Problems of ageing

Advances in medicine and improvements in living standards mean that more and more people in Western society are living well into their sixties and seventies, air age previously considered old. but now just an extension of middle age as discussed in the previous article good nutrition helps the body deal smoothly with the ageing process

One of the major problems

I find among older people is keeping up their interest in eating Sometimes this is because they have lost a partner, and the thousand and routine dating with someone else no longer exists. It is also easy to fall into the trip of thinking that you don’t need as much food when you get older and you don’t need to pay as much attention to your diet. While there is some truth in the notion that you don’t need to take in as many calories as if you were doing active work vector body still needs a regular and plentiful Supply of nutrients. Without the right food, the body can become malnourished. weak and generally depressed. Minor cuts and sores are slow to heal, constipation become a long-term problem. und mustering the energy to take a walk can seem an impossible task.

In general terms an elderly person needs just as much protein, carbohydrate. vegetables, fruits, dairy products and water as a person in middle age. They may be less active. but the fact that the body is working less deliciosity means that it needs more of a nutritional helping hand Keeping a food diary for a couple of weeks is a good way of checking your nutrient balance. If you find you are living on tea and toast make an effort to get more variety into your meals. Begin the day with porridge, have salad at lunchtime. and a piece of fish or chicken breast with a good helping of vegetables for your evening meal. If you stew same apples or pears with dried fruits like apricots or figs, you can have them warm on their own or with a simple crumble topping or keep them in the fridge to eat cold. stirred into thick yoghurt. Never think it’s not worth cooking just for yourself

The best way to judge whether your body is getting the right amount of food is by your right. If you are maintaining a steady weight then you have the balance right. If you are ailing weight it may be because of some medication you are taking or it may be that you are relying too heavily on high-fat foods. Ready-made, convenience and fast foods attend high in fat Even if you do a lot of your own cooking fat is very tasty and it is easy to be tempted to fry things rather than using other cooking methods such as boiling and

baking. If you are losing weight, you are clearly not eating enough for your needs Lack of appetite is a common problem in older people, and it may be compounded by medication. For more advice, see below. As well as keeping up your nutrient intake through a well-balanced healthy eating pattern, there are a few specific nutrients and common health problems to which you should pay particular attention.

VITAMIN D

Vitamin D is primarily produced by the action of sunlight on our skin, but as we get older the amount of time we spend outdoors generally decreases. This can cause our bodies to become deficient in vitamin D, which is needed (along with calcium) to maintain strong bones. Since bone mass begins to deteriorate gradually from the age of twenty, you can see that by the time you are sixty your bones are at far greater risk of fracturing unless you get enough vitamin D and calcium from the foods you eat. Try to go for a stroll or sit outside every day as that your skin can synthesize some vitamin D. Alternatively, or ideally as well as this, you should boost your intake of vitamin D rich foods: herring. kippers and mackerel, canned salmon, sardines and tuna, cod liver oil: liver: margarine eggs full-fat dairy produce – milk, cream, butter, cheese.

DEHYDRATION

Dehydration is common in elderly people Sometimes you just forget to drink, especially the healthiest drink, water. When you remember, you tend to drink tea or coffee, both of which dehydrate the body. The fear of incontinence can also stop you from drinking. As distressing as incontinence can be, dehydration can cause serious health problems, such as kidney failure. Drinking water and other caffeine-free drinks in small volumes throughout the day can help reduce incontinence. It is generally large volumes of liquid at a time that cause incontinence. suggest you stop drinking a couple of hours before you go to bed, which helps prevent night-time incontinence. Take a glass of water to have at your bedside, just in case you wake up thirsty,

CONSTIPATION

Constipation is often a worry for older people. It is partly caused by the gradual slowing down of the metabolism, but is undoubtedly exacerbated by dehydration and the failure to drink enough water. Taking laxatives may seem the obvious solution, but it would be far better to correct constipation by increasing your fiber and water intakes.

LACK OF APPETITE

Mary elderly people seem to suffer from a lack of appetite. This is sometimes a side effect of medication or can be due to a zinc deficiency. Depression can also cause you to go off your food, if you are feeling low Dealing with depression – but remember, don’t suffer in silence, ask your doctor if there is anything, he or she can do to help you Don’t think that you have to make a great effort to prepare and eat a large meal. It’s far better for you to have lots of different snacks throughout the day healthy snack I have looked at ways to stimulate the appetite in more detail   (under the general heading of dementia, but please don’t let that put you off, First. here are a few hints:

• Boost your zinc intake. Try to include zinc rich foods in your daily and weekly eating plan, tinned sardines on toast, cheese, especially crumbly white cheeses such as Cheshire: a casserole of lean red meat sources of inch). If you cannot eat these foods, consult your doctor are suggest you read dietitian, who may suggest a zinc supplement.

• Seize the hungry moments. Keep a small stock of biscuits in an airtight tin by your bed in ease you wake up feeling stake. Keep small pots of biscuits, nuts and dried fruits around the home to remind you to cat when you feel hungry.

• Have a little tipple. Alcohol can stimulate the appetite so enjoy your favorite aperitif of sherry, gin and tonic, or a glass of wine are champagne – all best served chilled. You will probably find that its quite easy to nibble at crisps. nuts or cheese while you sip your drink Wine with the meal can also increase your appetite and nutrient intake Check with your doctor to ensure that alcohol is not contraindicated for any reason, and remember that excessive amounts of alcohol can put you off your food: moderation is the key. Sometimes alcohol can dry your mouth slightly so intermingle sips of alcohol with sips of water.

Side  effects of medication

The amount of medication we take in our twilight years can be astounding ranging from indigestion remedies and laxatives to blood pressure pills and anti-inflammatories. These drugs can affect your appetite, eating habits and Nutritional needs. What you eat can help or hinder the action of the drugs.

All too often people don’t realize that the reason they crave foods or cannot manage to eat much is nothing more complicated than a side effect of medication Some elderly people undergo needless medical investigations for symptoms directly attributable to a drug they are taking. This is not a direct criticism of the doctor, unless the person or an informed relative or friend tells the doctor or specialist about the medications, they are taking incorrect drug decisions can be made. In addition, elderly people often continue to take medication prescribed for a specific complaint way beyond the required time,

sometimes people may have been on a certain drug for years, then quite suddenly they start feeling less well. As we get older our bodies change in composition and metabolism, we may develop more fat or become thinner, we store less water, and the functioning of our heart, liver and digestive system change – all of which can cause our body to react very differently to drugs People involved in preparing meals for elderly people need to be aware of the drugs they are taking and how their body cars be affected. An example of this is tolbutamide, a drug used to manage diabetes by lowering blood glucose levels in older people it can have an excessively strong hypoglycemic action causing the blood sugar levels to drop too low.

This can make them feel shaky, tearful depressed week and always wanting sweet foods. The reason why it affects older people differently is twofold: as we get older the composition of our blood changes, and our livers become less efficient at metabolizing foods and drugs the result is that more tolbutamide will be left to work in the blood. Simply changing the medication can eradicate these symptoms. If there is no alternative to taking tolbutamide, you should make sure that you take it with or immediately after food, to lessen the risk of hypoglycemia. if you know how a drug is likely to affect you it can help you to juggle your food and drugs. Keeping a food and symptom diary times when you take your tablets, should give you plenty of information upon noting the which to act.

For instance, splitting breakfast can help you feel better or increase your food intake if necessary. Having a simple biscuit and drink with the medication first thing and then leaving a couple of hours before having some breakfast cereal, eggs and toast can suit some people better than eating it all at once. Many drugs make the appetite disappear.

This situation can pull people into thinking that their body would tell them if they needed to eat: unfortunately, this is not always the case. Drugs which decrease appetite include anti-cancer drugs, morphine, non-steroidal anti-inflammatories, theophylline’s, iguanids, glucagon and the digitalis group. On the other hand, some drugs can dramatically increase appetite, leading to excessive weight gain, which can aggravate, among other things, heart conditions and diabetes. Drugs which increase appetite include insulin, thyroid hormone steroids, some antihistamines, sulphonylureas and psychotropic drugs. Elderly and frail people are particularly vulnerable because certain nutrient needs take on a greater importance they need to maintain their calcium intake to protect their bones, and their iron intake to prevent anemia.

The interactions and side effects of medication can make this a little tricky. Many drugs directly alter mineral and vitamin absorption and metabolism, which if unnoticed can lead to deficiencies. For example, anti-cancer drugs can impair the absorption of food and affect thiamin (vitamin B1) status and iguanids (used to treat certain forms of diabetes) can reduce vitamin B2 and folate (folic acid) status. Prolonged aspirin treatment, commonly used for people with a history of thrombosis or heart problems, reduces the amount of vitamin C in the body. Ask your doctor to explain the nutritional implications of any drugs you are taking, and if necessary, boost your intake of the relevant nutrients.

Dementia

Dementia is defined as a state of serious emotional and mental deterioration We all expect some mental deterioration such as slight forgetfulness, as we grow older, but if this deterioration occurs before the age of sixty it is called presented dementia. Relatives notice that the person starts to forget things, especially things that have happened recently. They can remember things from the distant past, but forget whether they have been shopping or received a phone call. Later there may be a widespread loss of intellectual functions. One of the symptoms which can cloud the diagnosis of dementia is the fact that the sufferer may become depressed, which in itself can cause a change in personality.

It is likely that the individual is not acutely aware of the change in their mental and physical well-being, but to see someone you love slowly lose their mental capacity, which in turn affects them physically, can cause a great deal of strain in relationships. Many of my patients find one of the most stressful aspects of being in them forties and fifties are caring for a parent suffering from dementia.

There are many types of dementia, but one of the most common is Alzheimer’s disease. Alzheimer’s was named after the German scientist who first described the syndrome. With this condition there are various biochemical disturbances which cause changes not only in the behavior of the person but also in the nutrient requirements. If you understand some of the ways in which the body changes, you can begin to understand why someone behaves as they do from a nutritional perspective, some of the most important changes are:

• Changes in the levels of neurotransmitters, chemicals within the brain which recognize hunger and fullness,

Reduced activity of the cholinergic systems, which leads to intellectual deterioration and poor memory function. This means they can forget when and what they have eaten

• Deterioration in the ability to identify smells. This can have a profound effect on the types of food they want to eat. Patients can develop bizarre eating habits such as eating whole jars of marmalade

• Changes in amino acid and glucose metabolism – in other words the way their body deals with proteins and sweet foods is altered. Changes in vitamin and mineral turnover.

ALUMINIUM AND ALZHEIMER’S

There has been much publicity about the link between aluminum and Alzheimer’s disease. It originally arose because high levels of aluminum were found in the brains of some patients with Alzheimer’s, and some studies suggested that Alzheimer’s disease is more common in areas where there is a greater level of aluminum in the drinking water. Many of my patients worry that drinking tap water will cause them to develop Alzheimer’s There is no evidence to support this, as the aluminum level in drinking water varies from glass to glass and the value does not give an indication of the bioavailability of the aluminum, the ability of the body to absorb it.

In many instances the aluminum is simply excreted without passing into the body cells. I advise patients to carry on drinking water from the tap, or use an approved water filter if they don’t like the taste. If you are worried about your water contact your local water authority The only concern I have is with the use of aluminum cooking pans. There  some evidence to show that aluminum can dissolve from the pan and pass into certain foods. Although the evidence is not conclusive as to whether aluminum toxicity causes Alzheimer’s, I would suggest that you use non-aluminum cooking pans.

Food considerations

As well as Alzheimer’s disease and presenile dementia there are many other types and causes of dementia. Although these conditions bring nutritional factors of their own. the following section on managing dementia may give you some useful tips People with dementia are often underweight. There are a number of possible causes.

Their food intake may be poor because they have forgotten to eat, or they cannot find foods they fancy because of changes in their sense of taste and smell. If they are physically infirm, this affects their ability to prepare and eat foods, and in the later stages of dementia they can develop problems chewing Some medications can cause the mouth to become dry or give a strange taste Changes in taste and the ability to recognize what they should be eating can be dramatic in some cases patients eat totally inappropriate things, such as tissues in the final stages of dementia the ability to swallow and the desire for food or fluids can disappear.

In homes or in hospitals dementia patients can fall victim to lack of time and inflexibility in the menu. Feeding someone with dementia can take hours they may refuse mouthfuls, sit in silence for minutes or get up and walk away. All this can be extremely challenging for anyone looking after them, but there are many things you can do to improve the situation. It is important not only to tackle the psychological, social and physical challenges, but also to provide the body with the appropriate nutrients to support the nervous system.

STIMULATING THE APPETITE

There are a number of tactics to encourage a dementia patient to eat more of the right foods .

• Build up a selection of small meals and snacks, rather than the traditional three meals a day. This increases the likelihood that they will in the course of a day, consume more nutrients .

Don’t over face them with food. Serve small but tasty dishes. If they cannot cat a large serving you are reinforcing the sense of negative achievement. If they get through a small portion you can always serve seconds.

Take some time think about the presentation the dish, this paramount stimulating the senses and encouraging them eat.

• Choose meals such casseroles, hot pots, and rather than piles of meat with different vegetables. Sometimes difficult to cope with more than one thing. There plenty meals which provide proteins, carbohydrate and essential vitamins and.

• Augment favorite foods with something which makes them little more Even they don’t manage many mouthfuls, the nutrient and calorie value of each mouthful For make mashed potatoes extra creamy by adding spoonful of double sour cream grated Serve fruit with cream, ice cream, yoghurt custard.

Keep the taste buds on their toes, plan have plenty variety during day in terms of color, taste, temperature and texture. However, important not to confuse the taste buds within one meal Dishes such soup with croutons or chocolate mousse with crisp biscuit can serve mousse its own, and offer the biscuit Crisp textures hidden smooth foods cause choking, especially the dementia affects the ability.

Have little bowls of nibbles around the house. They stimulate the tempt the eye and turn the taste buds. If the patients find cheese dried raisins and apricots, filled dates there you will sur prized how they will graze their way through quite lot without realizing.

• Have slices of arranged small covered or chilled the fridge for them to pick at. Do the same with raw vegetables such sticks carrot or celery with dip of mayonnaise soy sauce ramekin Some may find raw vegetables hard you could have small slices of or ciabatta bread with the dips.

MAKE  LITTLE EFFORT TO PLAN

One of the most demanding aspects about looking after someone with dementia is the time takes feed Careers find it very disheartening spends hours trying to make an appetizing dish only have refused. They take as rejection not only of their but also of their love The best way to go about cooking for and feeding someone with dementia make special effort to Depending their mental and physical state you should try to include them the planning on some days they fancy one thing in particular Food will often seem more appetizing they are able join in with simple activities such going the shops to buy some fruit, looking at unusual or even choosing chilled meal.

Try not disempower by choosing all their unless they too ill pate. If they are unable to leave the home, bring home selection of things that have caught your eye and discuss what they would like to they live alone and can manage to cook, but need some help organizing their food store or deciding which meals to suggest you make large batch of a dish such as a casserole or flan and stock up their fridge and freezer with individually wrapped portions.

Keep them supplied with easily eaten foods which don’t need tin openers or scissors to track the packaging. You can also make cakes and biscuits for morning and afternoon snacks The test time of day for eating is usually in the morning up until lunchtime as cognitive abilities are generally better at these times. Confusion and agitation tend to increase as the day goes by It also helps if you refrain from having distractions such as television on during meals as this can confuse them and distract them from eating .

DON’T OVER FACE THEM WITH CUTLERY

Sometimes people don’t bother with eating because they find it difficult to deal with cutlery. If this is the case, choose finger foods such as little quiches, open sandwiches fat broads and crisps with cheese and yoghurt dips Serve deep fried potato skins to scoop up a casserole I suggest you set just the cutlery needed to eat one course many things on the table can confuse dementia patients. at a time, as too I think geriatric bibs are unnecessary and a little degrading A napkin, even if it is disposable placed over the clothing is much more civilized. You can buy beautiful plastic tablecloths to protect the table. Remember not to overfill cups and glasses as this increases the risk of spillage.

FOOD SAFETY

Remember to respect food hygiene advice (see Food safety in the homes of people who live alone it is a common occurrence to find food out of date and stale. Check the stock of food regularly as the last thing you want is for anyone to end up with food poisoning.

REFUSAL TO EAT

People suffering from dementia often refuse to eat. They can be so insistent that they refuse to open their mouths or sit down at the table. This can be a result of depression or a physiological response to the brain damage. Some drugs can also kill the appetite Grasp every little opportunity for them to eat. If they don’t want to eat proper meals, try them with some nutritious drinks such as homemade milkshakes made with puréed fruit (bananas, strawberries and raspberries are good), which can be enriched with ice cream or yoghurt. I have given some recipes for fruit drinks such as strawberry and passionfruit punch. Hot chocolate intake.

Homemade soups from a mug are good for keeping up their calcium are easy to eat or drink The odd day of not eating much will not cause them any harm the likelihood being that they will make up for it on the following day. However, if you find that they are going for a few days without eating, you must seek medical advice.

The effects of medication

Discuss the times of taking medication with their doctor, sometimes taking medication before or after food can make a big difference to their appetite. nutrient absorption and taste buds. If they say they have a strange taste in their mouth, it may be that a change in medication could improve the situation,

• Strongly flavored foods such as red meat sometimes tastes metallic in this instance choose protein dishes based on cheese, fish, eases. poultry or pulses

• You may find that tea and coffee taste unpleasant. The positive side of this is that reducing the intake of tea and coffee helps with the absorption of important vitamins and minerals However removing tea and coffee leaves a gap in the day which traditionally provides an opportunity to eat a stack. Look for alternatives such as herbal or fruit teas, orange blossom tea or ginger tea or try a glass of boiled water with a slice of lemon or lime:

it cleanses the palate and provides the comfort of sipping a hot drink • An uncomfortably dry mouth can be caused by drugs that affect the natural process of salivation. Not surprisingly, it tends to be dry foods that aggravate a dry mouth and make it sore, No avoid grills, roasts and fries as well as very hot or spicy foods. Instead, try casseroles or fish with a sauce Have on hand plenty of cool, refreshing drinks such as freshly squeezed fruit juices and drink these throughout the day.

SWALLOWING DIFFICULTIES

Difficulty in swallowing dysphagia) is common in the later stages of dementia Some may simply have difficulty managing solid things such as piece of meat or crusty bread, whereas others may only be able to take liquid foods Whichever form it takes, you can usually find a tasty option to enliven your meals.

• Try to choose foods which are naturally soft and easy to swallow. such as souffles, omelets, mousse Cook interesting recipes and encourage the patient to eat with you, rather than isolating them with a dish of slop.

• If they can only face liquids remember that soups come in many flavors and textures.

• Encourage them to take small sips of a drink while they eat, as this can help ease the food down.

ALCOHOL

Check with their doctor first, because some medications do not mix well with alcohol. If the doctor approves a pre-meal tipple can help increase the appetite and stimulate the taste buds. Something you may discover by trial and error is that alcohol adversely affects some dementia sufferers, causing them to become agitated or depressed If they want a drink before a meal, which in some household’s forms part of the ritual of eating, but you don’t want them to have alcohol, serve a sparkling mixer or fruit juice in a special glass as a refreshing alternative to alcohol