How can I stop my mother with dementia from biting her nails?

A fellow caregiver asked...

My mother is 87 and in the moderate stage of dementia. This last week she has started to chew voraciously on her fingernails, which she has never done before, and can't be stopped by gentle reminders. Also her table manners have deteriorated and she eats with her utensils in one hand and her fingers on the other and again keeps on despite reminders. Any suggestions would be appreciated.

Expert Answer

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

There are so many manifestations of dementia in the elderly and, most particularly, in the progressive type such as Alzheimer's disease (AD). Putting objects in the mouth is known as hyperorality as is generally noted in some elderly dementia patients who have been diagnosed with Lewy Body disease. As diseases like AD move into the later stages, the recognition of utensils frequently is lost; the patient no longer can identify what to do with a knife, a fork, a spoon, and other dining articles such as sugar or salt and pepper. When this begins, as it is for your Mom, this is a signal to remove these items from her mealtime serving and replace your regular menu with a Finger Food menu consisting of foods that can be picked up with fingers rather than with silerware. Sandwiches cut into small pieces, soups served in a mug, cut up veggies and fruits are all ideas for making dining as easy a possible for your parent and as pleasant as possible for the caregivers.
Don't reflect on what you are placing on the meal plate. I have witnessed appetites improve greatly for AD folks once a finger food menu has been introduced featuring such delicacies as pasta sandwiches, cold cut / cheese rollups stuffed with a favorite jam or preserve, and broccolli spears dipped in honey. The addition of sweetness often aids the dining process. Using a bright solid color plate, and keeping her 'space' totally uncluttered also makes dining easier by helping her to focus on the task. You may also want to try wrapping her hand in an ice cube soaked wash cloth and allowing her to such on the cloth rather than chew her nails. Do discuss this with her physician and ask an Occupational Therapist (OT) for fresh ideas. I suggest also a call to your local chapter of the Alzheimer's Association for further info on this manifestation. Do take care of YOU!