Concentrating Nutrients for Elders (or, Pleasant Days start with Good Nutrition, Part 2)

For the vast majority of elders, being on “a diet” is not a good thing. Even if your elder is over- weight it can be very detrimental for them to lose weight too fast, or even at all. It is far more important for the elder to get the nutrients they need than to lose weight. Younger people can “diet” because most will have nutritional reserves in their bodies to draw from. Elders usually don’t have these reserves. So always think about nutrition first, then worry about being overweight later. Of course, the elder’s physician may have some dietary concerns. These would probably only be to limit cholesterol for someone who’s cholesterol is too high; to limit calories and/or sugar for a diabetic with uncontrolled blood sugar; or to limit salt intake for someone with fluid retention problems.
It’s often hard to get an elder to eat enough protein and/or calories, which will lead to malnutrition, and lots of problems leading to very unpleasant days. These suggestions are for people who eat very small portions, don’t finish their meals, or skip meals.
Some examples:

• Use three different fruits cut into manageable pieces for your elder and mixed together with a tablespoon of lime or lemon juice as a side salad for lunch. Add a little sugar and let it sit for about an hour to make it more enticing. Fresh fruit seems to "go down" better than raw vegetable salads.
  

• Jello: exchange half of the water for orange juice. Not only does this give extra nutrients that count for part of the fruit group, but it tastes sweeter, too.

• Top fruit or jello with flavored yogurt instead of whipped topping (counts as milk, rather than just extra sugar).

• Pancakes: add an extra egg for more protein. If using a mix that calls for water, use ½ milk and ½ water.

• Mashed potatoes: use milk, sour cream or yogurt rather than just water or broth when mashing.

• Cook hot cereal with milk instead of just water.

• Add milk to coffee instead of non-dairy creamer.

• When making meatloaf, hamburgers, or meatballs: use oatmeal (the “one-minute” kind) instead of bread crumbs. (whole grain)

• Dessert: make a fruit and yogurt parfait by layering fresh fruit (which has been “marinated” in a little sugar for ½ - 1 hour) and vanilla yogurt. (Fruit ½ - 1 cup; yogurt = milk ½ - 1 cup)

• For a sandwich filling: add ½ cup of minced vegetables to tuna, diced meat or shredded cheddar cheese. It will make the sandwich more moist, easier to chew, and you don’t have to use much mayonnaise. Use pickles, olives, onions, cucumbers, lettuce, peppers, shredded carrot, celery, avocado, even pineapple.

• Offer fruit preserves (less sugar here is OK, but usually not necessary unless the elder is diabetic) and encourage liberal use for whole wheat toast at breakfast. (Fruit, up to ¼ cup for 2 slices of toast).

• Put gravies, sauces, cheese sauces on food. This will boost calories and make the food easier to chew and swallow as well. If you use cheddar cheese in the sauce it will also serve to get more dairy nutrients in, which are rich in protein and calcium.

The other problem with having to concentrate nutrients, is having to choose wisely when feeding someone who has a small appetite. It may be fun to have an ice cream cone at midday, but if this takes the place of a meal it probably isn’t worth it. If your elder likes a lot of sweets and goodies but then will not eat a meal; I would suggest having a “goody” day one day a week where one meal can be replaced with choice sweets. For most people it doesn’t hurt to have sensible desserts every day after dinner. You be the judge. Most people can get enough nutrients out of a 1600 calorie diet, and it won’t hurt them to have an extra 200 to 300 calories for dessert. You would need to use some judgment if your elder is diabetic and on a strict diet. In which case, check with your doctor about speaking with a nutritionist for a specific plan to allow some sweets into the elder’s diet. If the elder is not on a strict diet, then plan desserts made from wholesome food. Rather than cake, try fresh fruit with flavored yogurt. Low cal jello desserts with fruit and topped with low cal whipped cream, or vanilla yogurt. Even ice cream is better, since it has milk in it and not just sugar and flour.

Some elders I have cared for have had poor appetites for various reasons, mostly having to do with chronic diseases and prescription medications. One lady in particular used to make me laugh. She would always remind me not to make her meals too large. When I assured her I would try to keep the meal small, but that she needed to eat enough protein, she would smile at me and say "Oh, I know you'll sneak it in somehow." Sneaking it in was alot easier than arguing about it, which led to yet another Pleasant Day.
Here's wishing you and your Elder "Pleasant Days."

image above by serenejournal
www.flickr.com photos

Pleasant Days start with good Nutrition

After caring for several elders in our home here on the beach in Punta Banda, I am convinced that successful caregiving (meaning the elder has Pleasant Days, and so do you) starts with good nutrition.

I know, everyone says everything starts with good nutrition, right?

Nutrition for elders is somewhat different from nutrition for everyone else, for lots of different reasons.
1) Many elders don't have an appetite.
2) They don't have the energy it takes to shop for, and then prepare food for themselves let alone clean up afterwards.
3) It's common for elders to live alone (spouse has passed on and children are grown), so eating has become a chore rather than a pleasant social experience.
4) Food just doesn't taste, or smell, the same anymore. Many elders can taste "sweet" more than anything else, so all they want to eat is sweet stuff with no nutritional value.
5) Medications either destroy the elder's appetite, or interfere with absorption, or cause the body to lose valuable nutrients.
6) Many elders have difficulty chewing foods because of poor dental care.
7) Some elders have difficulty swallowing for various reasons ranging from neurological problems, to cognitive problems.
8) Degeneration of the digestive tract, and it's blood supply, from the mouth all the way through to the colon prevents adequate digestion and absorption of nutrients.
9) Many elders don't have the cognitive ability, and/or the desire, to plan out nutritious meals. They may not even remember if they have eaten or not.
10) Many elders can't physically handle much salt in their diet. Prepared foods, the kind that most elders will eat due to ease of preparation, are over-laden with salt.
11) Some elders have severe endurance problems because of heart or lung disease and just don't have enough energy or oxygen to get through the physical act of eating a meal.
12) Some elders use food, and their eating of it (or not), as a control issue when dealing with family members.

Most elders have at least one, more likely many of the above problems.

It may not seem like a big deal to some. But inadequate nutrition can be disastrous for the elderly. I'm also talking about hydration here. Ensuring your elder gets enough food (with nutritional value) and fluids is the best way to help her/him feel their best.

"Best" means:
--the elder is more energetic and able to do more for her/himself;
--s/he is less likely to become immobile because of poor endurance, so you don't end up having to lift her/him around;
--s/he feels physically better and gets sick less often;
--her/his skin remains intact with less chance of life-threatening infection;
--s/he is in a better mood and tends to be much less grouchy;
--s/he has fewer problems with memory and reasoning skills;
--s/he retains body weight and fluid so medications don't become toxic and cause horrid side effects;
--s/he is more likely to have better bowel and bladder control;
--s/he can cope with pain issues much easier;
--and s/he is more likely to have the ability to enjoy a positive social life.

I'm sure there are some things I forgot. But you get the idea. You may not believe eating food can do all that. So here's a real life example:

We once cared for an elderly man who could not walk when he came to us. His family had been at a loss when trying to care for him, and he became progressively weaker, falling frequently, until he just couldn't get up by himself anymore, and his family was considering nursing home placement because they could not care for him. After he had been with us for a week, he was walking. Not only to the bathroom and all over the house, but down the road with my husband for walks everyday. His confusion cleared, and he was able to play his favorite card game (Rummy) with us in the evenings, and write poems again. Amazing! And no, there had been no changes in his medications. It was simply the food and fluids he was getting everyday in regular meals.

Here's another likely example:

If an elder takes a diuretic for retention of fluids caused by heart problems (which is extremely common), s/he needs to eat adequate amounts of potassium to offset the potassium the diuretic will cause the kidneys to excrete. The best sources are fruits and some vegetables. The easiest way to get in enough potassium is a glass of OJ everyday, and/or a fruit salad. Everyone should eat at least 1.5 cups of fruit (includes juice) everyday.

So what happens if s/he doesn't. This:
--muscle twitches, then muscle cramps
--loss of strength in muscles
--frequent falls
--"bad mood", with grouchy outbursts
--inability to remember things and reason properly
--delusional thinking leading to paranoia
--poor judgment leading to behavior problems
--nausea
--diarrhea
--intestinal cramping
--lack of energy
--severe potassium deficit can cause problems with the heart contracting, and lead to death.

So, you really want your elder to avoid all that. But, getting an elder to eat can be a problem all by itself.

First, you need to fix any of the "reasons" for poor nutritional intake listed above that you possibly can. Simply being there to prepare the right foods and provide encouragement will remedy many of the problems.

Second, you need to get your elder to eat a balanced, nutritious diet. If you need information about what a balanced, nutritious diet consists of, go to my list of links ("Links for your assistance") and click on MyPyramid.com. The site is very easy to navigate around and has all the information you need to be able to put together a good diet. This could be helpful to you, and anyone else in your family as well. Good nutrition for yourself will go a long way to prevent overwhelming stress from being a caregiver. When I first started caring for elders in my home, I knew about basic nutrition concepts (we have 5 grown children), but when I was working in institutions I always had the benefit of a dietician to call on. This site was a fantastic find. It makes being your own nutritionist so simple.

Third, you need to provide this diet in small meals with concentrated nutrients, that are appealing and easy to eat. Examples would be a breakfast consisting of:
--oatmeal 1/2 cup with 1/2 cup milk in it,
--coffee (2 cups with 1/4 cup milk in each cup), and
--2 scrambled eggs
--1 cup of OJ.
This is soft, not too much to eat, and provides 1 of the 6 oz. of whole grain (in an 1800 cal diet), 1 of the 3 cups of milk, 1 of the 1.5 cups of fruit, and 2 of the 6 oz of protein. I would cook the oatmeal with sugar or sweetner instead of salt. You can always add whole wheat toast, each slice being another 1 oz of grain. If you need more fiber, eat whole fruit instead of drinking juice. Juice is just easier to get down for an elder who has appetite problems.

Every morning I decide what we are going to eat during the day. I write it down on a slip of paper, split up by nutritional categories (meat, milk, fruit, grain, veg) and by meals, and tack it to the refrigerator. So if I get in a big hurry or have some sort of "emergency", or the elder I'm caring for is in a particular mood that day, I don't lose track of what I'm cooking.

I don't mean to suggest that you put your elder on a calorie count "diet". Most elders don't need calorie restricted diets unless they are diabetics that have a hard time controlling their blood sugar. What you do want to pay attention to is ensuring that your elder gets enough of each food group. This will prevent any nutritional deficiencies that cause problems. And if your elder can't eat all the food listed in the diet, cut down the portions proportionately in each food group rather than leaving some out. This way s/he will get as close to a balanced and nutritious diet as you can get. As time goes on, maybe s/he will feel better and be able to eat more. And don't forget the fluids. Dehydration can cause nausea and unwillingness to eat along with all the other "miserable-ness".

A note about fluid intake before I quit. In general, the amount of fluids you need should be about the same amount of cc's (or ml's, if you prefer)as calories you ingest. So most people would need about 1800cc to 2000cc per day. This is where the "8 cups of water" idea comes from. 1000cc is a liter, or basically a quart which is 4 cups. But remember, all that does NOT need to be water. Water is good, but there is water in everything you eat as well as drink. So count all the "drinkable" fluids you take and you'll be fine. For elders, many can't handle too much fluid, especially at first. Elders are notorious for not drinking enough fluid, and being slightly dehydrated. So, if you are just beginning to care for an elder, go easy on the fluids and gradually bring her/him up to the needed amount. (gradually meaning over about a week's time). You will find out, over about a month, what your elder can handle or not. Watch for signs of fluid overload, especially for elders with heart or kidney problems. Signs of for an elder would be obvious: rapid weight gain, edema (or swelling) of extremities, higher blood pressure and/or difficulty breathing. If this happens, back off on the fluid a bit and call the elder's physician.

More about concentrating nutrients and meal planning later.

I hope I haven't bored anyone. But this is so important to your elder. It's hard enough to be old--hard for the elder, and hard for the caregiver. In my humble opinion, nutrition and hydration are more important than most prescription medications. It is the easiest way to help your elder, and yourself, have Pleasant Days.