Feeding the elderly

[Jenise]

We spent three days last week with a couple who are each about 90 years old. They still live in their own home and get their own meals. But their appetites are small. One day, lunch was one slice of bread spread with mustard topped with one slice of Lebanon Bologna. Two pickles were sliced and shared, and some canned beets were passed.

That was fine for me, I didn't want more, but I worried about the small amount of protein content for them--Dick in particular, who is bent from spinal problems. Breakfast had been homemade blueberry pancakes with two sausages each, and dinner would begin with a big pot of popcorn at 5:30 as it does every day. I haven't quite determined what they eat for dinner when there's no company around, but sliced cheese and crackers is probably quite common. IOW, their standard diet is something of a carb load.

What raised my concern is that several hours after the lunch I just mentioned Dick, who had found his way upstairs to admire the new handicap rails we'd just installed for him, confessed that he didn't have enough energy to make it back downstairs.

So I wonder what, as we age, is our need for protein? What foods should we consume to meet our bodies needs best? What foods should Dick and Stella, at their age, eat to keep bones and energy levels strong? Are supplements a good idea? If any of you have been involved with elder care, what did you learn about their dietary needs?

All I've read, Jenise, seems to indicate that meager calorie intake seems to prolong life to some extent. There's been no breakdown of those calories into carbs, proteins or anything else. I'm interested in what others say in response to your post. With what I know, I can't imagine that supplements would hurt.

Such a hard topic, J. I know my dad who's now approaching 80 isn't nearly as interested in food anymore as he used to be. And it gets difficult for him to eat a wide range of foods, because of health restrictions/advice etc.

So it's often not just a case of what they should eat, as much as simply getting them interested enough to want to put more effort into it. I think supplements are a great idea, but again, most elderly people I know start the day with a cocktail of medications, so adding more to their routine could be cumbersome.

One thing I do remember reading recently is that chewing is important - and they now think that not chewing or the cessation of chewing has links to dementia, which has obvious implications for the elderly.

I recall something like 4 oz of protein/day as in meat is sufficient.

Part of the problem is their tastebuds are not as acute. Are they getting enough zinc?

If they have leukonychia (white spots) on their fingernails, that's a sure sign of zinc deficiency. But even if they don't, I'd try a multi-vitamin with zinc to see if that helps. It sure won't hurt.

Eating is just as important to the very elderly as it is for us. Not eating and getting the needed proteins, etc. is a big factor is eye sight loss, lack of energy, etc.

But as it was said in other posts, taste buds diminish, interest wanes, in both cooking and eating. If they are interested in a senior delivery of a meal everyday, most communities have that service. Usually the portions are very generous and many seniors have enough for dinner or lunch the next day. Supplements are good, if they remember to take them.
How thoughtful of you to be concerned about them.

Way to go, Jenise. My husband and I have a couple friends who are approaching their 90s. THey are independently living alone and taking care of their own needs as well. We saw the struggle about a year ago and made it a commitment to cook them a full, nutritious meal once a month and deliver it. It is enough for 4 standard size appetites, and I know that the wife breaks everything down and freezes it to get at least one meal (for 2) a week out of it for a few weeks. We check in once a week just to make certain other needs are being met. It's not alot, but at least I can sleep nights knowing this little bit is being done. I agree with others, maybe it's time to check into what's available through senior services in their community. Many churches also provide this service for their members and the elderly without a church home. I'm not sure about supplements. They may be taking other medications where certain minerals, etc. may change the absorption and cause other changes not recommended. So, I'd stay away from that one. But, what about fresh fruit? They can get their protein load with eggs and beans -- which is relatively easy. I agree. Try to help -- as little, but as much as possible -- if you know what I mean. And, good luck.

That is Holy Work, Jenise.


In relation to that....every Christmas Eve my son and I volunteer at the local food bank to pack then give out grocery bags of food to the neediest of the needy of our community....many of whom include the elderly, infirmed and desperately destitute.

A long, labor intensive 6-8 hour day, but if you cannot see God in those grateful sad faces...you will be hard pressed to see Him at all.


God bless the caregivers.

You are doing wonderful work, Jenise.

As I get older, I wonder more and more about a diet appropriate for my age. One role model: the people of Okinawa who have the oldest average age in the world. Lots of factors, I suppose, including a good human contact network (which may be the most important contribution you are making). Genetics, activity, all relevant I'm sure.

But diet: The traditional diet of Okinawa consists in portions made of a bowl of cooked food and a fruit. Okinawans eat daily seven portions of vegetables and fruits, seven of cereals and two of soy products. They take various portions of fish weekly and very sporadically meat and dairy products. Overall, their diet is low in calories and contains a lot of vegetables.

Janet and I are cooking and eating more and more to that standard. Our GP approves, with a glass of red wine for Bob, not so much for Janet.

Very well done on the support side. You have my admiration.

Regards, Bob

Another thing that is very often a reality for the elderly is dehydration. If you could get your friends to drink milk with something like Carnation Instant Breakfast mixed in, they would increase their nutrition as well as their fluid intake. Dehydration makes all the other issues of aging that much worse.

Jenise,

When I first read your post I immediately thought, that a simple Google search would come up with the answer. Well, it didn't. I have searched every possible wording I can think of, and other than scholarly papers, and or commercial web pages, I find not a lot of help. I can't even find a chart that pretends to give an answer just in calories, much less breaking that down to protein, carbohydrate and fat. I wonder if perhaps a call to the local "Meal on Wheels" might give one a bit of an insight. I've never dealt with them so have no idea the kind of meals they provide. You raise an interesting point, especially to me, who will turn 70 his next birthday, and who knows when this question will become of personal interest through need.

Bob, I had the same problem, and found the AHA paper the most current and best researched. Their summary:

Older Adults

Atherosclerosis is a chronic process beginning in youth. The risk of developing CVD increases dramatically with advancing age. Diet and lifestyle behaviors can decrease CVD risk.86 Also, ample evidence from clinical trials indicates that older-aged persons can make and sustain lifestyle changes, perhaps more so than younger adults.86,87 Because of the high incidence of CVD events in older-aged individuals, even relatively small improvements in risk factors (eg, small reductions in BP and LDL cholesterol through diet and lifestyle changes) should be of substantial benefit.88,89 In general, the goals and recommendations described in this document are appropriate for older-aged individuals. Because they have decreased energy needs while their vitamin and mineral requirements remain constant or increase, however, older individuals should be counseled to select nutrient-dense choices within each food group.90

http://circ.ahajournals.org/cgi/content ... /1/82#SEC6

Regards, Bob

[Robin Garr]

When I first read your post I immediately thought, that a simple Google search would come up with the answer. Well, it didn't. I have searched every possible wording I can think of

Try searching for the terms "geriatric nutrition" and you'll have a little more luck.

Jenise, <b>this book</b> looks like it might possibly be a good investment for you and your friends. Browse the Amazon link (yes, it's a WLP-commission link ) and see what you think.

[Robin Garr]

<b>this book</b>

WHOA! WHOA! WHOA! I hadn't noticed the freakin' PRICE when I recommended this. At $140 smackers, it had better be not just good but great. Harrumph harrumph harrumph!

Jenise, AARP is useful source of information on this subject. There are a couple of discussion groups for members, and often good articles available to everyone online.

A recent example:

http://www.aarpmagazine.org/health/livi ... _diet.html

Extract:

A 2006 article in JAMA caused a stir by announcing that in both men and women, caloric restriction—as spartan as 890 calories a day—resulted in a decrease in fasting insulin levels and body temperature, two biomarkers of longevity. Why? Because restricting calories also helps to eliminate those nefarious free radicals. Mattson explains: "When you overeat and more energy comes into the cells than you burn off by being active, you are going to have more excess free radicals roaming around." Still, he advises, don't panic over the idea of having to subsist on 890 calories a day. Mattson, who calls such a diet "starvation," believes we can all gain the benefits of healthy eating with a lot less pain.

Richard Miller, M.D., Ph.D., a researcher and professor of pathology at the University of Michigan, agrees. He has spent the last 20 years studying the ways in which dietary and genetic changes can slow the aging process. The research has shown that mice, rats, and monkeys that have undergone severe caloric restriction demonstrate all kinds of mental and physical benefits such as better mental function, less joint disease, and even fewer cases of cataracts. But it's unrealistic to try to replicate that in humans. "To copy what's happening in the lab, a man weighing 200 pounds would have to decrease his caloric intake by 40 percent for life, which would put him at about 120 pounds," Miller explains. "That's just not tenable."

Instead, Mattson and Miller advocate a more moderate approach. According to the Centers for Disease Control and Prevention, the average man in the United States consumes about 2,475 calories a day. That's roughly 500 more, on average, than he really needs. Likewise, the average American woman consumes 1,833 calories, yet probably needs only about 1,600. One way to ratchet down your caloric consumption would be to follow this simple equation: men should aim for about 500 calories at both breakfast and lunch, while women should strive for about 300 at each meal. Both sexes can then shoot for 1,000 calories at dinner.

Bickford, who prefers to think of caloric restriction as caloric selection, underscores the importance of getting as much of your caloric intake as you can not only from antioxidant-rich fruits and vegetables but also from nuts and flaxseed, which are loaded with vitamin E and omega-3 and omega-6 fatty acids. In fact, Bickford takes a page out of her own lab studies and starts her day with an antioxidant smoothie. You can try it at home by blending together one cup of frozen blueberries with half a tablespoon of spirulina (available in any health food store), half a cup of nonfat plain yogurt, one teaspoon of ground flaxseed, one tablespoon of almond butter or a half-handful of almonds, and a dash of soy milk. Consider what's in that blender as a gas tank full of high-antioxidant fuel for the day.

Of course, one can't help but ask: what's the fun of living to 102 if you're subsisting on spirulina shakes? Not to worry. If you splurge on a stack of pancakes with eggs, bacon, and sausage—packing in 2,000 calories before 10 a.m.—you can always take heart in new data about to emerge from Mattson's lab, which show that periodic fasting—skipping a meal here and there—can also help to eliminate free radicals quite beautifully. "From an evolutionary standpoint we just aren't used to constant access to food," he explains. "Our bodies are used to going days without eating anything. Yet all of a sudden, we are taking in calories all day long."

[Jenise]

To everyone, thanks for your comments. And I want to say this, I know Dick and Stella are grateful to have us in their lives but I have to say the privilege of this friendship is all ours. Bob and I are both orphans to a large extent, and we love this couple like parents. They live in our old neighborhood in Southern California, and we met nine years ago when near their house on a walk I tripped, fell hard and passed out. When I came to, there was this tiny white haired man petting my hand and whispering, "Come back, baby, come back." Jenise, meet Dick.

He got me home, and the next day he reappeared on my doorstep to find out how I was.

The 1300 mile distance between us makes looking after them more carefully an issue, but we do go visit about three times a year. And when we do, I help Stella (a great home cook, but easily tired by the effort these days) with meals that insure they have healthy, convenient leftovers, and together Bob and I perform some simple home repairs and look for ways to make the house safer for Dick. A son (and his family) who live less then ten miles away don't seem to drop in more than per month, if that, and I don't know why beyond having deduced that father and son are hawk and sparrow.

They do okay with fresh fruit, but could do better. The have a number of fruit trees (one of our jobs this time was to install a couple dozen fertilizer spikes), and the basket of ripening fruit Stella keeps on the counter always has something in it. But they probably only eat one serving per day, and if it doesn't happen at breakfast it probably doesn't happen at all. I haven't seen much evidence that they eat many vegetables, however. I suspect that with their reduced appetites and carb preference, when the meals got smaller it's the vegetables that got the ax.

Amazingly, even though he cannot now move without a walker, Dick (who still drives, Stella never has) still does their grocery shopping. A grocery store is only two blocks away, and about once a month he and Stella go together to Trader Joe's for coffee, bread and cheeses. I think that eggs are a frequent breakfast when company's not around, but company gets Stella's specialty: pancakes. Tiny, silver dollar sized, made with a sour dough starter Stella has hand-carried around the world throughout Dick's long and distinguished military career. Each pancake contains exactly one fresh blueberry, and Dick will eat fourteen (two batches) of them. Fourteen blueberries isn't a lot, is it?

As for community meal services, I hear you guys but at the moment, Stella would be affronted by the charity. You do give me an idea though about having food delivered by local restaurants every now and again. There's a decent Chinese restaurant close by that delivers. Meat and vegetable combination dishes would contain a lot of what they need to eat.

Jenise,
The restaurant delivery is great especially if you know the restaurant and trust that they execute your wishes long distance. The recipients would be reluctant to tell you if anything was amiss.
I would emphasize the comment about hydration. Dehydration impacts every organ function including taste and thirst triggers.
Loss of interest and appetite is not uniform in the elderly.