How to improve nutrition in the elderly patient
As people age, some elderly people become fussy with eating. This leads to nutritional imbalances and possible poor nutrition in an elderly person. If you are reading this article, you may be concerned with your elderly family member's diet.
Factors Contributing to Malnutrition in the Elderly
Some of the common factors that cause malnutrition include
Appetite Concerns: With age, many older adults experience loss of appetite. It happens due to loss of sense of taste and smell, chronic health condition or certain medications. Sometimes the loss of appetite happens because your elderly burns lesser calories due to less mobility and lack of physical activity.
Difficulty in Chewing & Swallowing: If your elderly are facing dental issues like denture not fitting correctly or other dental concerns, then they may have chewing difficulties leading to malnourishment and loss of weight. Besides, most people with age can face swallowing problems too, which makes it difficult for them to eat.
Chronic Health Conditions & Medications: Older adults often have a chronic health condition and take medications that impact their digestion and ability to absorb certain nutrients.
Mental & Emotional Concerns: If your elderly has any mental illness like dementia, depression or social isolation, it may affect their desires and ability to eat.
Loss of Mobility & Strength: Elders can become frail and immobile with age and are unable to shop for groceries and cook. Some of them are unable to make simple and easy to cook recipes too due to mobility issues. This inability to cook impacts their diet, making them weaker.
Ways to Improve Nutrition
There can be more reasons behind elderly malnutrition; however, mentioned above are some of the common ones. If your elderly is experiencing malnutrition or sudden weight loss, then you should consult the doctor to diagnose the underlying cause. Accordingly, you can implement the below tips and help your elderly.
Plan Meals Under Expert Guidance: If your elderly is facing dietary issues, then you can consult a geriatric dietician who can suggest a diet. According to the health condition and specific requirements, a certified dietician can advise a nutrient-dense diet plan and easy to prepare recipes.
Make Soft & Colourful Food: When cooking food for the elderly, ensure that it is easy to chew and swallow. By preparing such a meal, you can help your older adults to eat a wholesome and complete meal. Besides, ensure that simple food is not boring. Make it colourful and appetising.
Serve Small & Frequent Meals: In case of appetite concerns, you can plan small meals and servings for your older adult. It will not be overwhelming for them and can help in fulfilling their dietary requirements.
Make Meal-Time Enjoyable: If your elderly is finding mealtime boring, then ensure that they get accompanied during mealtime. You can have a caretaker for them or cook who comes and prepares and serves hot food. Besides, you can invite friends during mealtimes so that they can interact and enjoy the meal.
Take Advantage of Services: If you are unable to help your elderly, then you can seek professional assistance. An attendant can supervise the meal intake of your older adult, ensuring that they eat correctly and can keep you informed too.
To achieve a healthy diet, as an elderly person it may be necessary to make changes to the way you eat. The following guide contains helpful tips on healthy eating for the elderly.
Eat more fruit
Eat more vegetables, especially dark green, leafy and brightly-coloured ones.
Eat more calcium-rich foods (calcium-fortified soy milk, tofu, milk, cheese, yoghurt)
Replace refined grains with whole grains
Instead of white rice and white bread, choose brown rice, wholemeal bread and oats
Replace saturated and trans fat food with food containing unsaturated fat
Instead of deep fried meat, lemak dishes and fatty meat, go for lean poultry, fish, tofu and beans
Instead of cooking food with lard, ghee or palm oil, choose oils higher in unsaturated fat (e.g. sunflower, canola oils) Try to have plain water or unsweetened drinks (e.g. Chinese tea) instead of soft drinks, kopi, teh or other sugar-sweetened drinks.
Aim to drink around 8 glasses of water a day, even if you don’t feel thirsty.
Eat sweet desserts and snacks less often.
Use less salt and sauces, and cut down on salted and preserved foods
If you drink alcohol: Men should not drink more than 2 standard drinks a day and women no more than 1 standard drink a day.
One standard drink is equal to 220 ml of beer (about 2/3 of a can), 125 ml of wine (about 1 small glass) or 30 ml of liquor (about 1 shot glass).
What if I find it difficult to follow the guidelines?
It is not unusual for you to experience changes in your attitude and approach to food as you get older. Sometimes, medicine can also affect the way you eat or taste your food.
If you have difficulty following these guidelines for a healthy diet, the following information may help you. If you experience long-term problems with eating, consult a doctor who is trained in Geriatrics to advise you properly. You may need a formal assessment.
I can’t drink milk
There are many non-dairy foods that give you the calcium you need.
Soy milk, cereals and other foods fortified with calcium
Sardines and other fish with edible bones
Dark green, leafy vegetables like kai lan, spinach and chye sim
I have difficulty chewing
Methods to help you enjoy your food better:
Soften brown rice and wholemeal bread by:
Soaking raw brown rice in 2 ½ cups of water for half an hour before cooking. Add more water when cooking.
Eating your food with more liquid. Dip your bread in a drink or have porridge instead of rice.
Choose soft fruit like papaya, mango or watermelon.
Chop vegetables into smaller pieces and cook them longer if you must. Broccoli, cauliflower, and leafy green vegetables (without the stalk) can be prepared this way.
Replace meats with tofu, eggs and minced meat.
If your dentures give you problems, visit your dentist for a check-up.
I don’t feel like eating
If your food is tasteless, use herbs and spices to make your food taste better.
Make meals enjoyable by eating with your loved ones.
Eat smaller meals, more often.
What if I already have high blood pressure, diabetes, heart disease or some other chronic disease?
Most people can follow the healthy diet tips listed in this booklet, even if they are living with a chronic disease. If you are unsure, consult your doctor before changing your diet. Your doctor can advise you on how to modify your diet to better manage your high blood pressure, cholesterol and diabetes.
See your doctor if…
You have a persistent cough or feel pain when swallowing.
You lose weight unintentionally
What if I want to take (or am already taking) supplements?
Vitamin and mineral supplements do not replace a healthy diet, but as you get older, some vitamin and mineral supplements may help. See your doctor to discuss about the dose and type of supplements!
If you do not drink milk or eat foods rich in calcium,
Supplement with: Calcium & Vitamin D
Daily Supplementation dose: 800 mg Calcium & 800 IU Vitamin D
Maximum Supplementation dose: 1000 mg Calcium & 3,200 IU Vitamin D
If you wear clothes that cover your entire body, are of South Indian descent, or stay indoors most of the time,
Supplement with: Vitamin D 800 IU
Maximum supplementation dose: 3,200 IU
If you do not eat fish,
Supplement with: Omega-3 fatty acids (EPA & DHA) 500 mg minimum
If you do not eat meat, fish, seafood, eggs or dairy,
Supplement with: Vitamin B12 2.4 µg
I have seen some elderly on liquid nutritional supplements, can I take those?
Yes you can!
However, there are many types of such supplements and it is advisable if you have a medical review before you take these supplements.
These supplements can include milk based or lactose-free supplements and there are many such products in the market. Do discuss with your geriatrics-trained doctor before you start on these.
Dr Lee Joon Loong
Graduate Diploma in Geriatrics Medicine (Singapore)
Medical Director, Paddington Medical