Guiding the Hand That Feeds

The phone message from the patient's daughter is ominous. "Mrs. F. has eaten nothing all weekend. What should we do?" A 70-year-old woman with severe dementia, Mrs. F. rarely speaks, is confined to a wheelchair, and requires diapers because of incontinence. She has been kept out of a nursing home by the efforts of a devoted family and daily attendance at a geriatric day-care center. During the past year, her social interactions have decreased, and her food intake has become increasingly erratic. First, she stopped feeding herself; now, even though she is fed by hand, her intake continues to decline. . . .