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Mealtime Challenges Affecting Older Adult Nutrition

Over the past few years, much attention has been devoted to the American family dinner, with studies suggesting that children and teenagers demonstrate social, emotional, and physical health benefits when their families routinely eat together.  Less research has been done about mealtime routines for seniors, although most health professionals would agree that nutrition plays a significant role in the aging process.  Both physical and social factors impact older adult nutrition.

There are a number of physical factors associated with an individual’s ability to prepare and consume meals.  Oral hygiene is a primary factor to consider.  The presence and condition of natural teeth or dentures influences the types of foods that an individual may be able to eat.  If natural teeth are rotting and painful, or dentures don’t fit appropriately, nutritional status will suffer.  The ability to swallow appropriately is also significant, as individuals who suffer from impaired swallowing (also known as dysphagia) may experience increased discomfort with eating, and be at a higher high risk of choking or developing aspiration pneumonia (food particles end up in the lungs instead of the stomach).  Dysphagia may result from certain disease processes such as stroke, Parkinson’s, or gastroesophageal reflux disease.  Sometimes the cause of dysphagia may not be able to be identified, but changing the texture of foods as well as the thickness of liquids consumed may be necessary for the individual’s safety and nutritional health.

Medical conditions affecting the gastrointestinal tract will obviously play a role in diet and nutrition, but less obvious are medical conditions which affect a person’s mobility. Does the individual have the endurance and strength to navigate through a store to purchase groceries? What about carrying the grocery bags into the house once they get home?  One option to solve these difficulties is home delivery.  Check with your local grocery store for details.  Mobility will also affect the meal preparation process, and the design and organization of the kitchen will play a role in how much mobility is required.  Frequently used items should be kept in cabinets that are within easy reach, and a table to sit and work at is helpful for those who cannot stand for long periods.

Another physical factor may affect an individual’s desire to eat or cause a change in eating habits.  Older adults often take more medications than younger ones, and these medications can have side effects of loss of appetite or alterations in smell and taste. If loss of appetite is experienced, check with a physician to determine if medication may be the cause.  Some loss of smell normally occurs with aging, but medications, illness, injury, and smoking can cause additional loss.  Loss of taste occurs less frequently than loss of smell, and normal aging changes are only slight and usually unnoticeable.  Because the senses of smell and taste are closely linked, one may interpret the loss of smell to be that of taste instead.  The use of increased amounts of salt or sugar to compensate for the loss could be dangerous for people who have high blood pressure or diabetes and who should be following special diets.  The use of other seasonings such as lemon juice, vinegar, or herbs may improve the flavor of foods that taste bland.  Food safety also becomes a risk when these senses are affected because a person has a decreased ability to detect spoiled food.

The condition of dementia presents its own unique set of complications related to mealtime.  Someone in the early stages of dementia may forget or incorrectly measure ingredients when cooking, which will affect the taste of the food and can cause frustration and negative associations with meals.  As dementia progresses, individuals may forget altogether about mealtime, that they just ate (and insist that they are hungry), or which meal of the day they are eating (and request certain foods not traditionally served at that time of day).   Food preferences may be forgotten, which can lead to disagreements with caregivers and dissatisfaction with food choices, resulting in less than ideal food intake.  The ability to independently put together even a simple meal will become unmanageable.  At the end stage of dementia, the inability to feed oneself, and to chew and swallow food appropriately is present.

Next week’s article will cover some of the social factors that impact a senior’s nutritional health.

Karen Kaslow, RN