A Guide to Healthful Eating in Older Age

For a long time when I was a kid, I refused to eat anything but Velveeta mac and cheese. It was all that tasted good to me, despite my stubborn refusal to try anything else. My parents quickly came up with a clever solution. First, they added extra milk and real shredded cheddar into the standard Velveeta goop. Then, they started serving sliced apple wedges alongside the mac and cheese. A couple months later, they introduced other sides: broccoli, Brussels sprouts, and cauliflower, all seasoned with a liberal dose of Johnny’s. Within a couple years, Brussels sprouts became my new favorite food, and they’ve remained on the top of my list ever since. Though on opposite ends of the age spectrum, kids and seniors often share similar food sensibilities. Both groups are skeptical of change, which is why the gradual incorporation of new foods can be a good technique to help them form healthier habits.

The increasingly picky preferences of a loved one can be a challenging and frustrating situation for a caregiver. You want to ensure that your loved one remains in good health and gets the vitamins and minerals they need without having to fight them every step of the way. When my grandmother passed away, for months my grandfather subsisted on little else than Ensure shakes. He lost a huge amount of weight, and though people complimented his new figure, I worried he wasn’t getting the necessary nutrients to stay healthy. When I went to visit, I convinced him to refocus on “real” foods. I helped him cook some of his favorite meals with a healthy twist. Not only did we enjoy our time together, but I also gave him some ideas about how to make eating a more pleasurable experience. Taking your loved one’s preferences into account can go a long way in helping them adopt a healthier diet.

There are many physical, psychological, and situational reasons why people’s eating habits may change, narrow, or worsen, as they age including:

Depression

Depression causes appetite suppression in many people. If your loved one exhibits any of the symptoms of depression, contact their physician to figure out the best treatment plan. Many seniors have success with antidepressants, especially SSRIs, but there are other activities — exercise, increased socialization, and therapy — that can be equally beneficial. Additionally, malnutrition can bring on symptoms of depression, so make sure that your loved one is screened for potential nutrient deficiencies.

Loneliness

Eating provides more than just the energy to survive. Meals are a communal experience that many people grow up sharing with their family and friends. When people age and they begin to lose their loved ones, they may find themselves eating alone. Without the ritual, meals can become sad and tedious. Look into senior centers and places of worship that often offer communal meals. As much as you can, eat a meal with your loved one. Try not to make it seem like a chore but rather a chance to savor each other’s company and take pleasure in the tastes, smells, and textures of the food that you share.

Laziness

When eating for one, it can often seem like too much of a hassle to cook a full meal. There are many ways to lighten this burden, including make-ahead freezer meals, batch cooking, food delivery apps, meal kit apps, and scheduled social eating. Check out one of next week’s article: “Easy Freezer and Make-Ahead Meals for Seniors” to learn some recipes that will minimize their need to cook while maintaining a focus on health.

Sensory changes

As you age, your sense of taste and smell change. Foods that were once appetizing appetizing may no longer be appealing. Additionally, many seniors take a variety of medications that can affect the senses. Ask your loved one’s physician about the possible side effects of their prescriptions, and see if there are any other medications that may be a better fit. When cooking for your loved one, try adding spices, lemon juice, vinegar, and fresh herbs to add flavor to their food.

Chewing problems

Teeth become more sensitive as you age and many people require dentures. Chewing with the back molars may become difficult, making your loved one avoid meats, fruits, and vegetables that contain important nutrients. Ask your loved one if their teeth or dentures are bothering them and take them to their dentist to check for any problems. If your loved one wears dentures, ensure that they’re properly fitted.

Swallowing problems

It can become more difficult to swallow food as you age. A lack of saliva is often the culprit. Make sure that your loved one drinks plenty of fluids at every meal and encourage them to take a sip between bites. Keep a glass of water handy by your loved one’s favorite sitting spot and on their bedside table. Remind them to drink a full glass when taking their medications, before exercising, and before going outside on a hot day. If your loved one is in a nursing home, ensure that there is a hydration program that helps residents consume adequate fluids throughout the day. Encourage your loved one to drink alcohol in moderation, with a maximum of one drink per day for women and two drinks for men. Water, milk, and juice are the best options, and sugary or salty choices should be discouraged. As people age, their body water content decreases and they often become less capable of adapting to heat and noticing changes in their body temperature. Many medications are dehydrating, plus people often lose their sense of thirst as they age. Dehydration is associated with many elderly health issues, increases the risk of hospitalization, and is associated with increased mortality rates. Know the signs of dehydration and if the symptoms are severe, call 911.

Financial Limits

Depending on your loved one’s finances, they might not have the money to purchase fresh fruits, vegetables, and meats, which are costlier than packaged and frozen foods. One solution is to buy food in bulk at a store like Costco and split the foods with your loved one. Buying foods in large quantities is cheaper, and you can divide the bill as you see fit. Store- brand options, weekly sales fliers, and coupons can also lower the prices of fresh, healthy foods. Plus, there are certain canned, packaged, and frozen foods that can be part of a healthy diet, including: low-sodium canned beans (make sure to thoroughly drain and rinse to remove excess salt), low-sodium canned fish, frozen fruits and vegetables (without added sauce or sugar), frozen lean meats (unmarinated), and peanut butter (try to choose a brand without added sugars).

Community resources

Depending on where your loved one lives, the closest options may be convenience stores that offer few fresh foods. If your loved one lives in a nursing home, they may not have many dining options. Help your loved one investigate some other possibilities. If they live on their own or have a kitchen in their nursing home unit, try out one of the meal apps listed below, offer to pick up their groceries, go grocery shopping with them, or try out a grocery delivery service like Amazon Fresh. If your loved one is on a full meal plan at their nursing home, try talking to the staff about your loved one’s dietary restrictions and preferences. Help your loved one stock up on healthy snacks to keep in their room so that they can always have a nutritious option. If your schedule allows it, take your loved one out to dinner once a week or have them over for a weekly meal. Your loved one will look forward to this experience, and it might make it easier for them to bare the food that they’re served the rest of the week.

Lack of knowledge about proper nutrition

Even by old age, many people have never been taught about proper nutrition. In addition, many seniors don’t realize that nutritional needs change as you age. After reading the rest of this article, you’ll know more about how to support to your loved one’s dietary needs and you can teach them what you learn. Doing more research on elderly nutrition and nutrition in general will benefit you both. It’s never too early (or too late!) to establish healthy habits. By focusing on nutrition together, you can prevent your loved one from feeling singled out or punished.

Lack of transportation or mobility

If your loved one can’t drive or has difficulty walking, it might be impossible for them to go shopping at the grocery store. If time allows, offer to take them on a weekly trip to the market. You can do your food shopping together, and you can help guide your loved one toward making healthy choices. Another great option is to introduce your loved one to one of the many meal kit apps that are available. These services will deliver ingredients and recipes right to your loved one’s door and all they have to do is follow the instructions to make a delicious meal. Check out one of these excellent apps to give it a try:

• Freshly: Freshly is a Phoenix, Arizona based business that delivers cooked meals to your doorstep once a week. Their food is already cooked, sealed and ready for the fridge/microwave.
• HelloFresh: This plan is a great option for older people, since they focus on providing healthy, clean, and lower calorie meals to their customers. Dietary restrictions, preparation time, ingredients, and nutrition facts are listed for each recipe, making it easy to customize the service to your loved one’s needs and desires. They offer three plans: the classic, the veggie, and the family plan, and you can pick between three or five recipes per week. Prices start at $8.75 per serving.
• Blue Apron: One of the most popular food prep apps, Blue Apron is committed to sustainability and making cooking an enjoyable experience. They change their menu options weekly, and useful tags (Quick & Easy, Mediterranean Diet, Customer Favorite, etc.) are listed below each recipe to aid in the decision-making. Prices start at $8.74 per serving.
• Green Blender: This choice is ideal for seniors who have trouble chewing, refuse to eat, or dislike cooking. The service delivers organic and nutrient-packed ingredients for 10 smoothies a week using 5 different recipes. A blender is required, but you can purchase an affordable and reliable one here. Prices start at $4.99 per serving.
• Daily Harvest: This company offers smoothies, soups, harvest bowls, lattes, overnight oats, and chia parfaits, making it another great option if your loved one prefers easy preparation or has difficulty chewing. Daily Harvest delivers frozen foods for maximum convenience, and all their meals are ready to eat in minutes. Smoothies simply need to be blended; soups, bowls, and lattes need to be microwaved; and oats and parfaits need to be soaked overnight. Recipes focus on healthy, organic ingredients. Prices start at $6.99 per cup.
• Home Chef: Choose between 10 dinners, a number of breakfasts, a smoothie recipe, and a fruit basket that change every week. Every meal takes 30 minutes or less to prepare and you can plan your meals up to five weeks in advance. Prices start at $7.99 per serving.
• Chef’d: This is a great option if your loved one has certain dietary restrictions. They offer several meals plans including the Atkins plan, the American Diabetes Association plan, and the Weight Watchers plan. À la carte options are available, but so are bundled options that include meals, snacks, drinks, and an assortment of fresh fruit. Prices start at $9 per serving.

But what should my loved one eat?

Malnutrition is common among the elderly, and it’s even more worrisome that it’s often undiagnosed. According to the scholarly article, “Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients,” it’s estimated that between 2%-16% of community-dwelling elderly people don’t get enough protein and calories. When vitamin and mineral deficiencies are included, as many as 35% of people over the age of 65 may suffer from malnutrition. Hospitalized seniors and seniors in long-term care facilities fare even worse, with estimates of malnutrition ranging as high as 60%. A variety of medical and behavioral factors contribute to elderly malnutrition. Keep an eye out for the following signs that may indicate your loved is suffering from malnutrition:

• involuntary weight loss
• abnormal BMI (body mass index)
• specific vitamin deficiencies
• decreased dietary intake
• decline in cognitive functioning

If you suspect that your loved one is malnourished, contact their physician to schedule a nutritional screening.

Bodies and nutritional needs change in older age, making seniors especially prone to malnutrition. In later years, you lose muscle mass, burn fewer calories, and your immune system weakens. Because older people have lower caloric requirements, it can be especially difficult for them to get all the vitamins and minerals they need to stay healthy. However, by focusing on the most important nutrients for seniors, foods can be wisely chosen to fulfill their dietary requirements. In particular, you should help your loved one focus on consuming enough of the following nutrients:

Calcium

Older adults need calcium to maintain strong bones and teeth. A lack of calcium can result in osteoporosis, the primary cause of hip fractures. Fat-free or low-fat dairy products are great sources of calcium, but so are some types of fish (sardines, salmon, perch, and rainbow trout), soybeans, dark leafy greens, dried fruit, legumes, nuts, and calcium-fortified products including juices and grains. People aged 71 and over should aim for 1,200 milligrams or at least three servings of calcium-rich food per day.

Vitamin D

Vitamin D deficiencies are common among older people who don’t spend a lot of time outside. Bones can’t absorb calcium without vitamin D, heightening the risk of osteoporosis. Some examples of foods high in vitamin D are: fatty fish (tuna, mackerel, and salmon), beef liver, cheese, egg yolks, and foods fortified with Vitamin D including dairy products, juices, and grains. For the elderly, fish, eggs, and fortified foods are the best options. People 71 and older should aim for 800 IU per day.

Vitamin B12

Vitamin B12 is essential for the formation of red blood cells, maintenance of a healthy nervous system, and DNA synthesis. Enough vitamin B12 may prevent certain mood disorders, central nervous system disorders, and dementia. The best sources of B12 are: eggs, dairy products, meats, fish, shellfish, and poultry. Be sure to check the nutrition labels on processed foods, as some beverages and meat substitutes are fortified with Vitamin B12. Older adults should aim for 2.4 milligrams per day.

Fiber

Fiber helps people maintain regular bowel movements, lowers the risk for heart disease, and can possibly prevent Type 2 diabetes. Foods high in fiber include: legumes, vegetables, fruits, whole wheat breads and pasta, bran flakes, and oatmeal. You can also try adding flaxseed meal, chia seeds, or psyllium husk to your loved one’s morning smoothie. A little goes a long way, so be sure to check the serving size to fit your loved one’s daily requirements. Elderly women should aim for 21 grams of fiber per day, and men should aim for 30 grams per day.

Potassium

Potassium helps prevent cramps, boosts heart health, decreases high blood pressure, and protects against osteoporosis. Try out dark leafy greens, bananas, sweet potatoes, avocado, yogurt, or dried apricots to fulfill your loved one’s daily potassium needs. Low-sodium salt is another source of potassium, and might be a good option if your loved won’t give up the salt shaker. Seniors should aim for 4,500–4,700 milligrams of potassium per day. Excessive potassium is problematic for people with kidney problems, so be sure to consult with your loved one’s physician if this is an issue for your loved one.

Omega-3 Fatty Acids

Omega-3s play a structural role in cell membranes, provide energy for the body, and are used to form eicosanoids, which are signaling molecules that have a wide range of functions in the body. The best sources of omega-3 fatty acids are: walnuts, soybeans, winter squash, spinach, wild rice, and salmon. Some foods are fortified, so be sure to check the labels on eggs, margarine, milk, juice, soy milk, and yogurt. The recommended daily intake is 1.6 grams for males 51 and older and 1.1 grams for females 51 and older.

Ideally, your loved one can consume the proper amounts of these nutrients through their everyday diet. In order to investigate the amount and types of nutrients in the foods that your loved one eats, check nutrition labels or go to an online nutrition database like SelfNutritionData, Myfitnesspal, or the USDA Food Composition Databases, where you can search by food or nutrient. Sometimes, it may be necessary for your loved one to take a dietary supplement to meet their nutritional needs. Always consult with a physician before your loved one starts a dietary supplement, as these pills can interfere with other medications or medical conditions.

Foods to limit

In contrast to the nutrients listed above, foods high in certain nutrients should be limited or avoided among the senior population. These nutrients include:

Saturated and trans fats

These kinds of fats raise “bad” (low-density lipoprotein) cholesterol levels in the blood. High cholesterol contributes to a range of health problems including heart disease and atherosclerosis. Saturated and trans fats are commonly found in fatty meats, skin-on and dark meat chicken, butter, ice cream, cheese, coconut oil, solid shortening, and hard margarines. Additionally, trans fats are found in many processed snack foods. Before buying anything, be sure to check the nutrition label. Anything above 0g of trans fats should be avoided. That being said, not all fats are bad. Consuming unsaturated fats (monounsaturated and polyunsaturated) in moderation can even help lower cholesterol levels. These kinds of fats are found in: olive oil, avocados, nuts, seeds and fish.

Sodium

Too much sodium can lead to high blood pressure. Adults over the age of 51 should aim to consume less than 1,500 mg of sodium per day (about 2/3 of a teaspoon of salt). Always make sure that you or your loved one reads the nutrition facts to determine the sodium content and serving size, since many packages contain multiple servings. Processed foods should be limited, as they’re higher in salt, and using salt in cooking should be discouraged. Teach your loved one to substitute flavorful alternatives instead such as spices, salsa, lime juice, or nutritional yeast. Rather than keeping a salt shaker on the dinner table, just keep the pepper grinder. Pepper can add some pizzazz to a finished dish and it will be easier for your loved one to avoid salt if it’s not an option.

Caffeine

Talk to your loved one’s physician to determine if your loved one can consume caffeine. Most elder people with heart conditions and high blood pressure should avoid all caffeinated beverages. If your loved one is told that they have to quit caffeine, help them ease into the switch by brewing decaf coffee, buying decaf tea, and (if they can’t do without), buying caffeine-free soda.

Added sugars

By reading nutrition labels, you can find out how much sugar is added to everyday products. You’ll be surprised. Of course candy, cookies, ice cream, and soda are full of sugar, but there are plenty of sneaky culprits like sliced bread, peanut butter, and processed meats.

Eating the rainbow

Foods high in unhealthy fats and added sugars are called empty calories, which are high in calories but low in nutrients. Examples include chips, candy, cookies, soda, and alcohol. Teach your loved one how to spot empty calories and how to choose better options. Even though they might be hesitant to give up their favorite treats, they’ll soon find that nutritionally dense foods keep them satisfied for much longer.

Emphasize to your loved one the importance of “eating the rainbow,” meaning eating a variety of fresh, whole foods in every color. In addition, teach them about the four main components of a healthy diet:

• A variety of fruits and vegetables
• Whole grains
• Lean meats, beans, eggs, seafood, poultry, and nuts (in moderation)
• Fat-free or low-fat pasteurized dairy products

When eating out, advise your loved one to choose foods that are baked, broiled, braised, grilled, steamed, sautéed, poached, or boiled rather than fried. Foods that are marinated, coated in spices, or served in a vegetable-based sauce or broth are preferable to breaded foods and those smothered in a creamy or buttery sauce.

Fitting it all together

Now that you know the components and factors that make up a healthy diet for seniors, how do you fit it all together?

Start with baby steps. Like my parents did for me, make a gradual transition into healthy eating habits. Try out a number of strategies, from food prep apps to shopping together to make-ahead meals. Choose foods that provide the different nutrients your loved one needs and try combining them in different ways. Determine which foods your loved one most enjoys that can supply them with the nutrients they need.

If you can, the best step in determining an ideal regime for your loved one is to accompany them to their physician. Before the visit, familiarize yourself with the Mini Nutrition Assessment, the most widely used screening tool for malnutrition, and ask your loved one about any questions that may arise from looking over this questionnaire. This preparation will help you inform your loved one’s physician about their behavior so that they can make the most accurate assessment of their health. Depending on your relationship with your loved one, you can ask key questions to the physician during or after the appointment, when you may be able to request a private word with their doctor. Important questions to ask include:

• What is a healthy weight for my loved one?
• Are there any particular foods or nutrients that my loved one needs to limit or avoid?
• Are there particular foods or nutrients that are especially important for my loved one to consume?
• Would a blood test be helpful to ensure that my loved one is getting enough nutrients?
• Do any of the medications that my loved takes have side effects that could affect their nutritional health?

Brainstorm any other specific questions before going to the appointment and make sure to explore the many nutritional resources available — dieticians, counseling, classes, and online instruction. This article is merely a primer. Food is a complex and expansive topic. (Everyone needs to eat, after all) You can never know too much. To find out more about nutrition recommendations, check out:

• ChooseMyPlate: USDA’s revamped nutritional guidelines (replacing the food pyramid) that emphasize consuming fruits and vegetables with every meal.
• Healthy Eating: The National Institute on Aging provides information, advice, sample menus, and instruction on how to eat nutritiously in older age.
• Dietary Guidelines for Americans: Up-to-date recommendations that reflect the most recent scientific evidence.

And don’t miss the upcoming article about food safety to prevent against food-related illness. Food mishandling and poisoning are especially threatening to the elderly population due to weakened immune systems, so it’s important to know the tools that will keep your loved one’s foods safe. Also, stay tuned next week for “Easy Freezer and Make-Ahead Meals for Seniors” so that you and your loved one can to get into the kitchen and start cooking. To stay up to date about these articles and more, sign up for our newsletter and you’ll never miss out!

This post originally appeared on the Ayuda Care blog. For regular articles on aging, visit www.ayudacare.com to sign up for our newsletter!