If you’re caring for aging parents, you know how deeply it affects you when they’re not eating well. There’s a domino effect … and it can feel like a scary one.
It’s easy to find yourself wondering, “Why won’t she just eat? I don’t understand.”
Or saying, “Dad, you know you can’t lose anymore weight, why aren’t you even trying the food I cooked for you.”
Through my years working with family members and their aging parents in long-term care, I heard these questions time and time again. And I saw the stress that caregivers go through when their parent, spouse, sibling or friend just won’t eat.
In this article I’ll be sharing information to help you as a caregiver do your important job. This job that is largely falling on the ‘sandwich generation’ who have many things they’re trying to juggle – kids, grandkids, jobs, aging parents … and perhaps health concerns of their own.
With all of this going on, you don’t have time to search the internet and piece together all the information you find … hoping that the next thing you try will work.
Sure, online support groups can make you feel like part of a group instead of all on your own with this. But there are so very many opinions swirling around out there! What works for one person might not work for you, especially once someone has multiple health conditions.
The good news is that there are some general things you can learn today that can help you feel more confident in your day-to-day caring work.
In this article I’ll share information about
- Top 5 nutrition-related problems for seniors
- 3 key points about nutritional needs for elderly
- 10 tips for getting aging parents to eat
- Pros and cons of offering commercially-prepared nutritional supplements
- When [strongly] encouraging someone to eat could be dangerous for them
About seniors nutrition
Simply thinking of seniors as older versions of adults couldn’t be further from the truth when it comes to nutrition. Unfortunately this was the case until relatively recently. Research is catching up though. We are starting to get more facts about the best strategies for people to continue living their life well as their bodies age. But there’s still a ways to go.
We do know that by the time we’re reaching retirement age (or sooner for some people), our bodies are showing the effects of a lifetime of stresses. This is often the time when people start to receive new diagnoses for heart disease, diabetes, cancer, kidney disease and maybe early onset dementia.
With each condition, there are different nutrition things to consider. And if your loved one has multiple conditions, your job as a caregiver can feel more tricky.
Top 5 nutrition-related problems for seniors
Let’s begin by taking a look at the most common nutrition-related concerns I find when working with adults who are about 70 years or more.
- Constipation and/or diarrhea
- Loss of appetite
- Muscle loss
- Chewing or swallowing problems
Unfortunately, these problems often come along together. And things get a little more complicated when there are multiple concerns happening at the same time.
As you know, the domino effect can kick in quickly when we’re talking about nutrition and aging. When it comes to nutrition, so much is interrelated, as you can see here:
3 key points about nutritional needs for elderly folks
- Nutrient-dense calories
If someone isn’t eating as well as they used to for whatever reason, there are a few key nutrition points to pay extra attention to. Let’s look at these a little more closely.
Not eating enough in general can lead to problems such as pressure ulcers (aka bedsore), significant weight loss and muscle breakdown. While weight (ie the number on the scale) can be regained, regaining muscle mass after it’s been lost is harder. And decreased muscle can mean more weakness, more falls, extra work for your heart and less independence for everyday activities.
Focusing on protein-rich foods during periods of poor intakes won’t prevent all muscle loss, as we also need to move those muscles in order to maintain them. But having enough protein is crucial for people who have extra stress on their bodies or are trying to heal wounds.
In general, there isn’t really one specific vitamin or mineral that’s most important to focus on. The goal is to make each bite count for as much as possible.
At the end of the day, if someone won’t eat much, I’m personally a huge supporter of getting in whatever calories we can. As I mentioned above, protein is very important – but without enough calories of any kind, the body breaks down muscle in order to fuel essential systems like our lungs and heart.
Many times though, it’s the sweet sugary junky sorts of foods that people will accept over ‘healthier’ options. When I’m not feeling well, I know an ice cream is much more tempting that a salad! This tends to be a hard one for many caregivers for multiple reasons. Especially if they already suspect that sweets and treats may have been at least part of the reason their loved one got sick.
Having said that, there are ways to bump up the nutrition of these ‘treat’ foods. For example, people often find it easier to drink something than to eat when appetite is low, making highly-nutritious shakes a popular choice. Read my post Avoiding Unplanned Wintertime Weight Loss for a bit more about this.
If nothing else is working, focus on getting fluids in as much as possible. Ideally it will be a short-term concern and some weight might be lost. But without enough fluids, our bodies can’t function and that dreaded domino effect will kick in sooner.
While important for everyone, fluid intakes are particularly important for people with diabetes. If someone with diabetes is battling an infection, their blood sugars may spike meaning they can be at higher risk for dehydration than others when they’re sick.
Knowing what nutrients are important can be helpful … but it doesn’t change the fact that sometimes it feels like you just can’t get your senior to eat.
10 tips for getting aging parents to eat
1. Understand that all conditions have their processes, many of which affect appetite.
And not only can health conditions affect appetite, but medication can too, either directly or indirectly. For example:
- kidney disease: Side effects of failing kidneys can include high potassium in the blood, fluid retention and possible build-up of waste products in the body leading to nausea and loss of appetite. Fluid restrictions and a low potassium or ‘renal’ diet might be needed – but these can be bland and unappealing … further changing someone’s willingness to eat.
- dementia: There are multiple ways that dementia affects eating – from remembering how to use utensils to remembering what food even is and what to do with it. In late stages, the sweet receptors on the tongue stay fine-tuned meaning people tend to favour sweet foods. Try to use this to your advantage and make nutrient-dense options that are sweet.
- COPD: When you can’t breath well and are breathing through your mouth, it becomes hard to chew long enough to eat. Eating can be tiresome and even scary for someone as they stop breathing in order to chew and swallow. COPD also increases some people’s energy needs meaning they can be at greater risk of unplanned weight loss.
2. Let them eat cake (unless they didn’t like cake to begin with).
If they have diabetes, know how their blood sugars are and if they are under control. There’s likely no reason to be overly restrictive with desserts or other treats if blood sugars are stable. A poor appetite can lead to low blood sugars if someone is taking diabetes medications or insulin. Be sure to speak with a doctor or dietitian for more help on this.
3. Get social (unless that is a source of anxiety for them).
Eating together works to encourage intakes. If you make it a social time for conversation, it can also take the emphasis/focus off of their eating. And this might be a welcome change for someone who feels like they’re now in the spotlight for all of their daily activities, from eating to bathing to how they spend their leisure time.
4. Try multiple small meals and snacks through the day instead of just 3-meals-a-day.
This can take some pressure off for both you and your parent – what doesn’t get eaten now can be made up for later. For many of the people I work with, even just the sight of a large plate of food makes them want to get up and leave. It creates anxiety, nausea and guilt because they know it’ll get thrown out if they don’t eat it. Giving them smaller portions can actually lead to more food being eaten.
5. If your parent has been using a liquid nutritional supplement, question if it is impacting their ability to eat at meals/snacks.
Because these products are very filling, too much can fill up the little bit of appetite your loved one has and therefore make food quite unappealing. Keep reading to find out more about using commercially-prepared supplements later in this article.
6. For people with dementia, try offering ‘finger foods’.
As a person’s memory deteriorates, so does their ability to use utensils. Finger foods can be helpful for those just can’t sit and remain at the table for a whole meal. They can also be helpful to keep weight on when someone spends their day pacing and walking around. Keep in mind that supervision is very important to prevent choking risks as well as to ensure food isn’t put into drawers or other places that could make a comfy home for pests.
7. Tune in to their bathroom habits.
Constipation is a common reason for decreased appetite (1). If you don’t think they are having enough fibre, add it gradually and make sure they’re drinking enough fluid.
Fibre needs for people over 50:
- Men – 30g per day
- Women – 21g per day
Note: fibre supplements might help to promote regularity but don’t give the same health protection as fibre found in foods
8. Try easing off with the pressure to eat.
Recognize that it may not be their choice to eat less. Some people are very aware when they’re not eating well which is already creating a lot of stress for them and may be further decreasing their ability to eat. Few people actually try to pressure someone to eat and any [strong] encouragement to eat is most often from a place of caring. But for someone who’s not able to eat and already upset by it, your tone, facial expression and other unconscious reactions about their eating can say more than the actual words you use.
9. Consider an assessment by a swallowing expert (called a speech-language pathologist or SLP).
People may refuse to eat, even though they’re hungry, if they are having difficulty chewing or swallowing.
Some red flags of chewing or swallowing problems can include
- poorly fitting dentures
- large amounts of food left in the mouth after a meal,
- excessive chewing
- complaining they feel like food is stuck in their chest area after swallowing
- unexplained weight loss
- leaving food uneaten
- … and others.
Sometimes people have a cough while they’re eating, but not always! It’s important to talk with your doctor if you suspect this is preventing them from eating or drinking.
10. Consider an assessment for depression.
Many health conditions are closely linked to depression leading to decreased willingness to eat, increased sleeping and poor quality of life. Depression is not just ‘feeling down’ about your health. Talk with your doctor if you suspect that you’re parent is experiencing depression.
Should I give a nutritional supplement?
This has definitely been a popular topic of conversation whenever I’m talking with people caring for aging parents with poor appetites. Unfortunately there is no black-and-white answer to this one – it really depends on the person and the situation.
Nutritional supplements, such as Boost, Ensure, Glucerna or Resource are all-to-often recommended by family doctors when a senior isn’t eating enough. Products such as these do have a place in supporting nutrition in some situations.
Unfortunately, they are being used as a starting off point when someone is eating less than usual. So for a lot of people, I’d say we can try some supplement-free way to boost their nutrition.
For other people though, I’d say yes a supplement might be a good idea. Such as in the case of a pressure ulcer, possibly during recovery from surgery or if someone is considered high nutritional risk.
I work with a philosophy of ‘food first’ for most people. Ideally if you’re able to talk with your healthcare team early enough about a poor appetite, we don’t have to be playing catch-up with nutritional supplements. Instead we’ll be determining possible problems and finding solutions before seeing a significant amount of weight loss or signs of malnutrition.
But at the end of the day, what do you think is the most interesting thing I found through the years when working with elderly folks?
That I was being asked by doctors, nurses, family members or other caregivers to provide supplement drinks. Rarely was it the senior themselves asking for them.
When eating can be dangerous
Unfortunately, as you’re well aware, a major decline in appetite is not always avoidable or ‘fixable’. You can encourage, assist with eating and offer many different foods … but still nothing changes.
There are many reasons that people slow down or stop eating. It’s second nature to jump straight to the worst-case-scenario. Providing food is often the most familiar way of caring for someone, especially a parent. And when they aren’t eating anymore, we may not know how else to nurture. We wonder if they’ve given up.
If your loved one’s health has been on a steady decline it’s time to talk with your healthcare team. Sometimes appetite can improve once an illness has resolved. But if someone is approaching the end of their life, putting pressure on them to eat can be harmful. Even if you’re not saying the words, people can sense your expectation for them to eat and may do so even if they really don’t want to.
Encouraging someone to eat when they show no interest in food can created emotional stress … but it can also be physically uncomfortable to eat or even lead to bigger health concerns.
As organs start to slow down, the body simply cannot digest, use or get rid of food or drinks that come in. This can lead to nausea, pain, bloating and fluid retention as well as accumulation of waste which can be harmful and uncomfortable (2).
As well, when people sleep more often, they either aren’t awake long enough to eat or they may not have the strength to swallow food safely. This can lead to inhalation of food or fluid into the lungs causing an infection known as ‘aspiration pneumonia’.
Even when your loved one is not eating, you have care options. Ask your healthcare team for more information about how to nurture without food, comfort-care feeding or tube feeding (if appropriate for your situation).
How a Dieititan can help you in caring for aging parents
As I’ve mentioned, once health conditions begin to pile up, nutrition can get more complicated. And when you have your plate full already with the everyday demands of life, complicated health stuff can feel like the last straw.
Having health professionals on your team can relieve some of the stress. They can provide you with sound advice and help you understand what to expect at different points of the health ups-and-downs when you’re caring for aging parents.
A Registered Dietitian who understands nutrition and aging can help you:
- Untangle all the recommendations so you can make informed choices for nutrition priorities
- Manage an aging parent’s weight if they aren’t eating well
- Decide if an oral nutritional supplement is the best choice as well as which one to use
- Work with you to make a custom care plan for your loved one’s nutrition – a plan that you can follow with confidence and that you can share with the rest of your healthcare team
- Give you back some control over your situation
- Take care of your own health so you can care for your loved one better while preserving and protecting your nutritional well-being at the same time
If you want to find out more about how a dietitian can help you care for your aging parent or another senior loved one in your life, I’d love to chat with you. You can set up a free 15-20 min chat with me so we can talk about what you’re finding most challenging. There’s no commitment and no pressure to work with me. It’s simply a chance for you to ask me questions, see if our nutrition views match and figure out if I’m the best person (or not) to help you and your loved one.
1. Nutrition for the Older Adult 3rd ed, 2019. Melissa Bernstein and Nancy Munoz.
2. When Death is Near. virtualhospice.ca, http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Topics/Topics/Final+Days/When+Death+is+Near.aspx. Accessed July 10/19
Angela Hubbard is a Registered Dietitian (RD) and Certified Diabetes Educator (CDE) with 10 years experience working in the field of nutrition. Her work focuses on helping people take back control of their health & weight … before it feels like their health controls their life. In her off time she loves swapping recipes, creating and exploring Northern BC life with her young family.