Some time ago, a friend asked me to post a blog about ways to support elderly or infirm relatives who had lost their appetite, had been ill or were losing weight for no obvious reason. At the time, I noted it on my “blogs to do” list but put it aside.
Recently, I have been doing a bit of work for my local NHS trust. This has included working with elderly people in the local community who are at risk of being malnourished. It’s the same kind of work I did when I first came to the UK in 1999, home visits for the “at risk” elderly offering nutritional support to reduce risk of malnutrition. Sadly, since that initial post in 1999, the numbers seem to have increased enormously. This has also been highlighted by the recent BBC television programme, “When I get older”, in which older celebrities spend some time with elderly people in their own homes in an effort to reveal the difficulties and issues surrounding their everyday lives. One of these issues includes malnutrition. It is estimated that there are around 1 million elderly people in the UK who are at risk of malnutrition. It seems this is a blog and an issue that can’t just be “put aside”.
There are so many reasons why elderly people might be at risk. These include:
Biological and medical consequences of ageing
Including : diminished sensory properties, reduced thirst, malabsorption, increased metabolism, chewing and/or swallowing problems, chronic disease, dementia, depression, physical disability and medications.
Including : immobility, social isolation, low income, limited food storage, inadequate cooking skills, gender roles and the passing or a partner and shopping difficulties.
Many older people also tend to eat food of low nutrient density. Most critical nutrients include calcium, iron, zinc, vitamin B12, B1, D, and folate.
It’s a very difficult problem to tackle and can be very frustrating when trying to encourage clients or family members to eat when they have the difficulties as listed or, indeed, no desire to eat. The consequences for rapid weight loss and malnutrition can be great – risk of falls and fractures, pressure sores or non- healing wounds and skin tears, worsening of chronic diseases and the risk of infection are possible consequences as is declining cognitive function.
So what can we do about it? At a higher level, The British Dietetic Association have launched a campaign “Mind the Hunger Gap”, to highlight levels of malnutrition and to call for action and support to tackle the issue. On an everyday level, when caring for a family member who has lost interest in eating and has some of the problems above which may have led them to be at risk of malnutrition, there are a few things that we can do.
Practical Tips for “building up” someone with a reduced appetite
- If someone is eating less, it’s important to make sure that what they do eat is of value and is nourishing. It’s a good idea to make sure the diet is balanced and that there is some protein (to maintain muscle) included at each meal, as well as carbohydrate, fat (for calories especially), fruit and vegetables and fluids. Try not to let them fill up on fluids however, if possible, and offer them after a meal or as a between meal snack.
- Offer a variety of attractive, tasty, good-smelling meals and snacks. Use garnishesand sauces to enhance appearance. Often elderly people will need more flavour in their meals due to loss of taste sensation.
- Ensure meals are of appropriate consistency and that meat and vegetables can be easily chewed.
- Offer meals in a relaxed environment. Don’t start rushing around cleaning the house. Sit down and chat and relax with your family member while they eat. Use plain plates & tablecloth for those who are confused and finger food for those having difficulty manipulating cutlery. – e.g. mini quiche, scotch eggs, sandwiches, cut-up fruit, ice cream in cone, mug of nourishing soup.
- If caring for someone who is cooking their own meals and where cooking skills are an issue, try to deliver a few meals a week or use one of the “meals on wheels” style delivery organisations. You could also try to do the initial stages of cooking or preparation to make it easier for those who have limited cooking skills or who find it an effort to cook. Microwave meals may also be useful.
- Try not to put your family member off the meal by offering too large a plate full of food. Often this can put people off trying even a small amount. Start with a small plate, which can appear more manageable, and build from there. Use guided choice – offer a choice of two or three foods rather than asking “what do you feel like?”.
- 3 small meals a day plus snacks in between meals is the aim…every bite counts. Make sure food is in eyesight rather than hidden away in cupboards. Put some snack style foods close by where your family member sits to watch television or by the bed.
- Don’t stand on ceremony. If the person you are caring for feels like cereal for dinner and eggs and bacon for lunch, then take the opportunity to give them a meal they are sure to eat.
- Offer at least 1 pint milk a day to drink. Milk is wonderful for adding protein and calories. Use milk instead of clear drinks where possible. Adding milk powder to milk also increases the protein and calories. This is commonly suggested by Dietitians when trying to achieve weight gain in clients.
- Ditch the restrictive diet. This isn’t the time to worry about cholesterol. Many times I’ve seen elderly people who are not gaining weight as they are too afraid to add high fat and high calorie meals to their menus. This is the time to use full fat products and high energy snacks. If there are any specific medical issue which are of concern, you should get some individualised advice from a Dietitian.
- Share and socialise. Sharing meals with other people has been shown to increase intake due to social interaction. See if there are any clubs or groups where your family member can join in.
- Build up on meals – quality not quantity. Add calorie and protein boosters to meals. The trick is to look at each meal and think about what you can add to it to increase its quality without making it a huge and off putting meal.
Some examples of what you could try:
- Add cheese to salads, soup, sandwiches and meals.
- Add sour cream, butter and oils to meals, vegetables and potatoes. Mashed potato is excellent for adding cream and butter and cheese to. Crackers, tea cakes and scones should be buttered.
- Add cream, full fat yoghurt, evaporated milk or custard to desserts, fruit and cereals.
- Use milk and creamy based sauces and dressings at meals
The most important thing is to keep a watchful eye over the person you are caring for. Often when we are close to someone, we can be reluctant to push then to eat and can often fail to notice rapid weight loss and reduced intakes. And if you are concerned, of course, try the tips above but always consult your Doctor to rule out all the reasons for weight loss and loss of appetite and your Dietitian for help and support along the way.