Eating Resources For The Elderly
As the world has become more modernized, people are living longer. In the year 1900, the global average lifespan was 31 years. In 2018, average life expectancy in the United States was 78 years. Living longer can lead to many more enriching and happy experiences, but as anyone who has cared for an aging relative knows, longer lives come with new and challenging physical and mental hurdles to overcome.
Some of the challenges of old age are illness, poverty, losing a spouse, loneliness, and depression. Physical and mental decline is common among the elderly and can be a significant source of stress for the individual as well as their caregiver. Another set of challenges that affects elderly individuals and their caretakers are eating difficulties.
One study examined 520 elderly patients who were in hospital rehabilitation, they found that 82% of the elderly patients had difficulty eating. Some of these difficulties are related to dysphagia (difficulty swallowing), chewing difficulties, reduced taste perception, poor digestion, and reduced appetite. Eating difficulties can make meal times stressful and unpleasant. Our golden years should be a time of joy, enjoying life’s many comforts, including eating delicious foods. With a little modification to the way food is prepared and served, you can bring the joy back to eating!
Factors That Make Eating Difficult For The Elderly:
Swallowing difficulties, known as dysphagia, affects between 300,000-600,000 people in the United States each year. Up to 68% of nursing home residents are affected by dysphagia. As we age, our muscle mass decreases and tendons and ligaments become less elastic, this decrease and strength and loss of range of motion decreases our ability to swallow (Sura et al. 2012). Certain age related diseases or health conditions, like stroke or dementia, can lead to dysphagia.
Dysphagia can make it difficult to eat foods that are not pureed and to drink liquids that have not been thickened. Those with dysphagia can accidentally aspirate their foods and liquids instead of swallowing it, which can lead to pneumonia. These swallowing difficulties can lead to decreased food and liquid intake, which can result in malnutrition and dehydration.
Physicians, speech pathologists, and dietitians/nutritionists can assess an individual with dysphagia to create individualized diet plans, with proper texture modifications, to endure adequate health and nutrition.
Chewing difficulties are common among the elderly, one survey showed that it affected 38.7% of individuals in an older population. Chewing efficiency is directly correlated with an individuals dental health. Healthy teeth are critical for proper chewing. The older someone gets, the more likely they are to get gum disease or cavities. This makes it not too surprising that tooth loss increases with increasing age.
According to the American College of Prosthodontists, “more than 36 million Americans do not have any teeth, and 120 million people in the U.S. are missing at least one tooth”. As average lifespans continue to increase, so increases the number of people missing teeth. 90 percent of people with no teeth have dentures. Eating with dentures is kind of like walking with a prosthetic leg, with practice it can partially restore function but only with patience and practice. Not all foods can be eaten with dentures; fresh fruits and vegetables and tough meats are particularly difficult to chew with dentures. One study showed that denture wearers were at greater risk of malnutrition than people who still have their teeth.
A dentist can facilitate maintaining dental health and can ensure that dentures are properly fitting.
Taste is the bodies way of discerning what foods are good to eat and which ones are not. One study found that one’s sense of taste decreases with increasing age. They found an even greater decrease in sense of smell. Salt and bitter taste acuity decreased with age, but sweet and sour taste acuity did not. They interestingly found that cleaning the tongue by brushing increased taste sensation in older patients.
It has been found that age related loss of taste and smell can lead to poor appetite, inappropriate food choices, and decreased energy consumption. In a sample of nearly 500 individuals with loss of smell, 92% reported a reduced appreciation for food and drink.
So how can we make eating fun for the elderly? Effort should be made to compensate loss of taste and smell with flavorful herbs, spices, and sauces. Another study showed that flavor enhancement and textural change makes eating more pleasant for the elderly (they added cherry flavoring and cream topping to custard and found that it increased the “pleasantness” of the custard to the elderly. Bright colors can also make foods more interesting.
As the body ages, digestion can become impaired. Some factors affecting age-related impairments of digestion are: insufficient food breakdown due to age-related chewing deficiencies, prolonged transit times in the stomach and colon, impaired gut motility, degeneration of nerves involved in signaling the GI tract, and decreased intestinal absorption of some nutrients.
Poor digestion can lead to malnutrition. To counter malnutrition, one study suggested, “1) increasing eating frequency with at least three meals a day and snacks between meals, 2) increasing nutrient density of meals by enriching traditional foods with milk powder, whole milk concentrate, grated cheese, eggs, fresh cream, and nuts, 3) using fortified foods like enriched bread, yogurt, or pasta, 4) drinking nourishing fluids such as milk drinks, smoothies, and juices, 5) prescribing oral nutrition supplements in specific diseases related to malnutrition, eaten as snacks, or added to meals, and 6) developing foods with textures that are adapted to the oral health of elderly consumers.”
Poor digestion can also lead to constipation. Constipation may be improved by increasing fluid intake, increasing physical activity, and increasing fiber intake to 20-30 grams per day. An article in the American Family Physician recommended Miralax to treat constipation. Physicians are the best resource to evaluate and treat chronic constipation.
Between 15-30% of older people are estimated to have a reduced appetite. It has been shown that poor appetite may lead to nutritional problems.
Common causes of reduced appetite (and some solutions) in the elderly are:
- Dry mouth: try offering regular sips of water, avoiding dry foods, and using salivary substitute products
- Impaired smell or taste: enhance the flavor of food with pepper, spices, and herbs. Using sauces and toppings can enhance the texture of foods, which has been shown to make foods more pleasurable for the elderly
- Ill-fitting dentures: ill-fitting dentures should be examined by a dentist, who may recommend a denture reline, denture replacement, or implants to improve dental function
- Depression: cases of depression should be referred to a physician for evaluation
- Decreased physical activity: gradually increasing physical activity.
Your Goals When Preparing Meals For The Elderly:
- Cook three meals a day and provide healthy snacks in between meals.
- Try to have a variety of foods at each meal. Include foods from each of the food groups. Having a variety of foods each day can give you some ideas of their food preferences.
- Foods with bright colors (like carrots, sweet potatoes, broccoli, and tomatoes) will look more appealing. Use sauces, gravy, or whipped toppings to create textural complexity.
- Make sure to provide plenty of liquids to prevent dehydration.
- Every individual’s eating situation is unique. Make sure each meal is the proper texture/consistency (as determined by a physician and dietitian). This will ensure full enjoyment of the meal and will help minimize the risks of choking or aspiration.
- Ask your physician and dietitian about the specific dietary restrictions/recommendations for your situation.
- Eat together as a family whenever possible. Meal times are a great opportunity to strengthen social and family relationships. Eating with others is generally a more positive experience than eating by yourself.
- It is important for elderly individuals to have friends. According to one study, “The effects of social activities with friends may become more important and may act as a buffer against negative effects of aging”. What better social activity is there than sharing a meal with friends?
Some More Easy To Chew Recipes
Helpful Cooking Appliances When Cooking For The Elderly
A crock pot is a simple way to prepare meals in advance. Cooking foods, especially meats, at controlled temperatures for long periods of time makes them easy to chew and delicious!
There is no finer way to puree foods than a Vitamix Blender. It can turn any food into a single, smooth texture which is easy to swallow.
A food processor is a must have for finely chopping, slicing, and pureeing foods. It does all the work for you, which is especially helpful if your age or health status limits your ability to chop and slice foods by hand.