Decreased eating is a common concern for caregivers of the elderly population. Diminished caloric intake may, or may not result in malnutrition. Many seniors who are relatively inactive do not need as many calories as those who are physically active.
Many factors contribute to the decreased eating we observe in the aged. Being aware of them and determining which apply to our care receiver’s situation, is a good place to begin. They include:
- Disease processes affecting appetite; ability to feed self, chew, swallow, or absorb nutrients; impaired elimination; and distressing symptoms such as nausea, vomiting, diarrhea, and constipation
- Dementia, especially Alzheimer’s
- Dietary restrictions imposed by medical conditions or use of certain prescription medications
- Need for supplemental enzymes as we age, and probiotics (beneficial intestinal bacteria) to assist digestion
- Allergies or food intolerances
- Unrelieved pain
- Missing or no teeth; poor-fitting dentures; mouth sores
- Diminished senses–especially seeing, smelling and taste
- Limited mobility to shop and prepare meals
- Low income
- Decreased socialization or isolation that results in routinely eating alone
- Emotional states such as loneliness, depression, grief, or anxiety
- Mental health disorders
A recent example is a discussion I had with a cousin, whose 87 year-old mother came home from the hospital after having a heart attack (myocardial infarction), congestive heart failure (CHF), and coronary artery bypass graft surgery (CABG). Aunt Rose (not her real name) is petite and small-boned; I never remember her weighing more than 120 pounds. She did lose weight during her week in the hospital. Consequently, her daughter (who is a new caregiver and lives in another state) is worried and is pushing her to eat more.
Aunt Rose lives alone in her rural farmhouse; she sees no reason for that to change. She has always shopped and prepared her own meals. Now she has new dietary restrictions: 2 grams of sodium per day and low fat. Seemingly every food product in the house is now suddenly on the “banned” list. She also needs to weigh herself daily, to detect a sudden weight gain of two or more pounds, which would mean that she would need to take a diuretic for her CHF. So there are some challenges to be addressed, especially since her daughter is leaving in a couple more days. Perhaps Rose will benefit from drinking one or more nutritional supplements per day.
Another relative of mine, who I’ll call Mary (not her real name), is also an 87 year-old woman. She, too, has decreased eating, but her situation is entirely different–she has dementia. She offers more resistance to eating now, except for sweets. When it’s mealtime, Mary often says (with an attitude) to her caregiver husband, “I’m not hungry!” She has lost about five pounds in as many months. Two foods that Mary always loved are fresh garden salads and dark chocolate; fortunately, she still gets pleasure from eating them both.
Mary usually refuses to go out to eat, which would be a nice break for her husband and provide some variety and socialization for both of them. Part of her reluctance to go out is the dementia, but also because of her history of irritable bowel syndrome (IBS). She still remembers having problems with diarrhea and is afraid that it will happen again without warning. Her GI symptoms have been managed nicely the past few months, with use of daily enzymes, a multi-omega supplement containing perilla seed oil (reduces inflammatory response), and probiotics. They are an established part of her routine; so for now, she accepts them.
What is your care receiver’s story about decreased eating? What issues and successes have you had?