Poor diet can lead to serious problems

Aging column by Dr. Michael Gordon (04-12-2002)
Reprinted with permission from the Toronto Star

"I don't know what to do doctor, but my mother can't maintain her weight," the daughter told me. She was sitting beside her mother in my office.

"How much weight have you lost and over what period of time?" I asked her mother. This was a long and complicated geriatric evaluation, which included weight loss along with other medical and psychosocial problems. Frequently-asked-questions about weight include: what is the "right weight" for an older person, what can cause weight loss and what can one do to address the problem?

Malnutrition in seniors is a real health issue. It may result from medical conditions such as depression, thyroid disease, diabetes, gastrointestinal problems such as hiatus hernia, constipation and others, or appetite-suppressing side effects of medications. Some seniors, especially the very elderly and frail, even without definable medical causes, don't eat a nutritionally adequate diet. I have seen older patients, some poor, some not, who apparently consume only tea, toast, some canned foods and sliced meats like bologna. They eat an inadequate variety of foods, deficient in the essential food groups and the vitamins and minerals needed to maintain their health and decrease the risk of disease.

Health food A diet containing insufficient fibre is a major cause of chronic constipation, especially when coupled with low fluid intake and constipating medications. For those with poor bladder control, the fear of incontinence may result in inadequate fluid intake, a special problem during summer.

A few years ago, Quebec's University of Sherbrooke researchers found that 68 per cent of older Canadians consume no more than 1,000 calories daily - less than the daily recommended 2,000 calories needed by older men and 1,700 calories by older women. The body and the brain require certain nutrients to function properly. Serious nutritional deficiencies increase the risk for physical and mental disorders as well as undermine the immune system, thereby increasing the susceptibility to infections.

Some older adults lose their interest in food for various reasons. Our sense of smell, which enhances the ability to taste food, may deteriorate with age or be damaged by recurrent respiratory tract illnesses. Our sense of taste may also decline, so we're less able to detect sweetness and saltiness. Unfortunately, our ability to taste the tartness of flavors is believed to increase in some seniors, making it difficult to enjoy certain foods, such as tomato-based sauces that may need a little sugar to enhance their flavor.

Living and eating alone is a risk factor for malnutrition; it may result in decreased motivation to cook and prepare meals. That is why social opportunities for eating, as may be found in senior centres and social meal programs, can improve the nutritional status of those who attend.

Dietition Carol Robertson offers advice on how to ensure a nutritious diet for your loved one. When visiting, casually open their fridge and cupboards to see what foods and beverages are on hand. Are there fresh vegetables and fruits, cheese, meat, juice, milk, and nutritious snack foods? If the fridge looks empty and contains foods with expired dates, that's a warning sign. In a supportive and sympathetic way, ask what kinds of foods he or she has been eating lately. It could be that your relative needs a helping hand, but is reluctant to bother you. Help with shopping or, if necessary, do it for them. When making meals for your family, make a little extra to freeze and send over.

Encourage your loved one to take a complete multivitamin supplement and to drink an extra glass or two of milk daily; chocolate milk is a special favorite and offers great taste and extra calories. A common quick fix is to put the person on a canned supplement with a doctor's approval. In some cases, when there are swallowing or eating problems, nutritional supplements may be necessary to provide a substantial source of nutritional intake. But for independently living seniors, eating nutritious and balanced meals is the preferred way, with dietary supplements used as nutritional augmentation.

More tips to enhance nutrition: use grocery stores that deliver, especially those that offer fresh, single serve meals; look into Meals on Wheels programs; use nutritious microwavable frozen entrées; and avoid dehydration by always having beverages readily available.

There are also ways to re-awaken lazy taste buds. From easy-to-prepare marinades for meat to using honey, sugar and various condiments in favourite sauces and dishes, it's a matter of spicing up meals.

Dr. Michael Gordon is Vice-President of Medical Service at Baycrest, a professor of Medicine at the University of Toronto, and a member of the National Advisory Council on Aging.

These columns appeared in The Toronto Star in 2001 and 2002 and are reprinted with permission.