Nutrition and the elderly: eating problems

Health24's DietDoc Dr Ingrid van Heerden has written a series of articles specially aimed at the nutrition of the elderly. This is Part 2:

In The diets of older people: physiological changes we discussed the physiological changes that occur with ageing that can have a drastic effect on the diet and nutrition of older people. Each one of these problems can be solved, provided they are diagnosed. So if you are a senior citizen who is struggling with eating or if you are looking after an older person, be aware of the fact that seniors can have physiological problems related to eating, but that there are solutions that can make life much easier for all concerned.

a) Improved Digestion

Digestive enzyme or stomach acid deficiency

If you suffer from poor digestion because you are not producing enough digestive enzymes any more, or lack stomach acid to digest foods properly, then a simple test can identify these conditions and your doctor can prescribe enzymes and/or stomach acid supplements for you that will make all the difference to digesting your food properly again.


If you are constipated, you may initially need to take a mild laxative such as Fybogel to stimulate the function of your digestive tract. It also helps to increase your dietary fibre intake by having 1-2 teaspoons of digestive bran with your breakfast cereal and eating cooked, dried fruit regularly (puree the cooked, dried fruit if necessary). Try to increase your liquid intake moderately by having 2-3 glasses of water a day to assist digestion. The use of probiotics or “good microorganisms” like Bifidoflora which you can buy at health shops, will also help to restore your regularity without having to resort to using harsh laxatives, which can cause diarrhoea, nutrient losses and dehydration.

b) Improving Oral Health

Dry mouth or xerostomia

If you suffer from dry mouth or xerostomia, always sip a little water, fruit juice or rooibos tea with your food to make chewing and swallowing easier. Adding a bit of liquid to solid foods such as thinning porridge or breakfast cereal with warm milk, can make it much easier to chew and swallow, and also ensure that you have adequate calcium intakes and avoid dehydration.

 Have your teeth and dentures checked regularly and tell the dentist if you experience problems. It often takes only a small adjustment to make dentures fit properly so that you can chew your food without discomfort. Use a good denture fixative (e.g. Corega) to keep your dentures firmly in place. Practise good oral hygiene (brush teeth regularly and rinse your mouth with an oral antiseptic), to prevent tooth and gum infections.

If you wear dentures then make quite sure that you chew your food carefully and thoroughly before you swallow. So what if it takes you longer to finish your plate of food! As long as you get the maximum benefit from your diet it does not matter how long you take. Caregivers must make allowances for seniors who wear dentures and give them the time they need to carefully chew their food.

c) Improved sensory perception

If you are plagued by reduced taste perception (dysgeusia) and impaired ability to smell (hyposmia), discuss this problem with your doctor because some medications can contribute to reduced taste and smell. The doctor may be able to adjust your dosage or change your medication so that you can regain these senses that make eating enjoyable once more.

Caregivers should ensure that food for seniors is as visually attractive as possible to make up for blunting of the sense of smell and taste. Serving grey porridge or pale macaroni and cheese on white plates, is enough to blunt the appetite of anyone!

The use of MSG (Monosodium-glutamate), which is a taste enhancer, or soy sauce in small quantities, can improve the taste of many foods. So despite the fact that many people regard MSG as dangerous and high in sodium which could exacerbate hypertension in susceptible older people, this flavour enhancer can be used to stimulate the taste buds and actually reduce the amount of table salt (sodium chloride) that older people use. Add a pinch of MSG or a few drops of soy sauce to meat, fish and egg dishes to make them more palatable.

d) Improved Metabolism

Insulin resistance

To combat reduced glucose tolerance, insulin resistance, and the development of type 2 diabetes with increasing age, it is a good idea to start using a low-fat, low-glycaemic index (GI) diet before the problem gets out of hand.

Because it is quite tricky to apply a low-fat, low-GI diet, it is important to consult a clinical dietitian to assist you or your caregivers to apply this type of diet. Visit the Association for Dietetics in SA's website and click on "Find a Dietician" to find a dietician in your area. You can also contact The Glycemic Index Foundation of SA to obtain more information, including handbooks and recipe books, that explain the principles of the diet. Also visit the GI section on Health24.

Increased physical activity

Because the resting metabolic rate (RMR) is suppressed as individuals age and become less active, it is essential for you to be as active as possible within the constraints of your physical condition. No one expects a frail older person to run the Comrades or climb a mountain, but you can start going for gentle walks in the garden, or join a Seniors Activity Group or try swimming in a heated pool. Walk to the shops and if you are able, climb stairs instead of taking the lift. Every little bit of physical activity will help in so many different ways to keep you healthy and fit.

Physical activity:

  • Counteracts weight gain and insulin resistance by stabilising blood glucose and insulin levels
  • Improves the mood and lifts depression (a common condition that many older people suffer from)
  • Increases the RMR which also prevents weight gain
  • Promotes peristalsis to prevent constipation
  • Improves blood circulation to all parts of the body, including the brain
  • Increases lean body mass

e) Improved diet

The most important objective of Diets for Seniors is that they must be ‘nutrient dense’, without being excessively energy dense. This means that diets designed for older people should contain more high quality proteins, vitamins, minerals, antioxidants, phytonutrients and dietary fibre per kJ of energy than ever before. There is no room for ‘empty kilojoules’ in the diets of seniors. Each food that is included in the diet of older people must be rich in protective nutrients to ensure that Seniors receive the maximum nutrient intake possible.

Once again this is difficult to achieve, especially if the person in question has problems with chewing or swallowing. For this reason it is a good idea to consult a dietitian to help you or your caregivers select foods that have a concentrated nutrient content, but are easy to eat, and have a tempting taste.

- (Dr IV van Heerden, DietDoc, July 2010)

Any questions? Ask DietDoc

Read more:

The diets of older people: physiological changes 

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