What are the common dietary problems in the elderly?

Part two in our three-part series on nutrition

Read Part one here.

What are common dietary problems in the elderly?

Common dietary challenges that the elderly may experience, include altered taste, difficulty swallowing, nausea, vomiting, constipation or irregular bowel movements, unintended weight loss, malnutrition, cognitive decline like dementia, and dehydration.  

1. Change in taste

Usually, taste bud cells on our tongue are replaced every week. However, after the age of 50, the taste buds begin to reduce in sensitivity which makes it harder for the elderly to taste foods. There are also other causes of change in taste which include medications, infections, dental issues, medical procedures, and dry mouth. Dietitians can assist with this issue by altering the menu to enhance flavour and stimulate the taste buds. This includes understanding specific spices, herbs, seasonings, and foods that boost the flavour profile of a meal or implanting strategies during mealtime.

2. Swallowing Difficulties

As we age, the nerves that are responsible for moving muscles become less efficient. Chewing food can be tiresome and cause jaw pain and the food we eat may not be properly broken down into smaller pieces. In the throat, the muscles are not effective and may cause difficulty in swallowing compared to when we were younger. To assist with swallowing difficulties, it is best to refer to a Speech Pathologist. Once a resident has been assessed by a Speech Pathologist, refer to a Dietitian to optimise the quality of eating and to recommend foods that follow a specific texture modified diet personalised to that resident’s nutritional requirements and preferences.

3. Nausea

The elderly are prone to developing medical conditions, and many of these conditions may cause nausea as a side effect. These conditions may include infections, gastrointestinal problems, dehydration, medications, cancer treatments, the flu or simply food poisoning. Those who are sick can have heightened senses, and aromatic foods may be too overwhelming, which may lead to poor appetite and nausea. There are several ways to encourage feeding when the resident is nauseous. This includes opening the food cover away from the person, offering cold and bland foods such as sandwiches, crackers, biscuits, lemonade, ginger ale, avoiding high fatty foods, and offering small, frequent meals. If nausea continues, refer to a Doctor and Dietitian.

4. Constipation

Irregular bowel movements are another common issue for the resident. This is mainly due to poor muscle and nerve coordination, bed rest, some medications, not enough fluids, not enough fibre or poor oral intake. Poor bowel movements may cause further issues such as poor appetite, haemorrhoids from straining on the toilet, bloating and flatulence. A Dietitian can assist with a high-fibre diet and encouragement of liquids such as water, juice, soups, broths, coffee and tea to help soften the stool, as well as personalised recommendations.

5. Diarrhoea

On the other hand, diarrhoea may be another bowel issue that may occur due to infections, food poisoning, poor bowel muscles, some medications, food intolerances and gastrointestinal disorders. Along with watery stools, diarrhoea can cause abdominal cramps, urgent need to toilet, mucus in the stool, bloating and irritation. Dietitians would personalise their recommendations and may assist with a high-fibre diet as this can help absorb water and bulk up the stool along the gastrointestinal tract. Hydration is so important, as frequent diarrhoea loses a significant amount of water, and the body needs to be replenished with water and electrolytes.

6. Weight Loss

Unintentional weight loss is another big issue across aged care, particularly heightened with COVID-19 as well. Weight loss usually occurs due to loss of muscles, fat, and water and often related to reduced food intake. Those who are inactive or have reduced mobility are also seen to lose weight. The reason being that when the body is not receiving enough nutrition, it will find it elsewhere in the body which is usually the muscles and fat. Loss of muscle results in poor mobility, high risk of falls and exacerbation of weakness. Reversing weight loss is highly recommended as poor management of weight can lead to serious medical conditions including malnutrition. Dietitians assist by assessing food intake, taking into consideration of food preferences to tailor their approach and optimise the best nutritional source of energy, protein and other nutrients as required.

7. Malnutrition

Malnutrition in aged care is a deficiency of nutrients such as energy, protein, vitamins and minerals. Energy and protein are key to providing fuel and promoting muscle growth to prevent injuries, falls, decline in cognitive status, reduction in mortality, and overall improve general well-being. Those who are at risk of malnutrition or who are malnourished will need to be referred to a Dietitian who can offer personalised dietary advice. The high energy and high protein diet is the recommended strategy to improve nutrition status. Dietitians will also recommend foods that are high in energy and protein such as high protein milkshakes, cheese and biscuits, meat, fish, chicken, eggs, yoghurt, ice cream and food fortification. Malnutrition screening is also an important tool to identify residents at risk of malnutrition or who are malnourished.

8. Dementia

Dementia refers to a set of symptoms caused by various brain disorders. These symptoms include memory loss, poor cognitive function, confusion, reduced concentration, and personality changes. Providing a balanced diet with a variety of foods from the five food groups is important to optimise the health of those residents living with dementia. However, dementia can make it quite difficult for individuals to simply put food into their mouth as they can forget to eat and drink, refuse food, not recognise food or utensils, have a diminished sense of taste and smell and at times, paranoia. Certain strategies may be recommended by a Dietitian, such as provision of high energy and protein foods familiar foods, minimise noise and distractions such as television and music, place distracting objects away from the dinner table, provide appropriate food for the texture modified diet a resident may be on, encourage feeding assistance and optimise the mealtimes experience to encourage oral intake.

9. New Medications

The elderly may face several conditions which require the use of a wide range of medications. The combination or new medications may cause side effects such as nausea, constipation, altered taste changes and mental fatigue. These symptoms can lead to poor appetite and gastrointestinal symptoms. In severe cases, multiple interactions of drugs may lead to a greater risk of dehydration, functional decline, cognitive impairment and decline in nutritional status. Dietitians can assist by assessing what nutritional impact symptoms there are from the medications, reducing these symptoms to improve the quality of life and prevent further exacerbation of nutritional status.

10. Dehydration

Thirst senses in the brain decline as we get older, which makes it harder to understand whether we are thirsty or not. Regardless, poor fluid intake can simply lead to confusion, headaches, dizziness, concentrated urine, and dry mouth, lips and eyes. To help with hydration, offering liquids such as water, juice, milk, tea, and coffee are a great way to incorporate more water into the body. There are also liquids in foods that contribute to hydration which includes fruit, vegetables, custard, soups, sauces, and gravies. Even ice, icy poles and ice-cream are fluids and great to include more of on a hot day.

Continue reading Part three – How do you promote good nutrition in the elderly?