Nutrition and Aging

By Patti Bonisteel, RD

I’ve known Patti for about twelve years, and have always admired her commitment to the well being of her clients, and her belief in an holistic, interdisciplinary approach to providing care and services to the elderly. I am proud to have her as part of the Diamond Geriatrics team.

The nutritional status of older people is affected by a variety of physiological, psychological, economic and social changes. The relatively higher prevalence of chronic and acute diseases, the use of multiple prescribed and over the counter medications, and tendency to be sedentary also have an impact on nutritional status.

Chronic disease or medications used to treat it may change or decrease sense of smell and taste. Without the sensory stimulation, hunger is the only incentive to eat. It becomes a chore, the pleasure centres of the brain are not stimulated. In many ways our society has become a “live to eat” one—there is a whole cultural orientation around food and restaurants. Impairment of taste and smell separates people from this orientation. Even family life centres around food, at least still on the holidays. The smells of Christmas, for example, or the warmth of sitting around the table with loved ones are examples of aspects of life which shift when senses fail. The loss of the anticipation or achievement of pleasure, either physical, social, or familial, can lead to depression, and thus to malnourishment.

Older people often have untreated and undiagnosed conditions called delirium. These may often present with the same symptoms as dementia, but if properly diagnosed and treated, they are reversible. Changes in intake and nutritional status may indicate an untreated delirium. Blood tests and urinalysis, plus physical exam can detect a delirium ,distinguish the causes, and indicate treatment.

Sometimes people with dementia forget to eat, don’t know how to prepare food or feed themselves, and don’t know when they are hungry. They may have a sore in their mouth, constipation, or other pain, but not be able to tell someone that they are uncomfortable, so instead they just stop eating. Poor oral hygiene often accompanies increasing dementia as people forget or become unable to carry out personal hygiene. Dementia may also cause restlessness or some agitation. People with dementia can sometimes be easily distractible. Restlessness, agitation, and distractibility interfere with the ability to sit still long enough to eat a meal.

The results of a stroke can also lead to nutritional deficit. Stroke can cause difficulty swallowing (called dysphasia). This puts people who have had a stroke at risk for choking. Choking can lead to aspiration pneumonia, a condition where food and/or fluid go into the airway and cause an infection. Stroke may also cause what is called right or left sided neglect, in which even if a plate of food is in front of them, if it is on one side of their body, they may not know it is there.

Intake of food and liquid may decrease due to mood changes such as depression. If you are depressed, you may not feel like eating. If you are lonely or grieving for a lost spouse, friend, or lifestyle, you may not wish to eat. There is no “reason” to go on, and you lose not only the wish to eat, but also the energy to prepare food or eat.

A common problem with older people is chronic pain. For various reasons, chronic pain is often undiagnosed, under-diagnosed, and undertreated. People may feel that they have to “just live with it.” The result may be that they are in too much pain to eat, or onset of depression. Pain management treatment should be reviewed by a physician, and a specialist called in if necessary.

Regular physical activity promotes strength and endurance and helps maintain ideal body weight. Unfortunately, older people may have impaired mobility due to disease, pain, beliefs about aging, etc. and will let exercise go.

The result of the impaired mobility is often impaired nutritional status. If a person cannot shop, if they cannot stand at a counter to prepare food or cook, if they are afraid of falling, one result will be that they will decrease intake. They may not be able to reach cupboards or into drawers to take out food or equipment, or they may have impaired agility so cannot prepare the food or use utensils and equipment.

COPING WITH CHANGES

SENSORY CHANGE:

Loss of smell and taste affect the nutritional intake and status of older people.. If diet is restricted in salt, sugar and/or fat, it may be less appealing. Sensory changes may be caused by medication or disease.

Suggest:

1. Experiment with low sodium seasonings such as lemon juice, Worcestershire, spices and herbs
2. Liberalize diet (less restrictions) may help improve intake
3. Review medications
4. Physicians assessment
5. Vary textures and colours

LOSS OF TEETH:

Loss of teeth, poor fitting dentures, poor oral hygiene may result in a change of eating patterns.

Suggest:

1. Have dentures adjusted
2. Modify food texture by steaming, mincing, pureeinge
3. Goal is to ensure variety without compromising on nutritional value
4. Change in food items

OSTEOPOROSIS:

Calcium is the nutrient most often deficient in the diet of older people, a result of decreased intake and absorption. A reduction in weight bearing exercises, combined with a sedentary lifestyle is also a contributing factor.

Suggest:

1. Walk, lift weights, group fitness if possible
2. Join the “1000 Club”; aim for 1000 mg of calcium and 1000 IU of Vitamin D
3. Use a combination of dairy and supplements to meet requirements

CONSTIPATION:

Constipation is five times more frequent in older people. It is often a result of insufficient fiber and fluids, lack of exercise and certain medications.

Suggest:

1. Increase dietary fiber in diet i.e. fruits, vegetables, bran, flaxseed
2. Encourage fluid increase to a minimum of 6-8 cups per day
3. Increase physical activity

DEMENTIA:

Restlessness, anxiety, forgetting how to eat, loss of skills in preparing food, lack of awareness of thirst or hunger or the meaning of the physiological symptoms

Suggest:

1. Small, finger foods, such as sandwiches
2. Supplements such as Resource or Boost
3. Change of food texture
4. Multiple small meals throughout the day
5. Review and modify environment to decrease stimulation

DYSPHAGIA:

Difficulty swallowing which puts people at risk for choking

Suggest:

1. Thickened fluids
2. Swallowing assessment by Dietitian, Occupational Therapist, or Speech Language Pathologist

NOTE: Dysphagia is extremely dangerous and needs to be assessed carefully. People with dysphagia may have risk levels high enough to warrant insertion of a feeding tube.

DEPRESSION:

This can lead to a lack of desire to eat and decrease in energy or will to prepare foods

Suggest:

1. Improving taste or smell
2. Psychotherapy or medications
3. Modify environment, increase social stimulation appetite stimulants

IMPAIRED MOBILITY:

Restlessness, anxiety, forgetting how to eat, loss of skills in preparing food, lack of awareness of thirst or hunger or the meaning of the physiological symptoms

Suggest:

1. Modify kitchen design
2. Kitchen utensils and equipment designed for people with disabilities
3. Frozen or other meals brought into the home, for example Meals on Wheels
4. Assessment by physiotherapist and occupational therapist
5. Home help to assist in preparation or serving

Optimal nutrition promotes both physical and mental well being. Malnourishment or dehydration is easily missed in older people, or not discovered until there are falls, illness or delirium. It is essential that their nutrition be monitored. If it appears compromised, an in-depth assessment is undertaken. Similarly, when other conditions are present, caregivers need to remain vigilant to the possible effect on nutritional status. Creative solutions and modifications to environment and other system can often be developed to improve nutrition.