors among the elderly are an expression of a "need"; whether to be in control, to gain attention, to use the bathroom, to be left alone, or a feeling of fear or pain. 
• Dementia is a decline in thinking skills exhibited by a gradual loss of memory, disorientation, difficulty learning, loss of language skills, and decline in ability to perform routine tasks.
• Alzheimer's Disease, where there is a gradual loss of brain cells, exhibits behaviors like delusions, hallucinations, searching for loved ones, sun-downing, wanting to go home, suspiciousness and losing or misplacing objects.  They lose short term memory and retain long term memory.
• Depression is exhibited by appetite changes, sadness, cognitive impairment, isolation, thoughts of death, fatigue, sleep pattern change, and decreased interest in activities. Medical illness can cause depression symptoms.
• Anxiety disorders occur often among the elderly, such as obsessive compulsive disorder, social phobia, panic disorder. Symptoms of anxiety can become excessive enough that it interferes with activities of daily living.
• Refusal to eat can be caused by: decrease in appetite, decrease in sense of smell and taste, problems with oral hygiene, not wanting to eat alone or in big groups, the type of food is not what they are used to eating based on lifelong patterns, physical problems that make it difficult to eat, food is unappetizing, depression, using food as a means of control, and a way of ending one's life without overtly committing suicide.

As Consultant Dietitians we have encountered this behavior often among the elderly population which can cause weight loss, malnutrition and dehydration. Seniors take an average of 5-7 different types of medication each day which can affect taste and appetite. Poor dentition can make it uncomfortable or painful to eat foods. Finally, behavior challenges like depression, not wanting to eat in big groups or by themselves, and confusion can lead to decreased intake. The seminar provided suggestions for improving intake with the focus on getting to know each resident as an individual and tailoring a plan to fit their specific needs.