Malnutrition in the Elderly

[Rustic Pumpkin]

Seeing Clunks post on Michaelmas where he says that two family members were so sadly born with cleft palette and hare lip, most likely through inadequate diet during pregnancy, made me think of this.

I am a committee member of an Over 50's Forum, and as such get invited to attend all manner of events and talks addressing a diverse range of issues. In the post last week I received an invitation to a forum on Malnutrition in the Elderly. Sadly, it is such a great distance away I will be unable to attend. I would dearly love to be able to go, for this issue is something I have seen with so much first hand experience. I am constantly on to my mother that a slice of toast for breakfast, followed by a lunch of a slice of bread and butter with a packet of crisps and a couple of biscuits does not in any way shape or form constitute adequate eating and nutrition. I have an elderly cousin who takes three days to eat what I would eat in one meal! They wonder why they are suffering from so many complaints.

I understand that certain complaints can be age related, but how much of what people suffer later on in life (talking 65 onwards here) is down to inadequate nutrition? I know my mother doesn't eat correctly, I know she doesn't get all the right balance of nutrients, but I cannot do anything to make her eat better. Yet, she makes sure Dad gets proper, balanced meals! I do my utmost to persuade her to eat correctly, but nothing can shift her from this unhealthy habit. I cannot convince her to do some simple changes like have a piece of fruit with her breakfast, put a slice of ham or beef in between her bread and butter, have a piece of fruit after her meal. The food is here, in the house, but she still manages to throw away more than she eats.

Okay, rant over, normal reading may be resumed, unless you want to rant too!:)

p.s. I still wish I could get to the forum!

[Crocus]

Hi RP, is there perhaps a reason your mum doesn't want to add fruit to her diet? x

[souter girl]

False teeth especially if they don't fit too well often deter the elderly from eating fruit. I have also read recently that the sense of taste and smell diminishes with age - so food isn't so interesting. My father latterly would take hours to eat a sandwich, often leaving most of it and claimed he wasn't hungry and would feel sick if we tried to get him to eat more. He was skin and bone at the end and no way could I tempt him with little delicacies.
As for how the elderly are often left to feed themselves in hospital when they can't even reach the food, or cut it up, that is criminal and a disgrace in a civilised society. Don't get me started!!

[keepersdaughter]

Rustic, I wonder if your Mother would be more inclined to drink rather than eat. I recall my father being ill and not feeling inclined to eat but would have Complan. I'm not sure if this is still available, but maybe something made up with milk for protein and calcium.
Maybe Boots or a local healthfood shop may have something?

[jazzactivist]

I think that KD has made a good suggestion, Rustic. The thing with not eating is that the stomach shrinks and so it becomes harder and harder to eat an adequate amount. Also, some types of medication suppress appetite too. What about juices or smoothies made with fresh fruit? Could you make a couple of jugs up for your mum when you go round to keep in the fridge and help herself. She only needs a small cup of one of these to help with her health.

[Healing Hands]

I had an Uncle who was in his 80's and he died from Malnutrition, it was very hard for me as I felt I was neglecting him but I did ask him if he wanted meal on wheels to come and visit, I also took food around to him when I could, but after he died and I went into clear the house, he had all the food I brought him just stacked up all over the place. He just did not want any outside help what so ever. He kept cats (strays) well that is what he said until we found out that he was feeding others people cats around the neigbourhood. There was cat meat in the cooker all over the place.

It was just so sad to see. I knew my Uncle was giving up after my father died which was 7 years ago now, he was the last of his family, he had no children as his wife could not have any and they lived with my grandmother, so she died then his wife and then my father some years later it was too much for him, 7 months after my father died my Uncle passed away.

I was a bit cross because he was a christain man, and his church did nothing to really help him either, but then my Uncle may not of wanted any help from his church either, I know my family has some stubborn streak in them!

But sometime I feel with the old that they cannot eat as much as they used to and find it difficult to cook for themselves also, I have an Aunt who is 90 and she is still cooking for herself, although my cousin and my mother make sure they are meals they are ready made by the family for my Aunt to re-heat.

[Rustic Pumpkin]

I was at a talk yesterday which discussed issues within the NHS and how to complain with effect. Without going into great detail, an example was cited where an elderly lady actually died of starvation while in hospital!!!

Apparently, one member of staff brought and served the meals, while they were cleared away by another member of staff. No one noticed, or noted in paperwork, that this woman was not eating any of her food. Eventually, she died from being too under nourished to cope with her disease.

On a personal note, this happened to Dad when he has been in hospital, so it is by no means an isolated case. I made sure that I was there for at least his evening meal and brought him in plenty of fresh fruit and drinks (as well as treats of cake and chocolate) and sat there actively encouraging him to eat. Several times he did not like any of the food that was on offer and they just left him with no food at all.

[sheddie]

I can empithise with this topic as my Mum lost her appetite too. I think sometimes it is the way it is presented, far too much can be overpowering where a smaller amount might get eaten, also a lot have ill fitting dentures where they have lost weight and need help cutting food or meat and things difficult to chew could be done in a food processor. When Mum was in hospital we made sure we was there at meal times as I know the nursing staff have lots to attend to. maybe it is a job where voluntary workers are needed. Please don't start me off!!X

[Cathie_W]

Re nutrition for the elderly

We realised that my elderly mum at one stage had stopped eating and we realised that she had a problem with swallowing - perhaps that might be worth checking.

[sunflower]

Malnutrition amongst the elderly is a complex issue. Over the years, I have been the main carer for three of my relatives. My first experience was when my Great Aunt came to live with us for six months when my twin sons were four years old. She decided not to eat except breakfast. Auntie liked porridge, and I soon learnt you could 'hide' all manner of nutrients in porridge. For example. Vit drops, mashed bannana, beaten egg and so on. Of course, nowadays, there are laws against doing this because you are giving someone food against their will and they cannot recognise the individual foods!!!! But in the 70's it was ok...I think. Anyway, it stopped her starving and she recovered enough to go back to her own home and live a further 5 years...until she was 95.
It is important to offer people with poor appetites little and often. So, instead of breakfast, lunch and dinner, you can break it up into 6 small snacks which if you are clever enough!! may just amount to the same calorie intake. It is also important to offer what they fancy, not necessarily what is 'good' for them. For example, a bar of chocolate, slice of fresh cream cake etc.
AND get this!! as a registered nurse I have even offered to go out to Burger King for patients, because they did'nt like what was provided on the hospital trolley. The Burger king can be seen from our ward window, and the smells are inviting....no matter what one thinks about fast food!!
Fortified drinks can be obtained on prescription so that elderly people do'nt have to pay for these drinks.

[keepersdaughter]

I wonder how much of this may be psycological. Tastebuds diminish and die off as we age (that's why children are such picky eaters apparently, they have thousands). We are not as active so we don't need or burn as many calories. And elderly people may have physical ailments, particularly those who are in hospital which prevent them from cooking. They may also be scared to be in the kitchen, handling hot things or fear of falling. But I wonder how much of it can be attributed to perhaps giving up as it were, loss of interest in life/loss of interest in food. Women no longer have others depending on them and men no longer have careers, maybe they lose interest in food as they lose interest in other aspects of their life. They no longer feel needed, valued, depended upon or cared for so they stop caring for themselves.

[sunflower]

I'm sure you are right KD. I remember my Great Aunt saying that after a particular bad bout of flu, she had lost her taste and food felt like cotton wool in her mouth. Also, I do'nt know what it's like in the USA, but here, it is really, really, difficult to open some packets, jars and bottles. Even food that is wrapped in plastic is difficult to break. I'm always commenting to Hubby about frail elderly people, especially with Arthritis trying to undo the packages.

[keepersdaughter]

You're right Sunflower, sometimes you have to end up attacking things with scissors and even then you have to pry the item out and if you're careful and patient enough, do you come away without cutting yourself on the packaging. How difficult must that me for frail elderly hands and wrists and dimming eyesight. Rustic, is the area you work in or volunteer related?

[franbee]

For older people, especially living alone, a company called Wiltshire Farm Foods will deliver nutritious ready meals to their freezer. All they have to do is heat them in the microwave.
An elderly friend had these for if he didn't feel like cooking, and MIL has them, she never cooks now except the odd egg and toast.
I think the type of accommodation elderly people have is important. They need regular supervision, someone popping in once or twice a day, checking that their diet isn't restricted by ability to prepare the food. But in the end, you can't make people eat or drink. My Mum died after a week with us and a week in hospital. I think she knew she was ill but didn't admit it, but wouldn't eat or drink, even when you tried to help her. I think she knew what she was doing, had had enough aged 90.
her sister on the other hand was in a nursing home with dementia, and when I visited her just before she died she was tucking into a sausage sandwich and crisps, despite having few teeth. No problem eating there.

[Rustic Pumpkin]

We tried the Wiltshire Farm Foods here, but found that they were quite expensive. That was about 4 years ago, so I doubt they are any less expensive now.

I actually offered to go in to supervise Dad at mealtimes when he was in hospital, and as he was on a side room I would not have interferred with anyone or anything, other than make sure he ate his meals. I was refused.

KD, I don't work at the moment, I am Dad's full time carer now. This is just something I have a very active interest in, as I can see how it is affecting my aunt, my mother, my father and others. There are a lot of useful suggestions and comments coming forward here. Thanks, everyone for this.

[dinger]

When my mum was in hospital I used to cook her meals of what I knew she liked and took it to her there . Sometimes she would'nt eat much at all but if I took her a small rice pudding egg custard or something like that we could come away at least knowing she had eaten.

[franbee]

The advantage of Wiltshire Farm Foods is that you either ring up with your choices, order on line, or pass an order form to the delivery man,and they deliver, once a month, at a designated time, bring the food in and put it in the freezer for you. You pay the driver. They are nutritionally balanced, and there are diabetic and vege meals available. They are more expensive than cooking your own, and the cheaper menus are not as good as the more expensive ones, but all round they are a good idea.

[Rustic Pumpkin]

Yes, although they were too expensive for us, I know someone who could afford them. That is all she ate, she never went shopping for food after she started with them, just things like milk, sugar, tea etc. She had breakfast, lunch and dinner all courtesey of Wiltshire Farm. She had minor mobility problems, but that was all, she just didn't like cooking.