When George came to us, he'd spent several months in the hospital. A tall man, he looked severely undernourished. "He's a small eater," his wife said. That's when I discovered his diet in the hospital consisted of sandwiches his family brought in and his favourite chocolate bar. I opened the drawer of his nightstand to look for something for him, and found it full of chocolate bars!
Nutrition and the elderly is a minefield of choices and difficult decisions. Meals should be a pleasant experience and not a tug-of-war. In the end, it comes down to choice, and your elder has the right to make that choice.
Let's look at a place to start and a question to ask.
In looking at nutrition, the place to start is to identify any gaping deficits. The best way to do this is to have your doctor perform a comprehensive blood workup. Simple blood work can easily identify which areas need attention. This should always include a fasting blood sugar to identify diabetes, B12 levels, and tests to check liver and kidney function. If a deficiency is discovered, it may be necessary to take a supplement to address it, but you can also look at nutritional answers.
Next is the question: What is your goal? Weight loss? Weight gain? Diabetes control? Improved nutrition? Bone health? There are so many reasons to look at nutrition, and you may be tempted to say, "All of the above." The truth is, you need to pick your battles. Choose one primary goal, look at a few simple changes that might be made and strategise how to make them.
Let's look at weight loss. Many elders have a decreased appetite. Perhaps they are bound to bed or a wheelchair and aren't moving enough to feel hungry. It's possible some of the medications they take suppress their appetite, and taste buds don't work as well as they used to. Another factor is texture. If they have difficulty swallowing, they may need their food minced or pureed. It may be exactly the same food, but I refer to this as "mush," and there's no way to make it as appetizing. All these factors combined can lead to significant and even dangerous weight loss.
How do you promote weight gain as a goal?
- Even people bound by wheelchairs benefit from fresh air and a change of scenery. Whenever possible, take them outside. Even if they aren't exercising, they may feel more hungry after a dose of fresh air and sunshine. If you are feeling adventurous, have the next meal outside.
- Speak to your doctor about the problem, and ask if any of their medications could be part of the problem. Ask for his/her suggestions.
- What do they like? Flexibility is important. Maybe you made a lovely chicken dish, but what they really want is a fresh omelette or a grilled cheese sandwich. What are they more likely to eat? Be willing to change the plan at the last minute.
- Be creative. One lady in my neighbourhood was extremely thin and losing weight. She loved her soup, but it was almost a clear broth, and she'd fill up on just a few calories and not be able to eat the protein portion of the meal. We started adding pureed food to her soup to make a thick broth. She still enjoyed her soup but got the benefit of the whole meal. Lots of healthy ingredients can be hidden in porridge, soup and spaghetti sauce. Just saying.
- Sometimes the doctor will order a supplement. Make sure this is given after the meal, so your elder gets the benefit of real food first.
- The social aspect of a meal is paramount. People eat more and better when they participate in an interesting and fun conversation. At work, I chat with those I am assisting, even if they can't talk back. It improves digestion.
- Don't focus on the goal. For the most part, your elder doesn't need to be aware that there is a goal. Keep meals and snack times fun and flexible.
- Keep it flavourful. Lemon, fresh herbs, a hint of garlic--use whatever you think you'll get away with to make your meals taste appealing.
All of these principals can be adapted to any nutritional problem. And don't forget to throw in an occasional chocolate bar!
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