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Posted: March 25, 2004

What Every Caregiver Should Know

Meeting the Challenge of Specific Nutrition Diets for Different Conditions in the Elderly

clip artProviding nutritious meals for an elder may be one of the most challenging, yet important aspects of care that you can provide every single day.

There are a plethora of barriers to good nutrition that might cross your path, like poor chewing and swallowing, depressed appetite, medications that interfere with eating, poor digestion, constipation, food intolerances, depression, and confusion. And as if these challenges were not great enough, chronic diseases common in the elderly may make the task of providing nutrition to your loved one even more challenging.

Up to 85% of the elderly suffer from at least one chronic disease, one-third requiring special diets because of them. A host of diseases that require special dietary considerations are more common among the elderly, including diabetes, cancer, heart disease, high blood pressure, stroke, osteoporosis and arthritis. As we age, kidney and liver function may decline, possibly imposing additional dietary restraints upon the daily program.

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Since many elders are at nutritional risk to begin with, further restriction of the diet calls forth more opportunities for poor nutrition. After all, it may be hard enough to get three balanced meals down your loved one without taking away the saltshaker or the sugar bowl from the dining table. Try to avoid making any unnecessary dietary restrictions so that the widest possible variety of foods of all major food groups may be consumed.

If a nutritionally compromised elder becomes diagnosed with a chronic disease, all factors must be considered before deciding what sort of diet might most benefit them. That nightly ritual of vanilla ice cream might be more beneficial due to its supply of calories and protein than possible health concerns.

In some cases, individuals have been hearing messages about reducing fat, cholesterol and sodium for decades. And now that they may desperately need the calories and protein from nutrient-rich food sources, they may be placing unnecessary dietary restrictions upon themselves by avoiding foods like meats, dairy products and casseroles.

Perhaps an elderly woman avoided calorie-laden foods her whole adult life while ?watching her figure,? but now that her weight totters below a healthful range, she may no longer resist eating high calorie foods. On the other hand, some individuals may consume meals better when they are presented with a diet that is familiar to them. It?s essential to remember that the dietary goal of each elder should be individualized to their needs in a particular window of time.

Diets for Diseases in the Elderly

Type 2 diabetes occurs in 18-20% of people over the age of 65 in the United States. Although there is debate regarding the best way to manage diabetes in the elderly, the fact remains that good glucose control may help avoid or delay complications. Diet, exercise, and a healthy weight are cornerstones of diabetes treatment. Depending on the overall health condition of the individual, glucose control and medication, a balanced diet with consistent portions of foods from the major food groups throughout the day with an emphasis on plant foods is generally the best dietary plan for treating diabetes.

Cancer can cause many nutritional deficiencies in the elderly. Between 20% and 40% of all cancer-related deaths may result from poor nutrition rather than the cancer itself. Protein and calorie malnutrition are common side effects of cancer disease and treatment. Site-specific cancers may directly interfere with nutrition, from difficulty eating to poor digestion. The goal of nutrition during cancer is to maintain a healthy weight, address poor appetite, and preserve the quality of life. This may require many imaginative strategies, such as nutritional supplements to tackle poor appetite or soft, moist foods to glide down a dry throat. Monitoring the intake and weight are essential, reporting changes to the healthcare provider as they occur.

Managing heart disease in the elderly poses many questions. Lowering saturated fat and cholesterol in the diet is aimed at reducing the long-term risk of cardiovascular disease. There is little research directed at the benefits of lowering cholesterol levels through dietary intervention for healthy people over the age of 65. Recent studies have suggested that blood cholesterol levels are poor indicators of heart disease in the elderly. It may be wise to discuss any fat and cholesterol restrictions with the healthcare provider before they are instituted, but if a well-nourished elder prefers these food choices and they do not interfere with the total dietary intake, it may be appropriate to continue this eating pattern.

Hypertension and Low Sodium Diets

Hypertension is almost ubiquitous in the elderly population, and low sodium diets are nearly just as common. Much discussion has surrounded low sodium diets and whether they are really effective in reducing blood pressure. A recent trial indicated that sodium restriction can substantially reduce blood pressure in the elderly. One of the easiest methods of lowering sodium intake is to remove the saltshaker at the table and in the kitchen. Most recipes can be prepared without salt. Salted, cured meats and cold cuts, processed foods, canned soups and vegetables, salted crackers and chips, pickles, and condiments are usually very high in sodium.

Osteoporosis brings a high risk of fractures to the elderly population, and the death rate associated with an osteoporotic fracture is as high, or higher, than other common diseases that affect elderly women, like heart attack, stroke and breast cancer. Not just an elderly women?s disease, 1.5 million men aged 65 or over suffer from osteoporosis. One method of treating the disease is by making sure that an ample supply of calcium and vitamin D are present in the diet. Boning up on dairy products, such as milk, cheese, yogurt, ice cream, and pudding can provide supplies of calcium. Nondairy calcium sources include fish with bones, calcium-fortified foods such as orange juice, soymilk, and some green leafy vegetables. Sunlight and vitamin D-enriched products can offer supplies of vitamin D.

Kidney failure is rising, doubling in the United States in the past 10 years, with many cases occurring in the elderly population. The kidneys decrease in size and function during the aging process, which may lead to reduced kidney function. Dehydration can further aggravate kidney function. When an individual is diagnosed with kidney disease, they may be placed on a special diet that may limit protein and certain minerals.

It?s important to discuss any disease conditions and dietary restrictions with the healthcare provider, so that the benefits can be sufficiently weighed against possible negative nutritional intake. Contacting a registered dietitian in your community (www.eatright.org) may help you develop a nutrition plan to manage their disease and individual health goals that you and your loved one can live with.

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Sharon Palmer is a registered dietician and writer who has managed healthcare food and nutrition departments for 16 years. She is a member of our Board of Experts in the Ask an Expert section of our website and can be reached at spalmer952@earthlink.net.

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