Nutrition for older people

Published August 2016

Contents

Introduction ..............................................................................................

A balanced diet for older people................................................................

Hydration...................................................................................................

Good sources of nutrients..........................................................................

Malnutrition in older people......................................................................

Causes of eating problems.........................................................................

How to encourage eating............................................................................

Finger foods................................................................................................

Recipe ideas................................................................................................

Textured Modified Diets.............................................................................

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IntroductionAs we get older, eating healthily is vitally important. It helps us to stay in good shape, physically and mentally, and provides a defence against infections.

Having a balanced diet that provides all the nutrients the body needs is of paramount importance at every stage of life. All of the major food groups - proteins, fats, carbohydrates, and vitamins and minerals - should be represented in our meals.

However, our relationship with food can change along with the ageing process. Sometimes older people develop problems maintaining the eating habits associated with a healthy lifestyle. Factors such as low income and mobility problems mean it can be hard for such individuals to obtain and prepare the food they need.

Age-related conditions such as dementia can also affect eating habits, causing people to lose their appetite and, in its later stages, sometimes leading to problems chewing and swallowing. Much of the guidance in this book is aimed at helping carers for people living with dementia.

If these issues are not addressed, they can lead to serious health conditions. Malnutrition can be a big problem for older people, significantly diminishing their quality of life.

Fortunately, there are a number of steps we can take to guard against this eventuality, adapting meals and food preparation to accommodate the needs of older people and those living with dementia.

Finger foods, for example, can be an ideal option for individuals living with dementia who do not have the appetite for a full meal. If the right ingredients are used, it is possible to create appetising finger foods that contain the nutrients essential for maintaining a balanced diet.

With all this in mind, we have prepared an in-depth guide to the topic of nutrition that provides details on how to maintain a balanced diet for older people. You’ll find information about malnutrition, which foods contain essential nutrients, and how to prepare finger foods, along with some recipe ideas to get you started.

Of course, maintaining a nutritious diet is only one part of a healthy lifestyle. Regular exercise and mental stimulation remain vital well into old age, to ensure that people are healthy, happy and have the best possible quality of life.

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A balanced diet for older peopleIt is important for older people to have a healthy, balanced diet to maintain physical and mental wellbeing, and avoid vulnerability to infection, reduced muscle strength and fatigue.

This involves eating a variety of foods from each major food group, basing meals around starchy foods such as pasta, potatoes, rice, cereals and couscous - preferably wholegrain varieties, as these are the healthiest.

The essential foods

Proteins are needed for growth and repair. Good sources of this nutrient are meat, poultry, fish, eggs, cheese, pulses, soya and nuts.

Saturated and unsaturated fats are required to provide energy, although some fats are healthier than others. Fats can be found in cheese, eggs, milk, yoghurts, oily fish and nuts. Oily fish are also an excellent source of Omega 3, which should be eaten at least twice a week to help protect against coronary heart disease and bone-degenerating conditions such as arthritis.

Carbohydrates are needed for energy. They come in two major types: simple and complex. Simple carbohydrates - also called simple sugars - are found in refined sugars, but also in more nutritious foods like fruit and milk. Complex carbohydrates - or starches - are found in foods such as potatoes, pasta, bread, cereals and other grain products.

Vitamins play an essential role in all bodily processes. A, D, E and K are fat-soluble and can be stored in the body, but the rest are water-soluble. Foods containing water-soluble vitamins must be eaten once they have been prepared or the vitamin content will be lost.

Minerals perform a number of vital functions. Calcium and phosphorous are required to maintain healthy bones, while iron is needed for the formation of red blood cells and is often deficient in those over the age of 65.

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HydrationIt is vital for people to take on a healthy volume of fluid. The human body is almost two-thirds water, and enough fluid must be consumed to remain hydrated. Failure to do so can result in tiredness, headaches and a general inability to perform. However, people living with dementia may be unaware that they are thirsty, making it more challenging to ensure they are suitably hydrated.

The word “fluid” does not apply exclusively to bottled or tap water; it also includes everything from soft drinks and fruit juices to tea and coffee, as well as the water provided by food. However, stronger alcoholic drinks - like wines and spirits - do not provide hydration effectively.

Although the majority of drinks are hydrating, there are other considerations; some drinks may also provide calories, which add to your daily calorie intake, while others contain essential vitamins and minerals. Some - such as fruit juices and carbonated drinks - are acidic, which may damage the enamel if consumed too regularly. Using a straw lessens the impact by reducing contact with the teeth.

The amount of fluid people need to consume is based on many factors, such as climate, the amount of exercise they do and their age. However, some general guidance exists. Under European recommendations, women are advised to drink 1.6 litres of fluid per day - equivalent to about eight 200 millilitre glasses - while for men, the figure stands at two litres per day. These volumes are in addition to fluid consumed in food.

It is also important to remember that too much fluid can be consumed. Drinking excessive fluid offers no benefits, and in extreme examples can even be harmful.

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Good sources of nutrientsFruit and vegetables are an excellent source of vitamins, minerals, fibre and carbohydrate, which is mainly present in the form of sugars. The recommended intake is five portions per day.

Eating plenty of fruits, vegetables and wholegrains can also help to prevent constipation, which often becomes a problem for older people.

Dairy products such as milk, cheese, yoghurt and fromage frais are essential components of a balanced diet, as they contain calcium, which is vital for bone growth and can help to reduce the risk of conditions such as osteoperosis. Leafy green vegetables and calcium-fortified cereals are also good sources of this nutrient.

However, it is important to limit the intake of foods high in fat, salt and sugar. Similarly, alcohol should not be consumed in large quantities as it has been linked to a number of physical and mental problems. As it is a depressant, it can exacerbate underlying appetite issues experienced by those living with dementia.

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Malnutrition in older peopleMalnutrition can be a common problem among older people, but it is often overlooked. According to the charity Age UK, around 1.3 million people in the UK over the age of 65 could be affected by the condition.

It can be caused either by an inadequate diet - eating too little, or not sticking to a balanced diet - or through difficulties absorbing nutrients from food. Common reasons for these problems are having a low income, reduced mobility or having a long-term health condition - factors that frequently affect older people.

Age-related changes can exacerbate the problem. These include the loss of cognitive function and deteriorating vision, which can prevent older people from maintaining good health and dietary habits in old age.

Depression, which has a high prevalence among people living with dementia, is another major cause of malnutrition, as it can lead people to lose their appetite. The best course of action in this case is to seek advice from a GP, as there are medications and counselling techniques available to treat depression.

The most obvious sign of malnutrition is a sudden loss of weight, although other symptoms include weak muscles, constant tiredness, low mood and suffering from more illnesses and infections.

As well as offering a balanced diet, there are a number of ways for carers to help ensure people living with dementia have a good intake of food, through stimulating their appetite and interest in eating and drinking:

● Try to encourage snacking or small meals, rather than regular set meals● Experiment with different flavours, as tastes in food can change● Create a light and friendly atmosphere● Serve smaller portions, as once food goes cold it is likely to lose its appeal● Consider pureed food - although be sure to consult a dietician or speech and language therapist (SALT) first, to ensure it is both nutritious and flavoursome

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Causes of eating problemsIf an older person is not eating as much as they should there are several possible reasons for this that are not necessarily a direct result of dementia. There are a number of measures you can take to establish the cause of the problem.

Communicating with the person is the best way of finding out why they are experiencing difficulties, but physical signs can also point to an underlying condition.

Sore gums, ill-fitting dentures, a dry mouth, or oral thrush can cause problems with eating and drinking. Gums that are red and inflamed, or that bleed easily when touched or when teeth are being cleaned, can be a sign of a sore mouth. Ulcers can also be a source of discomfort, while bad breath and complaints about a bad taste in the mouth are often signs of problems too.

Signs of sensitive or painful teeth include discomfort when eating some kinds of food (such as ice cream) and teeth that look loose or in a bad condition, for example broken or discoloured. Ill-fitting dentures or dental plates can be another reason for people eating less. If people are reluctant to wear their dentures, this could be a sign of a problem.

An individual may be inclined to eat less if they have a dry mouth, which could be caused by some medication, breathing through the mouth, very warm environments, an insufficient fluid intake or infections. If medications or infections are a potential cause of the problem, the matter should be discussed with a GP.

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How to encourage eatingEnsuring people living with dementia are in a comfortable environment while eating is essential to helping them enjoy their meal.

Make sure they are relaxed and do not feel the need to hurry their food. If possible, let them choose where they want to eat. Offering encouragement and gentle reminders about the food on their plate can also prove effective.

Different tastes, colours and smells can make food more appealing. If people do not eat their main meal, don’t hold back their dessert - they may prefer the taste of it.

Older people can sometimes have difficulty recognising food and drink, often due to damage to the brain, unfamiliar food, or how food is presented.

Explaining what the food is and ensuring they are wearing the right glasses can help, as can using colourful ingredients and serving meals in a brightly-lit environment, using clockwork presentation on a plate:

Chicken

Potato

Vegetable 2Vegetable 1

Another problem that can contribute towards malnutrition is a person’s positioning. If people are drowsy, slouching or lying down, it will make eating significantly harder. Ensuring they are alert, comfortable and sitting upright while they have their meal can help to ease problems with swallowing.

A physiotherapist can advise on positioning techniques and an occupational therapist can provide information about aids for eating and drinking.

It is also important to be adaptable when catering for people living with dementia. Their tastes can often change significantly, meaning they may sometimes express a preference for unusual combinations.

In addition, people should be allowed to choose what to eat as much as possible, and you should avoid limiting the foods that are available to them.

Older people often develop a taste for sweet foods in particular, so it can be useful to serve sauces or chutneys with savoury meals to make them more appealing.

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Finger foodsFinger foods have a number of benefits for people living with dementia - particularly those with more advanced forms of the condition.

As dementia progresses, it sometimes becomes more difficult for people to use cutlery, meaning finger foods can serve as an alternative to a full sit-down meal.

They can also help to preserve independence by offering an array of options from which people can make a selection.

People living with dementia tend to prefer being able to choose what they eat themselves rather than relying on someone else to feed them.

Another advantage is that, as people get older, they often do not want to eat at set times, and finger foods can be eaten throughout the day, as and when they feel hungry. After people have lost the ability to eat a full, sit-down meal, offering people finger foods can serve to renew their interest in eating.

As well as being easier for people living with dementia to eat, finger foods can provide a good source of the vitamins, minerals and other nutrients that are essential for keeping them healthy.

It is important to vary the types of food on offer, however, as people can easily get bored having the same kind of food day-in, day-out.

Recipe ideasFortunately, many finger foods can be prepared quickly and easily - and there are plenty of ways to create variations on a theme. Here are a few ideas based around some healthy foods.

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PeasPeas provide vitamins C and A, folic acid, thiamine, iron and phosphorus. Thiamine is used to regulate appetite, improve mood and maintain normal muscle function, while phosphorus plays a key role in keeping bones and teeth healthy.

Peas make an excellent finger food when mixed with mashed potatoes and turned into croquettes. Alternatively, pea fritters can be made by mixing them with gram flour, binding the mixture with beaten egg white, lightly flouring and either oven baking or shallow frying.

PotatoesAs well as being one of the best-loved and most commonly used foods, potatoes are a good source of fibre, water, vitamins B and C, and potassium. Their versatility makes them an ideal finger food ingredient. Diced and cooked, they can be used as an ingredient in frittata.

Serving them rosti-style is another option. Simply grate and squeeze/drain their moisture, mix with onion, sesame seeds or caraway seeds, shape palm-sized portions into flat patties and shallow fry. Small wedges can be brushed with vegetable oil and baked as a healthier version of chips. Seasoning them with curry powder, chilli powder or honey and mustard glaze will make them more appetising.

CarrotsCarrots are a good source of beta carotene, vitamins A and C, and antioxidants. They also provide fibre to aid digestion

A simple way to make them into finger food is to serve them as crudities with dips after washing and scrubbing them. They can also be sliced, brushed with vegetable oil and oven baked to make crisps. Alternatively, they can be grated and used as an ingredient in carrot cake.

These are just some ideas from a broad range of possible items - including asparagus, courgettes and cabbage - that can be used as finger foods. Fruit can also be used for this purpose, with tomatoes, raspberries and blackcurrants among the more suitable options.

Don’t be afraid to be creative when cooking for older people - it’s okay to experiment, and if they don’t like something, they’ll probably let you know.

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Textured Modified DietsThere are four types of modified diet: fork-mashable, puree, thin liquid, and thick liquid. Anyone requiring a modified diet should be assessed by a SALT team and follow their guidelines.

Fork-mashable foods

These are soft, tender and moist but need some chewing, and – as the name suggests – can be mashed with a fork. They often are served with a thick, smooth sauce, gravy or custard.

Older people who are experiencing difficulty swallowing may be referred by the SALT team to switch to a soft diet, as it is much easier to ensure they get the right nutrients this way, rather than using pureed food.

A large number of foods are suitable for this type of diet, including bananas, baked beans, avocados, scrambled egg, couscous and mashed potatoes, as well as well as minced beef, pork, chicken, lamb, and fish without bones.

As people on these diets can sometimes experience constipation, it is important to maintain a regular fluid intake. Including fruit (stewed, tinned or fresh) and soft or mashed vegetables or pulses (beans, peas and lentils) in soups or casseroles can also help to avoid this problem.

Puree

In the later stages of dementia and other conditions, it may become difficult for people to swallow food, meaning they require more assistance eating.

Carers often notice that food becomes lodged in the side of the mouth, rather than being moved to the back of the mouth and swallowed. Choking can also occur due to problems with the swallowing reflex. People who have experienced such problems eating can become fearful of foods that they find difficult to swallow.

However, if problems persist, it may be necessary to begin pureeing food. Before doing this, you should consult your GP, who can refer the patient to a speech and language therapist for a specialist swallow assessment.

They can perform a number of tests to determine swallowing ability, as well as giving advice on providing a pureed diet that is nutritious and remains flavoursome.

Thick and thin liquids

People who have difficulty chewing or swallowing may be given a liquid diet, of which there are two varieties: thick and thin.

Thick liquid diets incorporate three different levels of thickness:

● Pudding – Includes liquids that have been thickened to the consistency of a pudding, so they remain on the spoon in a soft mass.● Honey – Able to flow off a spoon in ribbons, these liquids have been thickened to the consistency of honey.● Nectar – These liquids are thickened to a consistency that coats and drips off a spoon, in a similar manner to unset gelatin.

Thin liquid diets can involve a variety of foods and drinks. Examples include broth, jelly, fruit juices, tea and coffee.

Further information

We very much hope this information has proved useful. Further information is available from Age UK, local organisations like Age Scotland, through their websites and through their phone help lines. Information is also available through the Alzheimer’s Society and Alzheimer Scotland.

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About

Barchester Healthcare is recognised as a major UK care provider that is committed to delivering high quality care across its care home and hospitals.

The organisation has adapted and grown over the last 24 years, focusing on older people needing nursing care in high-quality environments and providing personalised support for adults of all ages with a range of disabilities.

We pride ourselves on our expert dementia care. Our Memory Lane Communities are designed to encourage people living with dementia to stay as independent and active as possible. We understand that no two people are the same and take a person-centred care approach, recognising and celebrating each person’s individuality.

Barchester employs almost 17,000 people to care for more than 11,000 individuals at more than 200 locations in the UK.

For more information on choosing a care home, please visit www.barchester.com

Disclaimer

This Barchester Healthcare Guide provides information and resources and while Barchester Healthcare tries to ensure that material included on the Barchester Healthcare Guide is correct, reputable and of high quality, it does not make any warranties or guarantees in relation to that content. If we are informed of any inaccuracies in the material on the Barchester Healthcare Guide, we will attempt to correct the inaccuracies as soon as we reasonably can.