Caregivers often worry when their loved ones begin pushing away food because of digestive issues or a lack of appetite. We know that they need proper nutrition in order to maintain and improve their health, but how do we make this happen when they don’t want to eat?
For advice on this issue, I turned to Elizabeth M. Ward, M.S., R.D., who cared for both of her aging parents. As a registered dietitian, she takes a realistic approach to nutrition. Ward believes it’s important to consider each person individually when trying to come up with strategies for combatting poor nutrition. She also recognizes that devising these strategies involves a lot of trial and error and that effective techniques will probably change as time goes on. Ward addresses caregivers’ common concerns about senior nutrition below.
Reasons Why Seniors Don’t Get Adequate Nutrition
There are several common issues that can prevent older adults from getting the nutrition they need. Some of these can seem like small annoyances, while others are medically serious and more difficult to accommodate.
Therapeutic Diet Orders
“One-size-fits-all restrictive diets can be problematic,” says Ward. A general therapeutic diet order, such as low sodium or low sugar, should not prevent an elder from eating enough. If it does, Ward suggests that the order may be too restrictive and should be reviewed with the doctor or a dietician.
These orders are prescribed for a reason, Ward notes. “My mom had type 2 diabetes for years and restricted her sugar intake because of it. However, she lost a significant amount of weight between doctor’s visits one year. When her physician tested her blood glucose, we found that it was in very good control and she no longer had to take medication or follow a restricted diet. This is an excellent example of how dietary needs change over time.”
Any caregiver can attest to the fact that most seniors take a lot of medications. While some of these drugs can save lives, they can also cause unintended problems. “Side effects can include reduced appetite, dry mouth or a bad taste in the mouth,” Ward warns. “Some medications interact with the nutrients in healthy foods, such as blood thinners and vitamin K, to cause adverse effects.” Ward urges caregivers to read prescription inserts and work closely with a pharmacist and their loved one’s doctor to prevent and solve any medication issues.
As we age, our ability to enjoy food with all of our senses can be reduced. “One of the first senses to dull is smell,” explains Ward. “The ability to sense odors and scents is directly connected with our sense of taste, so many seniors tend to simply find food less appetizing. If you can’t taste and enjoy food, why eat it?” Vision problems can also affect a loved one’s appreciation of and involvement in meal times.
Age can also wreak havoc on our teeth, mouths and the very beginning of our digestive tract. “Many seniors have lost teeth or wear dentures that can interfere with their ability to chew food comfortably and effectively,” Ward points out. Gum inflammation, oral sores or poorly fitting dentures can cause pain and discomfort while eating, and neurological conditions like dementia and stroke can cause swallowing issues that make it both difficult and unsafe to eat certain foods.
Basic Nutritional Requirements for Seniors
Older people do have some unique dietary requirements when it comes to vitamins, minerals, fluids, protein and fiber. Caregivers can use these guidelines when cooking for their loved ones and to help monitor their diets.
Vitamins and Minerals
According to Ward, seniors need more calcium and vitamin D but less iron than their younger counterparts. In addition, individuals aged 50 and older are more likely to absorb vitamin B12 poorly. The recommendation from the Institute of Medicine is to get most of this vitamin from fortified foods or dietary supplements. The synthetic form of vitamin B12 used in these sources is better absorbed by the body than the kind that occurs naturally in foods.
Ward is also a big fan of a daily multivitamin. “My mom started with a regular pill for people over 50, which means it contains no iron or very low iron,” she says. “Eventually, that got to be too big for her to swallow comfortably. We cut it in half for a while, but then that didn’t work anymore either.” They switched to a chewable version and eventually settled on a liquid multivitamin. “It’s very important for seniors to get all the vitamins and minerals they need. Contrary to popular belief, daily multivitamins don’t overdo it on nutrients. In fact, most elderly individuals need calcium and vitamin D supplements to achieve the minimum required daily values.” This is especially important for those who do not go outside frequently and receive little or no sun exposure.
“I can’t say enough about making protein a priority in people of all ages,” urges Ward, “particularly in people with limited appetites who tend to gravitate toward simple carbohydrates when their hunger declines.” Protein is responsible for preserving muscle strength, bolstering the immune system, and for the growth and repair of all tissues, including surgical wounds and pressure ulcers. “Inadequate protein leads to skin breakdown and muscle loss, which leads to inactivity, which then leads to a decreased appetite, and becomes a downward spiral,” Ward warns.
Low fiber intake can result in constipation. Plus, many medications can slow down the GI tract, which increases the likelihood of constipation and discomfort. “I found it difficult to work enough fiber into the diet of a limited eater,” Ward admits. Seniors need about 25 grams of fiber daily.
It is important that elders consume about 64 ounces of fluid daily, but that is a very general recommendation. These fluids do not all have to be consumed in the form of water. Coffee, tea, milk, juice, broth, fruits and vegetables all count toward the daily intake. If a loved one has a condition like heart failure, a physician may suggest that they actually limit their fluid intake. Recommendations depend on your loved one’s individual situation.
How to Encourage a Senior to Eat
Since Ward knows all too well how nutrition plays a huge role in wellness, it was painful for her to witness her mother’s poor eating habits. Frustration can cause family members to cross the line between healthy encouragement and badgering. “I did pester my mom to eat,” Ward confesses. “I thought of it as encouragement, of course, but looking back, I am sure it was more like nagging.”
One of the best ways to encourage a senior to eat is to serve many small, nutrient-dense snacks throughout the day instead of the traditional three large meals. “A plate full of food can be overwhelming for someone whose appetite is diminished,” Ward notes. Smaller servings set a more realistic goal and do not highlight their “failure” the way a small dent in a large meal does. “Try not to put a great deal of pressure on your loved one to eat. If possible, give them the power to choose some of the things they eat, and keep mealtimes casual and upbeat.”
Tips for Fortifying a Senior’s Diet
“Implementing all of these guidelines is where things get tricky and where we caregivers need to get creative,” acknowledges Ward. People need adequate nutrition, but that doesn’t mean they have to eat large portions to get it. “Maximize an elder’s food intake by serving the most nutrient-rich foods possible and by packing their small meals and snacks with protein, nutrients and calories.” Ward offers her best tips for boosting a loved one’s diet.
- Easy-to-Consume Protein
As a caregiver, I focused on protein with my mom. Whole eggs are a great source of protein, vitamins and minerals. They are versatile, convenient, relatively inexpensive, and easy to chew and digest. In addition to eggs, I used Greek yogurt, cheese, cottage cheese, tuna fish, salmon from a pouch or can, and finely ground beef in pasta sauce to up her protein intake.
Swallowing foods safely became an issue for her, so I began blending her foods. I would make protein-rich chili with meat and beans and puree it. Full-fat cottage cheese blended to a smooth, creamy consistency can be used as a spread on top of whole grain toast, or added to jarred tomato sauce to create a protein-rich pink sauce for serving over pasta.
- Blend Up a Smoothie
Make your own smoothies from scratch or use the highest protein nutrition shake you can find as a base. Other protein-rich bases include ice cream and Greek yogurt. Simply blend your base of choice with a variety of fruits, vegetables and even healthy fats. (See my sample smoothie recipe at the very end of this article!) Keep in mind that most pre-made nutrition shakes are highly fortified with vitamins and minerals. If you use these shakes regularly, you probably won’t have to worry about giving your loved one a multivitamin. If they are on a blood thinner, account for the amount of vitamin K in any shake or ingredient you add to a smoothie.
- Try Protein Powder
Protein supplements are very useful for increasing an elder’s protein intake because they don’t require chewing and they don’t add bulk to foods. I prefer whey protein powder because it promotes protein-building in the body better, but you can also use dry milk powder or peanut butter powder. There are many varieties and flavors on the market. My mom loved oatmeal for breakfast, so I used a whey powder to transform this favorite of hers into a vehicle for protein. Luckily, she was also accustomed to preparing her oatmeal with milk rather than water. The combination of the dairy and the powder doubled up the protein content of this simple meal.
- Add Fats
Butter, avocado, creamy peanut butter, and canola, coconut, and olive oils, can be added to foods such as mashed potatoes, smoothies, pureed vegetables, soups, and so much more. I would load my mom’s foods up with healthy fats whenever I had the chance.
- Fill Up on Fiber
A good rule of thumb is to encourage consumption of whole grains, fruits and vegetables every day. Legumes, such as beans, lentils and peas, can be served pureed, mashed or whole. They are packed with fiber and other nutrients. Fruits and vegetables are also packed with fluid, which works with fiber to ease constipation. One of my mom’s favorite meals was Amy’s Kitchen canned lentil soup, which I would try to have her eat with a high-protein grain (such as whole-grain couscous) and a sprinkle of cheese on top for some extra fat.
- When in Doubt, Opt for Extra Help
While real food is the best way to obtain proper nutrition, sometimes seniors need a little help meeting their needs. With my mom, I used a supplement called Benecalorie, with a goal of adding 1 small container each day to her food. One container provides 33 grams of fat, 330 calories, and seven grams of protein, so it can add a lot of nutritional value without significantly increasing the volume of the food you serve it with. This option is not inexpensive, but it was worth helping my mother meet her nutritional needs. It can go in most foods and is easy to add to smoothies.
Basic High-Protein Smoothie Recipe
- 1/2 cup of plain or flavored full-fat Greek yogurt
- 2 to 3 tablespoons of protein powder
- 2 to 4 tablespoons of whole milk (use more or less depending on the person’s swallowing ability)
- Fruit, such as 1 large frozen banana or 1/2 cup of frozen fruit like berries, peaches or pineapple
- Cooked vegetables, such as canned pumpkin or sweet potato, and raw varieties, such as a handful of baby spinach or kale