Grandma Eats Like a Bird: Helping Caregivers Improve the Nutrition of Older Persons at Home

Abstract

The United Nations has declared 1999 the International Year of Older Persons. As the global community ages, dietetics professionals can highlight their role in promoting good nutrition in the golden years. They also face the challenge of educating those providing nutrition assistance to their loved ones and neighbors who are aging but still living at home. Monitoring the nutrition status of older persons who live independently is important, because as many as two thirds of free-living elders consume inadequate diets ((1)Melnik T.A. Helferd S.J. Firmery L.A. Wales K.R. Screening elderly in the community the relationship between dietary adequacy and nutritional risk.J Am Diet Assoc. 1994; 94: 1425-1427Google Scholar). At the same time, “it is very difficult to get older people to recognize that their eating habits have changed or are suboptimal for their particular nutrition needs,” according to Jane V. White, PhD, RD, professor with the Graduate School of Medicine, Department of Family Practice, University of Tennessee, Knoxville. When older people fail to appreciate the changes in their own eating habits, it helps to have an alert family member or friend reaching out to intervene. Dietitians can help family and friends become part of an effective first line of defense against poor nutrition in older persons. Many sensory factors contribute to shifts in preferences and appetites of older persons, which, in turn, can affect nutrition status. White explains that sensory changes in older persons can occur as side effects of medications, but they may also happen naturally. This can make food taste hopelessly bland or unappetizingly strong. Changes in vision can cause food color to lose its intensity and become less visually appealing. Likewise, auditory impairment makes it difficult for older persons to hear the crispness or crunchiness of chewing. This loss compounds the frustration of compromised conversational skills and detracts from the appeal of healthful social dining. White suggests simple things a caregiver can do to “enhance the eating environment” of older persons. Adjust the seasoning of foods to spice up or tone down flavors. For those with failing vision, be sure the eating area is well lit. Also, select a plate with a simple pattern or solid color that will not obscure the food placed on it. Play upbeat, familiar music at a comfortable volume. Researchers have learned that the appetites of older persons increase when they listen to music from their youth at mealtime. Finally, introduce at-home caregivers to some of the food products available, such as flavor enhancers, texture modifiers, and supplements, that help older persons enjoy eating. Dental problems also plague the older population, which can make eating painful. Oral discomfort limits the frequency, quantity, and variety of foods eaten. Ask older people if they have seen a dentist, and offer to accompany them to the dental office. White points out that 2 major causes of involuntary weight loss in older persons are dental problems and depression, so alert caregivers to the twofold benefit of making older persons smile. White was instrumental in developing the DETERMINE Your Nutritional Health Checklist (Figure), a useful nutrition screening tool that can help caregivers spot nutrition problems in older persons. Former president of The American Dietetic Association Ronni Chernoff, PhD, RD, FADA, associate director of the Geriatric Research Education and Clinical Center, Central Arkansas Veterans’ Healthcare System, Little Rock, considers the evolution of the DETERMINE checklist: “The original intent was for it to be a public awareness tool that older people may be at nutritional risk.” So successful and so needed has the checklist proven that it has been adapted to the clinical setting. Chernoff supports the idea of widening its application by sending the checklist home with patients when they are discharged from the hospital, because dietetics professionals “need more creative and pragmatic ways to get information about patients.” Using DETERMINE can help lay caregivers know when to worry about changes in older persons’ dietary habits and can motivate them to seek a professional nutritionist's help. Lay caregivers provide an invaluable service to the older persons in their charge—and to the community. But they cannot do it alone. They need the support of dedicated dietetics professionals, who should be armed and ready with resources to assist them.