University of Massachusetts Amherst

It's MORE Than A Meal

 

Special Nutrition Needs of Older Adults

barriers to healthy eating

Poor Appetite

Poor appetite can be common in older adults.  Possible causes include:

  • Grief or bereavement.
  • Fewer social contacts for meals.
  • Acute or chronic illness.
  • Sensory changes (vision, taste, or smell).
  • Medicines that affect appetite.

Tips to help older adults with a poor appetite:

  • Offer beverages that increase calorie or nutrient intake, such as milk, soup, or hot chocolate, in place of coffee and tea. 
  • Enhance the flavor of meals with spices and herbs.
  • Add variety and color to meals.
  • Encourage them to eat smaller meals more frequently, instead of large meals.
  • Make eating a special occasion. Create a positive atmosphere for dining that includes attractive lighting, tablecloths, a nice table setting, and appealing music.
  • Make eating a social occasion. Create special “events” with themes that participants will enjoy together as a group.

Dental Problems

Chewing problems may cause older adults to overly restrict foods important for proper health.  Poorly fitting dentures and missing teeth may cause older people to avoid fresh fruits and vegetables, which are important sources of vitamins, minerals and fiber. 

To promote dental health:

  • Serve foods rich in calcium and phosphorus.
  • Serve a variety of firm, fibrous foods to stimulate the release of saliva.
  • Encourage or provide opportunities for brushing and flossing teeth daily.
  • Encourage older adults to brush their teeth or rinse their mouths with water after meals.
  • Encourage regular visits to the dentist.

To address chewing difficulties in older adults:

  • Offer plenty of water or fluids with meals.
  • Offer foods that are soft and easy to chew.
    • Tender cuts of meat
    • Soft protein foods: eggs, milk, cheese, yogurt
    • Fruits and vegetables with peels removed
    • Fruit juices, canned fruits, and cooked vegetables
    • Cooked cereals, rice, or pasta
    • Mashed or pureed food, if needed

Swallowing Problems

Swallowing is a complex act. It involves the mouth, throat area, and esophagus, which in turn are controlled by many nerves and muscles. Swallowing is partly under conscious control. However, most of the swallowing process is involuntary.

Someone with difficulty swallowing has the sensation that food is stuck in the throat or upper chest. This sensation may be felt high in the neck, or lower down, behind the breastbone (sternum). It may result from problems that arise in chewing food, moving it to the back of the mouth, or moving it through the esophagus toward the stomach.

Common causes of swallowing problems in the mouth or pharynx:

  • Something that blocks the passage of food or liquid. Examples are anxiety, a tumor, or cervical spine disease.
  • Nerve and muscle problems resulting from stroke, Parkinson’s disease, Huntington’s disease, multiple sclerosis, myasthenia gravis, ALS (Lou Gehrig’s disease), muscular dystrophy, polio, or syphilis.

Common causes of swallowing problems in the esophagus:

  • Something that blocks the passage of food. Examples are tumors, foreign bodies, or a narrowed esophagus caused by radiation, medication, or ulcers.
  • Nerve and muscle problems resulting from certain diseases.

To address swallowing problems in older adults:

  • Chop foods in the blender.
  • Avoid dry, chunky foods. Choose foods with a smooth texture.
  • Add cream, gravy, or oil to foods.
  • Avoid serving hot or cold foods.
  • Avoid serving sticky foods.
  • Encourage older adults to rinse their mouths before and after eating.
  • Encourage them to eat in small bites, and to chew food well.
  • Refer them to their health care provider if the problem continues, even if the symptoms are intermittent.
  • If they suddenly show signs of choking and breathing problems, perform the Heimlich maneuver immediately.

Source: Medline Plus Medical Encyclopedia: Swallowing Difficulty, website www.nlm.nih.gov/medlineplus/ency/article/003115.htm

Sensory Impairments

As people get older, they become more likely to have sensory impairments (losses in vision, hearing, smell, or taste). These impairments can limit their quality of life, and affect their appetite and interest in foods.

Impaired vision can result from age-related eye changes or from diseases that affect the eyes (cataracts, glaucoma, diabetes, or macular degeneration). Vision may become less sharp. Older adults may find it harder to judge distances, focus on objects at different distances, or see items on the outside edges of the visual field. Their eyes may need stronger light to recognize objects, along with more contrast between light and dark objects. They may find it hard to read recipes, food labels, and labels on medicines.

Hearing problems can result from changes in the inner ear or from tinnitus (ringing or roaring sounds). Older adults may be less able to understand conversations or hear announcements, particularly in noisy or crowded environments. They may withdraw from social interactions with others at group meals.

A reduced ability to smell or taste can make it harder to discriminate between fine tastes, such as between turkey and chicken. Older adults may find it harder to distinguish between sweet, sour, and salty flavors. This can make them lose their appetite or their interest in food, and reduce their ability to detect bad odors in spoiled foods.

Tips for serving meals to adults with sensory impairments:

  • Create a positive atmosphere for dining that includes attractive lighting, tablecloths, a nice table setting, and appealing music.
  • Minimize distractive noises such as televisions and radios.
  • Provide a strong contrast in color (such as cream of wheat in a dark bowl).
  • Provide easy-to-grasp glasses and utensils.
  • Enhance the flavor of meals with spices and herbs.
  • Marinate meats in fruit juices, salad dressing, or sweet-and-sour sauce for extra zest.
  • Use colorful garnishes to make foods more appetizing.
  • Add variety and color to meals.

Sources: (1) Desai M et al. Trends in Vision and Hearing among Older Americans. Aging Trends, March 2001. Centers for Disease Control and Prevention. (2) Institute on Aging Learning Modules, University of North Carolina, website www.uncioa.org/ioalearning.

Cognitive Impairments

Cognitive impairments in older adults can range from minor memory loss to progressive dementia. Causes may include stroke, Alzheimer’s disease, neurological disorders, nutritional deficiencies, or the side effects of taking medicines. As a result, these adults may have a diminished attention span, an increased risk of choking, an inability to recognize thirst, an inability to recognize food, confusion about meal times, and confusion about how to use utensils.

Tips for serving meals to adults with cognitive impairment:

  • Serve meals in small dining rooms with a home-like atmosphere.
  • Provide meals and snacks at consistent times.
  • Provide a consistent seating arrangement to offer structure and cues to mealtimes.
  • Seat people next to compatible tablemates to reduce agitation.
  • Provide adequate lighting to help them recognize foods.
  • Minimize distractive noises such as televisions and radios.
  • Use square place mats to help define personal territory and reduce the chances for people taking each other’s silverware by mistake.
  • Use plain tablecloths and place mats to minimize distractions.
  • Provide a strong contrast in color (such as cream of wheat in a dark bowl).
  • Provide easy-to-grasp glasses and utensils.
  • Model the use of utensils to encourage others to mimic your behavior. Use verbal cues (“place the fork in your hand”) if necessary.
  • Remove utensils if using them becomes dangerous.
  • Put foods on small bowls or plates, and serve them one at a time.
  • Serve small portions of tasty foods that are spiced to their liking.
  • Offer some finger foods unless there is a risk of choking. Examples are mini-sandwiches and bite-size chunks of fruits, vegetables, or cheese.
  • To minimize the risk of choking, avoid hard-cooked eggs, chunks of meat, nuts, whole grapes, orange halves, popcorn, and hard candy. Remove any pits, peels, or bones from foods. Serve raw carrots in long slices. Dilute peanut butter with applesauce.
  • If they fail to recognize foods, encourage them to touch or smell the foods first. Feed them orally by hand if necessary.
  • Provide fluids on a routine basis (at least every 2 hours).

If these tips prove unsuccessful in encouraging food intake, refer older adults’ caregivers to their health care providers.

Source: Bakker R. Sensory Loss, Dementia, and Environments. Generations: Journal of the American Society on Aging. Spring 2003.

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Developed for the Massachusetts Department of Education Child and Adult Care Food Program by the University of Massachusetts Extension Nutrition Education Program. Permission is hereby granted by the Massachusetts Department of Education to copy any or all parts of this document for non-commercial educational purposes. The Massachusetts Department of Education, an Affirmative Action employer, is committed to ensuring that all of its programs and facilities are accessible to all members of the public. We do not discriminate on the basis of age, color, disability, national origin, race, religion, sex, or sexual orientation.

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