Arthur Bloch has slowly been losing weight over the past six months. His thyroid function and all his routine labs are normal. He has had a chest x-ray, and he had a colonoscopy and an upper endoscopy a couple of years ago. He says his appetite isn’t what it used to be. He tells me he doesn’t have any trouble swallowing.
His Parkinson’s Disease is causing him to speak in a quiet, almost whispering voice, and his body movements and facial expressions are sparse. I have wondered if he might be depressed. He filled out a depression questionnaire a couple of months ago, and it was fairly unremarkable.
He and his wife, Zena, have had their share of health problems. Zena has become quite frail and has a mild dementia. Over the past few months, they have been set up with Meals on Wheels and homemaker services. Neither Arthur nor Zena drives anymore, and they are getting rides from the Senior Companion program. They usually come to each other’s appointment, in fact they seem inseparable and very devoted to each other.
Today, Arthur happened to be in alone. Zena was at the hairdresser’s. I reviewed his negative weight loss workup with him.
“I know why I am losing weight”, he declared. I looked quizzically at him. He continued:
“It’s the Meals on Wheels. Zena was always a wonderful cook and I ate like a king for fifty-two years, but with her dementia, she can’t cook anymore. She feels bad about it, but we have no other choice except Meals on Wheels. I don’t care for many of the meals, but I don’t want to say anything. That would just hurt her feelings. So I say I’m not hungry.”
“But you are hungry”, I concluded.
“Yes.” His eyes teared up.
“Can you get some desserts and instant breakfasts?”
“I suppose.”
The mystery of Arthur’s weight loss may be gone, but I am just as helpless with a diagnosis as I was without one.
Might we think of hunger as physiological, appetite as emotional? Arthur has no interest in the food he's given; perhaps it is his grief--he has sufficient reason to grieve. We can separate (from my work experience), grief from clinical depression that the questionnaire looks for. Arthur needs supports in addition to food.
That is a heartbreak. I assume they are too rural to to get a resturant, a civic group or a church group to deliver something to look forward to a least once a week? I participated in such a scheme with a few friends for an food insecure elderly couple. Our effort was in addition to meals on wheels but we were not as rural as you are and the weather in the western Oregon was far more forgiving. It was a a four year effort, until they needed to move into an assisted accomodation but the food prep and give was easy to do just add two extra servings to my routine and make it special. I learned about the couple thru the local Rotary club. Maybe your post here will reach a local group.