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Posted October 10, 2007

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Nutrition: How to Encourage Elderly to Eat Better -- or Eat At All

Q. I am acting as caregiver for my grandmother. She has lost a drastic amount of weight over the last year and a half (after my grandfather died) and the result is severe. But she doesn't seem to care too much about eating. She'll usually eat a full breakfast (an egg, two strips of bacon, toast, hot chocolate and orange juice), but the rest of the day it's a struggle for me to get her to eat. For example, I'll serve her half a sandwich and she'll only half of that! She knows she has to eat, but she won't eat what I serve her. I've tried making creative dishes and nothing seems to work. How can I make her want to eat?

Camilla P., Laguna Hills, California.

A. You are describing a common problem among elders -- lack of appetite. Depression and a change in social environment can take its toll on appetite and nutritional intake, as well as other medical conditions.

First of all, I would suggest that you discuss the weight loss and poor appetite with her healthcare provider in order to determine if there are medical causes that can be addressed such as diseases, conditions, medications, poor dentition, etc. that might be affecting her appetite.

After all of those issues have been addressed, there are a few tips that can help your grandmother get more nutritional intake. It is very common for elders to eat their best meal of the day at breakfast, so I would continue encouraging her to eat a nutrient- and calorie-dense breakfast like you have suggested. Since she has a poor appetite, encouraging foods that are high in calories and protein instead of light, low calorie foods is preferred. Sometimes drinking is an easy way to get calories and nutrients, thus milkshakes or nutritional supplements like Ensure can be very helpful. Perhaps you can try a few flavors and brands of a nutritional supplement until you find one that she likes. Sometimes people like them better out of the can poured over ice with a straw. Try to encourage juices and nutritious fluids during the day.

If her appetite diminishes over the day, giving her small frequent feedings (every couple of hours) on small plates can help make the food appear not so overwhelming. Try nutrient-dense foods like cheese and crackers, nuts, cottage cheese, and yogurt for snacks. Also, smooth foods that glide down the throat seem to be attractive for those suffering from poor appetite, such as soups, stews, mashed potatoes, pasta, macaroni and cheese, etc.

Another tip is to encourage fresh air and whatever exercise she can participate in prior to her meals. Creating a pleasing social environment at mealtime, a time she can talk and socialize, can also improve appetite. Even letting her participate in meal preparation if she is able to, allowing the good smells of food to drift in the kitchen, talking about some of her favorite foods, and trying some old recipes may spark her intake. You might also want to discuss a multivitamin and mineral supplement with your healthcare provider, as certain deficiencies can further aggravate appetite.

This answer has been provided by Sharon Palmer, a registered dietician with 16 years experience managing healthcare food and nutrition departments. Her career has included clinical nutritional care for a broad spectrum of patients, from eating disorders to elderly. She also has managed the food and environmental services departments in several acute care hospitals. Ms. Palmer lives in Southern California and can be reached at spalmer952@earthlink.net.

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