Feeding the elderly: how to ensure a good diet

This Alter’Native Food 2018 conference talk addresses food for elderly people and the problems of malnutrition that can affect the elderly in institutions.

Food for seniors: eating well to grow old well

Food is linked to longevity. In France, it is an integral part of the culture, but this does not prevent us from being affected by the problems of malnutrition and poor diets. It is particularly the case for elderly people, who are the subject of this Alter’Native Food 2018 talk.

What relationship do seniors have to food in France?

Food is not only the means of satisfying a natural need, it also offers an opportunity to forge social ties

We spend a lot of time at table in France, and for Nicole Vidal, geriatric physician, “… eating is an essential activity, we eat every day, we spend a lot of time at table - particularly in France, and in this way we satisfy a natural need […]. For someone aged 80, this represents 2600 days in their lifetime spent satisfying this essential need.” Food is not only the means of satisfying a natural need, it also offers an opportunity to forge social ties.

Yet the population is increasingly being affected by chronic ailments such as diabetes, high blood pressure, obesity and malnutrition. The latter phenomenon particularly concerns dependent elderly people who do not take in sufficient nutrients for their bodily needs. Around 10% of seniors are malnourished, with this figure rising to 40-50% in retirement homes.

Malnutrition is a shortfall in dietary intake with respect to what our bodies need to maintain an energy balance. In France, it is estimated that there are 2 million malnourished people. Among the elderly, this shows up as weight and muscle loss, reduced physical activity and an increasing propensity to suffer falls. Added to this are tiredness, greater vulnerability to sickness and longer recovery periods.

Why does ageing increase the risks of malnutrition?

In ageing, we undergo physiological modifications that affect our senses, in particular taste and smell. Yet these are the very senses that convey the flavours of food. What is more, seniors tend to taste sugar better than salt, and this is why they tend to favour sweet foods more.

Other problems come along with advanced age, such as dental problems, more frequent drug-taking (altering taste and reducing appetite), and slower digestion for a longer-lasting sensation of fullness. Certain neurocognitive pathologies also bring with them memory problems, leading sufferers to forget to feed themselves. Lastly, the risk of finding oneself alone increases over the years, and solitude makes people less likely to eat well than when in a couple or as a family.

What are the good habits for the elderly to adopt?

It is important to respect a few simple rules to avoid the risks of malnutrition among the elderly:

The Nutriscore and INCO labels
  • Pay attention to the energy balance by avoiding special diets beyond 80 years of age: the priority is combating malnutrition and not chronic diseases.
  • Monitor the intake of proteins for building muscle.
  • Adopth a rhythm of three meals a day, with an afternoon snack around 4pm.
  • Do not exceed 12h of "night-time fasting", between evening meal and breakfast.

Foodstuffs to be favoured are proteins (15% of daily food intake), sugars (55%) and fats (30%), along with trace elements, vitamins and mineral salts. The quality of animal proteins is better than that of plant proteins for making muscle, but a balanced diet makes it possible to mix the two.

The INCO and Nutriscore labels are sure indicators of food quality, and so elderly people or those looking after them should pay attention to these labels. To monitor the energy balance of elderly persons, they need to be weighed. If weight loss is greater than 5% in less than one month or 10% in six months, this indicates malnutrition. The same applies if the body mass index is less than 21 for a senior citizen.

It is important these days to banish misconceptions: getting thinner and having less appetite as you grow old is not in fact the normal state of affairs. Conversely, a stable weight is indicative of longevity. It is also important to take pleasure in eating, while combining it with physical activity.


Read also : How to respond to new food fears and threats 


Concerning culinary dependency

Culinary dependency refers to when someone depends on someone else - either a member of their family or a professional - for their eating needs. The act of food provision is delegated to this person or these persons, either for shopping for food or for preparing meals. The elderly person no longer exercises their choice in what they eat.

Mastication and dysphagia pose problems for seniors who lose their teeth, with the risk of choking on large morsels of food that cannot be chewed properly. As a result, the dishes served up can be aesthetically unappealing, particularly since food textures are often altered in hospital environments.

All the same, even if certain pathologies have an impact on meal-taking, there is medication that helps limit the complications, and the elderly person concerned can adapt relatively well to the situation. The greatest impact often comes from the social upheavals. Having to go into an old folks’ home is often experienced as traumatic, as is finding oneself alone, the death of a loved one, or having to retire and finding oneself in financial difficulties.

What are the main profiles of those eating in institutions?

Most people in retirement homes tend to be modest eaters, with only 13% of residents fully covering their food needs. This is not because they are not given enough to eat, but because they do not eat the quantities that they should consume. This not only causes increased malnutrition, but also generates a great deal of waste.

To encourage modest eaters to eat well, the act of eating needs to be stimulated. This obviously concerns what is found on the plate, but not just that. The service and the context of the meal also need to be taken into account. Working on the nutritional enhancement of dishes without increasing their volume is also a solution, as is presenting meals that always look and taste good.

Three meals a day may not suffice, with this number having to be increased over the course of the day, yet while proposing smaller quantities so as not to discourage consumption. Adapting menus, recipes and ingredients is also important. Professionals in the sector need to be supported and trained on malnutrition so as to obtain the best possible results.

Speakers: Nicole Vidal, geriatric physician, and Virginie Van Wymelbeke, DIJON CHU hospital

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