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Five Nutrition Warning Signs for Caregivers and Their Elderly

What's Normal, What's Not

How can you tell whether your loved one's tendency to nibble on chocolate bars all day instead of real food is causing a problem? When do you know whether a halfhearted attempt at finishing breakfast each morning is cause for alarm? More than likely, these are red flags raised in the battle against poor nutritional status.

Malnutrition among the elderly is becoming a growing concern. An evaluation of community based nutrition programs of the Older Americans Act found that 67%-88% of elderly participants were at moderate to high risk of malnutrition. Fully 16% of elderly living at home consume less than 1,000 kilocalories per day. Geriatric malnutrition has serious fall out, as it leads to such problems as prolonged hospitalization, less successful treatment outcomes, poor wound healing, depressed immune function, increased risk of disease, increased risk of depression and higher rates of bone fracture.

And your loved one may not be the only one exhibiting signs of poor nutrition. Studies show that caregivers are much more likely to suffer from depression, chronic illness and poor eating habits than do non-caregivers in their same age category.

Here are five warning signs that may indicate that you or the one you care for is suffering from poor nutrition:

Poor Appetite. Sounds like a no-brainer. But answer this: When does poor appetite go from a nagging problem to malnutrition? You and your loved one should be consuming portions of foods that closely match the Food Guide Pyramid (see http://www.MyPyramid.gov to view the Food Guide Pyramid). Appetite that falls below this level for a prolonged period is cause for concern. Depressed appetite may be caused by a hundred different factors, with just as many approaches to improving appetite.

The first step is to identify the factors that are causing poor appetite. Gastrointestinal symptoms of constipation, bloating, heartburn or stomach pain may be interfering with appetite. These may be corrected with diet or medication and should be discussed with the physician.

Depression may cause a general lack of appetite, thus the causes of depression should be targeted. Make meals a relaxed, social and enjoyable affair to help combat depression at the dinner table. Often poor appetite comes down to the simple complaint, "I just don't feel hungry." Try small frequent feedings, fresh air prior to meals (and if possible an increase in activity), fragrant hot meals that stimulate appetite prior to eating, attractively garnished plates and an appealing dining experience. If candlelight and classical music get the digestive juices flowing, then go for it.

Take time to compose a food preference chart that displays favorite foods, recipes and snacks for your loved one. Tackle tired taste buds by boosting the flavor in foods with the extra use of favorite herbs and spices. A variety of textures, temperatures, colors and flavors may increase the appetite, as well. Try changing meal times to better meet the appetite. Many older people enjoy eating their largest meal of the day at breakfast when they feel their best, while dinner may find their appetite waning. And don't make the mistake of an unlimited intake of junk foods when the appetite suffers. A stomach full of candy and potato chips does little to nourish the body. If intake continues to remain depressed, try a nutritional supplement between meals.

Difficulty Chewing or Swallowing. Even if the appetite is good, tooth loss, poorly fitting dentures or dental pain can seriously restrict intake. In addition, certain medications and conditions may result in a lack of saliva, making it difficult to swallow. Don't waste time. Make an appointment with a dentist immediately if dental pain or difficulty chewing are nutrition roadblocks. Discuss any swallowing problems with your physician. In addition, choose soft, moist foods that are easy to chew and swallow. Try cooked pastas, cereals, stews, eggs, casseroles, canned fruits, puddings and yogurts. Take fluids with meals to assist in swallowing.

Medical Conditions or Illnesses that Affect Food Intake. If a new diagnosis for a medical condition that affects appetite has just cropped up, it may stir the pot of poor meal consumption. Some diseases like COPD directly affect appetite due to shortness of breath. Other diseases such as heart disease, renal disease and diabetes call for a restricted diet that may add extra demands on an already poor appetite. Special attention and care need to be directed to meeting the nutritional needs of the individual while providing for the special diet that addresses the medical condition. A consultation with a registered dietitian is a must to help plan an individualized diet that addresses these needs. See www.eatright.org to find a dietitian in your community.

Weight Loss. Weight loss can be a real problem, especially if it is rapid or if body weight falls below the desirable range for height. Make a food diary and keep track of foods that are taken in along with their calorie level. If the calorie level has fallen below 1,500 calories per day and portions of the Food Guide Pyramid are neglected, it's time to roll up your sleeves and get to work. Don't skip meals, and do your best to encourage significant food consumption at each meal. Offer nutrient-dense snacks between meals. Serve up power-packed beverages like milkshakes, nutritional supplements, milk, fruit juice or hot chocolate instead of water, coffee or tea. Stir extra nutrition into casseroles, soups and stews by adding cheese, milk, pasta or rice. It may be time to make an appointment with a registered dietitian to help create a weight gain or maintenance plan for your loved one.

Large Number of Medications. If the daily dose of medications adds up to more than three, drugs may be interfering with appetite. There's nothing like a stomach full of medications to kill the desire for lunch. Many over-the-counter and prescription medications have side effects of poor appetite or gastrointestinal discomfort. Drugs may also cause harmful interactions with each other.

It is important to bring along a written medication plan listing all over the counter and prescription medications to each doctor's appointment. This will help ensure that all medications are safely combined with each other and that the physician is aware of all current medications. Discuss with the physician any appetite problems related to medications. Do not try to discontinue any medication use without the physician's approval. Follow medication directions carefully, as many medications should be taken with a meal to prevent nausea, and some medications may carry specific directions about what foods may or may not be consumed with the medication.

Recognizing the warning signs of poor nutrition may be half the battle in fighting this all too common problem faced by the elderly. And while you're checking your loved one for these classic signs of poor nutrition, be on the look out for them in your self.

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Sharon Palmer is a registered dietician with a 16-year career managing healthcare food and nutrition departments.

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What Every Caregiver Should Know: Meeting the Challenge of Specific Nutrition Diets for Different Conditions in the Elderly -- 3/25/04

Weight Loss is NOT a Normal Part of Aging -- 6/21/05

Poor Appetite May Signal Time to Call the Doctor -- 9/25/06

Nutrition through a Needle or Tube: Lifesaving Challenges of Parenteral and Enteral Nutrition -- 3/30/05

For Caregivers and Their Elderly: Maintaining a Healthy Weight ? Avoiding Excessive Weight Gains or Losses With a Healthy Diet -- 7/31/04

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View The Caregiver's Hotline in which this article first appeared

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