Nutrition for the elderly

Aging is a natural part of life, but it is accompanied by some significant physiological changes. The elderly usually experience a decrease in digestive secretions, intestinal absorption and protein synthesis. It’s also accompanied by a loss of muscle and fat mass as well as a decrease in bone density. Digestion slows down, which makes older people feel less hungry. With all these changes, it’s valid to wonder how to adjust an elderly person’s diet so that it’s balanced and adapted to their reality. Here’s an overview of the issue.

Countering undernutrition and loss of appetite

Elderly people feel the sensation of being hungry less, and the synthesis (that is the production) of proteins is reduced, so it’s essential that the energy and protein intake is adequate. We want to avoid the loss of weight and muscle mass as much as possible, as this has significant repercussions on the level of energy on a daily basis. To do this, it’s important to choose foods higher in calories, because the elderly, with their decreased appetites, sometimes have the annoying habit of taking only a few bites of their meal. For example, adding cream to a soup, butter to mashed potatoes, opting for 3.25% fat milk, buying yogurt with a higher fat content, and spreading peanut butter on toast are just a few examples of energizing meals that can be served to seniors. One way to make cuts of meat or fish tastier is to add a sauce! This can be sweet and/or fatty, and it will add flavour to the sometimes dry meat as well as provide additional calories.

Focus on protein

When it comes to protein, it’s important to ensure each meal contains enough protein to prevent loss of muscle mass. You can enrich a meal with protein without it always being visible (as in the case of more traditional meals which include meat/poultry/fish). For example, you can add skimmed milk powder to a sauce, condensed milk to a soup, etc.

For more picky eaters or those with a reduced appetite, meal replacements can be used. These come in the form of drinks, puddings or bars, are high in calories, protein, carbohydrates, fat, and fortified with various vitamins and minerals. Be careful! Quite often these products don’t replace a whole meal because of their lower energy intake than a traditional meal! It’s important to rely on these products’ nutrition facts tables and complete the meal with fruit, raw vegetables, crackers, a little cheese or even a serving of dessert to meet Health Canada's recommendations.

The sensation of being hungry fades with age, so it’s better to enrich meals with nutrients rather than having to increase the amounts. For an elderly person, it is sometimes easier to eat several small meals or snacks a day rather than a few meals that are too large. However, it’s important that meals are eaten at regular times to try to stabilize the appetite and help the elderly reconnect with their signals. Seniors should be encouraged to eat their meals in groups, as this type of social activity encourages seniors to eat more. In rare cases of undernutrition where the lack of appetite affects health, doctors have the option of prescribing certain drugs which are intended to stimulate the appetite.

Another factor to consider is the presence of dry mouth. Chewing gum, brushing your teeth or using mouthwash are techniques that can help produce saliva and therefore stimulate the appetite.

Dysphagia - a swallowing disorder to watch out for

Another important aspect to consider in the elderly is adapting the textures and ensuring consistency of the foods and/or meals served to them. Many seniors have dysphagia, which is a swallowing disorder. Dysphagia can cause coughing during meals, risk of choking, change in voice, involuntary weight loss, and unusually long meal times. Depending on the degree of severity, dietary changes should be made. These will be determined by a speech therapist and/or nutritionist. Several types of modified textures can then be introduced, such as soft, tender/minced foods, mashed foods as well as liquefied foods. 

If in doubt, the elderly must first undergo an imaging test called a video fluoroscopic swallowing exam in order to analyze the ability to swallow properly. The results of this test will determine the appropriate texture and viscosity for the food/drink in the diet. Although textured food can sometimes seem unappetizing, some companies have, over time, developed products that look like real food for a better appearance on the plate than purees, because as the saying goes, “we eat with our eyes first”! In addition, in order to boost an elderly person’s appetite, the should be exposed to their favourite foods.

When there’s no thirst

The elderly are more at risk of dehydration, because the signals of thirst decrease with age. Dehydration is a common problem often caused by too much fluid loss, via the kidneys for example, or too little fluid intake during the day. Fluid requirements for an adult are approximately 2.5 liters per day. Dehydration is evidenced by xerostomia (i.e. dry mouth), very concentrated and coloured urine, an intense sensation of thirst, weight loss, constipation, irritability, drowsiness, asthenia (i.e. weakening of the body), delirium, seizures and, in rare cases, coma. In case of constipation, seniors need to drink more water, increase their fibre intake and be physically active. To help the elderly drink more water, you should always leave a glass of water easily accessible to them, get them to consume a water-based popsicle, suck on an ice cube, drink fruit or vegetable juice, eat soup before a meal or drink an energy drink, such as Boost or Ensure if the energy intake is rather low. 

In short, the diets of elderly people suffer repercussions related to age and the slowing down of various bodily reactions. The feelings of thirst and hunger subside and can lead to an - undesirable - decrease in lean body mass. To age in good health, the elderly must therefore eat adequately while maintaining an active lifestyle.

Familiprix in collaboration with Hubert Cormier