Tips for Improving Nutritional Intake of the Elderly
Elderly Nutrition: A Concern
Why is elderly nutrition a concern?
When we think of nutrition, our mind immediately turns to the issue of what foods we consume. We all know that fresh fruits and vegetables, as well as whole grains, are a good way to go. We know that getting enough protein—whether through meats, beans, legumes, or via some substitute—is also critical. We know to avoid high fat, sugar, and salt-laden diets. For the elderly, however, another problem can creep into the picture. That problem is undernutrition, which occurs as they begin to consume less food over time.
Certainly, lower consumption is not always a negative thing, but in some instances, it can put their health at risk. In some situations, undernutrition and malnutrition can act to create a number of other health issues; from hair loss to anemia to B12 deficiency, and on into the realm of more serious ailments. Those who are undernourished also tend to heal wounds more slowly and have difficulty recovering from injuries and surgeries. In more severe instances, undernourishment in the elderly can become life-threatening.
I am not a physician or nutritionist, I was a caregiver for my elderly mother and was a therapist who dealt with eating/swallowing disorders for many years. Any problems with eating or nutrition should always be discussed/evaluated by a physician. However, I want to share a bit of my experience to provide information for individuals who care for the elderly to help them recognize when a need exists and how to respond.
Why Does This Happen as We Age?
There are a variety of reasons why some elderly individuals may have trouble maintaining adequate nutrition, many of which are still being studied, but here are some common thoughts on the topic:
1. Changes in our senses.
Taste changes, we enjoy food less, and therefore, we tend to eat less. We don't anticipate food, we don't enjoy it as much. Smell can also decrease. Our sense of smell is actually a large reason for why we enjoy food.
2. Less activity.
Typically, someone who is 70 or 80 years old isn't nearly as physically active as they once were. Activity is theorized to increase appetite. Thus, lack of activity is another negative influence on elderly nutrition.
3. Medications and treatments.
Many older individuals take an increasing number of medications. Ingesting several pills each day can be filling, but beyond that, are the appetite suppressing side effects of many medications. Bronchodilators, some cardiovascular medications, and drugs used to treat dementia are among those that suppress appetite.
When medications are taken incorrectly (for instance on an empty stomach) or the medications taken are known to cause stomach irritation, digestive problems such as ulcers can develop. This irritation can inhibit hunger, create a feeling of fullness, and so forth.
Certainly, if an individual undergoes chemotherapy appetite can be reduced while radiation may cause inflammation or scarring in the esophagus.
4. Diseases and disorders.
Many elderly individuals may be dealing with a disease or disorder that can reduce their appetite or make eating difficult. Loss of motor function or reduced sensation can create problems. A stroke, for instance, could result in loss of motor function/movement in the mouth or the throat creating difficulty in consuming food orally. Parkinson's, multiple sclerosis, and other neurological diseases (including some tumors and cancers) can result in similar muscular problems that make eating difficult.
Swallowing problems (dysphagia) can also arise or a number of digestive disorders such as strictures and GERD (reflux) which can make eating unpleasant, painful, or difficult.
5. Dental problems.
Many elderly individuals have false teeth. If their dentures don't fit well, this can make chewing many foods difficult. If their dentures are old, they may also be worn down too much resulting in an inability to break down food efficiently. The individual may avoid meat and other hard to chew foods.
6. Psychosocial issues.
Many elderly individuals may experience isolation, depression, or other psychosocial issues that affect appetite and their nutrition negatively. Many seniors have to deal with families who are distant or too busy to socialize with them on a regular basis. Their friends may die and they may have or health or financial issues which escalate and lead to these issues of isolation and depression.
Pain can have a very negative effect on appetite as well. Working with a physician to identify the source of pain and to keep it controlled is critical if you are working to improve nutritional intake.
Tips for Improving Elderly Nutrition
Helping an elderly individual to improve nutritional intake can be difficult and there are seldom easy answers. However, here are a few things that could potentially help:
1. Decrease meal size and increase the frequency of meals.
An individual with a reduced appetite will likely respond more positively to small meals and snacks versus an overflowing plate. Smaller meals can also benefit individuals who have certain digestive problems.
2. Increase variety.
Certainly, although taste and smell may be diminished as we age, our appetite can be blunted somewhat by eating the same things over and over. This is something that isolated individuals tend to do. Thus, getting them to vary their diet more can help stimulate appetite and, in many instances, can improve the nutritional balance of their meals. While some elderly individuals may gravitate toward bland foods, trying foods with more and different flavors may help stimulate appetite.
3. Increase socialization.
Eating is a social activity for most of us and we tend to eat more in social situations. If an elderly individual lives alone, they don't get this interaction. Eating can become a chore. Moving eating back into the realm of socialization can help. It can also enhance their overall mood. Scheduling time to eat with an elderly loved one more often or hiring a companion can be two of the options available.
4. Increase the level of activity.
Getting an elderly individual involved in more physical activity can help stimulate appetite and improve nutritional intake. From taking a walk around the block to participating in group exercise, any activity can be beneficial as long as a physician approves it.
5. Investigate oral medications.
Talk with the physician about which medications may be reducing appetite. Can the medication be changed to something with less of a negative effect on appetite? Can some medications be taken via other routes to reduce the number of oral medications taken each day? Some medications, for instance, have an alternative that can be given less frequently or via a shot, a patch, nasal inhaler, or some other method.
6. Consider high-calorie supplements.
There are a number of products available that provide more calories, more protein, and other nutrients that can be used to supplement meals. Products such as Boost, Ensure, and other shake-like drinks are common. Again, check with the physician for recommendations on supplements to boost elderly nutrition. These come in the form of bars to chew, thickened drinks like shakes, and in a juice-like form.
7. Increase protein intake.
Although you want an increased caloric intake, increasing carbohydrates primarily isn't often the best way to do it. Increasing protein intake will offer more benefits and should be a target as well.
8. Evaluate the need for assistive or rehabilitative services.
Some elderly individuals may have difficulty preparing meals. Whether it is an issue of strength and endurance or something else, it is appropriate in some cases to have meals delivered or prepared ahead of time by a family member. In other situations, rehabilitation may be needed for the purpose of increasing strength and endurance or to evaluate the need for assistive devices to help with self-feeding.
9. Consider their mental health.
An evaluation by a healthcare provider/physician is important. If depression, or perhaps cognitive problems exist, they need to be addressed.
10. Consider Appetite Stimulants.
A doctor can evaluate and prescribe these as needed. Megestrol Acetate is one sometimes used for patients on chemotherapy but can be effective for other individuals as well.
11. Consider other physical problems.
If an elderly individual coughs during meals or seems to have difficulty getting their food chewed and swallowed, an evaluation is necessary.
Certainly, complaints of nausea, vomiting, bloating, and so forth could indicate digestive or other medical problems as well. Again, a medical evaluation should be pursued first in these cases.
In addition, check their dentures to be sure they fit well. If there has already been significant weight loss, this will influence the fit of dentures as will the bone loss that occurs in many individuals as they continue to age. Good dentition is critical for adequate elderly nutrition.
© 2009 Christine Mulberry