Food & Drink – Ageing

Definition of Food & Drink – Ageing

We all experience the affects of ageing differently. Maintaining a nutritious and balanced diet alongside mental, physical and social stimulation enhances healthy ageing.

Here we look at some of the most common challenges related to eating and drinking that can arise in the frail elderly. These can have knock on effects and implications for health, malnutrition and dehydration.

General Elderly Nutritional Requirements

In general ageing reduces the levels of energy required by the body, however nutrients, minerals and vitamins required by the body remain the same*. Following the ‘Eat Well guide’ is a the best way to maintain a healthy diet. Energy requirements decline because the basal metabolic rate decreases as a result of changes in body composition.  These changes are not inevitable and certain exercise regimes in old age can maintain lean body mass and a higher metabolic rate. The proportion of protein, fats, carbohydrates and fruit and vegetables remains consistent however the volume eaten may decrease.

There are acute conditions associated with ageing that can affect the metabolism and absorption of some nutrients. Medical advice must be taken and supplements and medication can be used effectively. The most common nutrient deficiency is a lack of vitamin D, needed to aid the absorption of calcium and form strong bones. This deficiency is seen most widely in institutionalised settings and where individuals can’t get out and about, reducing their exposure to sunlight. Foods high in vitamin D are milk, cheese, butter, eggs, fortified margarine and oily fish. Ensuring the diet has good exposure to these sources of vitamin D can reduce the need for supplementation.

Typical Meals and Drinks

The typical meals eaten by the elderly reflect their habits; earlier experience of different foods; and physical and mental abilities. If we are helping an elderly relative, friend or neighbour it is important to understand their likes, dislikes, habits and abilities so that you can support them in eating well. Sometimes we feel we can help by providing food and drinks that we understand to be ‘healthy’. This can cause concern and disruption at this stage in life and can lead to less being eaten and drunk. It is very important that we maintain a healthy weight; unexpected or unnecessary weight loss must be avoided.

The Malnutrition Universal Screening Tool (MUST) is a great way to monitor how someone is performing nutritionally.

Hunger, Thirst and Medication

As we age our senses tend to decline. There are physiological changes that reduce our ability to sense thirst and hunger. As a result meals may be missed, less is eaten at a sitting and less is drunk. If you are helping an elderly person remind and prompt them to eat and drink the things they like. Never assume they have finished just because they have stopped. It is important to understand their habits and use your instinct to judge how they are getting on with eating and drinking.

There are many conditions experienced by the elderly that require medication. Medication can affect taste, hunger and thirst, as well as cause a feeling of nausea. Check the side effects to medication as it can affect the best time to eat and help you to understand where fortification would be beneficial.

When eating and drinking are reduced there can be an increase in the prevalence of constipation. Constipation is where bowel movements are difficult to pass and become infrequent. Stools need fluid to help bulk them out and make them soft. Fibre, especially insoluble fibre, gives structure and helps with movement. Where these components are lacking problems may arise. Some medication and pain relief can also cause constipation.

Fortification and Prompting

As we have seen it is important to prevent unwanted weight loss. When reduced appetite or ability limits the amount of food eaten it might be necessary to fortify meals with extra calories and nutrition.

It is important to understand the underlying  cause of weight loss and if possible monitor the individual’s weight over time. If they are losing weight then start by prompting them to eat more at mealtimes. This regular reminding and motivating during mealtimes has shown to improve the well-being of elderly residents losing weight in care settings.*

If weight loss persists then adding extra fats, proteins and carbohydrates to the regular diet can quickly add calories without increasing portion size. If the meals are delicious and the food is eaten then this can work well to prevent weight loss.

Mealtimes can become a lengthy process and individuals can tire and fatigue. It will help to have more shorter meals with snacks throughout the day. This will provide the right nutrition over shorter eating times.

You may find that a decline in food intake occurs at the same time as a decline in activity and fortification is not needed.

Mobility

Reduced mobility can affect normal eating and drinking behaviours quite markedly, affecting the ability to:

• Get out and do the grocery shop
• Prepare ingredients, cook and wash up
• Open packaging
• Use cups and utensils to drink and eat
• Eat and drink independently

When helping someone it is important to ensure they are supported, however it is also vital to help in a way that promotes independence. There are many strategies, services, products and equipment that can be used to help maintain as independent a life as possible.

You can find more practical help on this and the other topics on our Hints and Tips – Ageing page.