Prescriptions
Undereating can be a problem for seniors

By Amy Tousman

It is a helpless feeling to see an elderly family member lose his or her desire to eat and subsequently become frail and thin. Excess weight loss in seniors may be caused by many factors. Natural biological effects of aging, medical problems and the social environment may contribute to unintentional weight loss.

It is natural to have a smaller appetite as we hit our golden years. The rate that food moves through the digestive system slows down. This causes a person to feel full with less food. Our metabolism also slows down as we age, so our bodies need fewer calories.

Also, as we age, the number of taste buds in our mouths decrease. A 70-year-old has half the amount of taste buds that a 30-year-old has. This means food does not seem as flavorful as it once did.

Loss of teeth or poor-fitting dentures make chewing and swallowing difficult. A dry mouth or mouth sores may also add to swallowing problems.

Illness, diseases and their treatments affect appetite. Cancer treatments such as radiation and chemotherapy may cause nausea and poor appetite. Medications such as Digoxin (used to treat congestive heart failure) can also cause these side effects. Antidepressants such as Prozac also may alter the way food tastes as well as decreasing the appetite.

Depression and feelings of loneliness decrease the urge to eat. Other contributors include loss of a spouse or close friends and having to eat alone. And some seniors simply forget to eat!

Although temporary weight loss is not usually a problem, long-term restriction of food intake is dangerous. Even though an older person's appetite and calorie needs may decrease, nutrient needs increase. If they are taking in too few calories, it often leads to deficiencies in protein, iron, calcium, vitamin C and zinc. These nutrients are important for helping keep muscles and bones strong as well as helping the immune system fight off infections. In addition, some nutrients, such as vitamins D and B12, and folic acid, are poorly absorbed by the digestive system of seniors.

Fortunately, there are lots of ways to help increase calories and nutrients in those with poor appetites. Here are a few:

• Serve small meals several times daily. It is easier to digest a small amount of food at one time.
• Increase protein and calories by adding powdered milk to fluid milk. The powder is an inexpensive "protein powder" and can be added to liquids, soups, hot cereal, scrambled eggs and pancake batters.
• Add oils, margarine or mayonnaise to foods. These condiments are approximately 100 calories per tablespoon.
• Serve liquid nutrition supplements such as Ensure or Carnation Instant Breakfast between meals or as a meal replacement.
• Trail mix made out of dried fruits and nuts packs a lot of calories into a small amount of food.
• Add eggs to soups, hamburger and casseroles to increase protein.
• Add cheese to sandwiches and vegetables to increase protein and calories.
• If loneliness is a problem, try to eat with the elderly person. If this is not possible, enroll him or her in a senior center or senior meal program where they can eat with others.
• If tastes have been altered, try experimenting with different flavor combinations, such as seasoning food with wine, garlic, basil, ginger or lemon juice
• If it is hard to eat whole fruits, blend them into a smoothie.
• Make milkshakes with ice cream, chocolate syrup and milk. Use Lactaid milk if lactose intolerant.
• Sauces and gravies add flavor to plain, dry foods and also make them easier to swallow.
• Serve soft foods to those with chewing difficulties. Examples include ground beef, egg salad, cooked vegetables, applesauce and canned fruits. Some food may need to be chopped or minced.
• Provide a multivitamin supplement formulated especially for seniors.
• Check with your pharmacist about side effects from medications.
• Take care of dental problems promptly.

Here's an easy recipe for a pudding that will help add calories and nutrition to a diet:

Calorie-Boosting Pudding

• 2 cups milk (those with lactose intolerance can use Lactaid milk)
• 2 tablespoons vegetable oil
• 1 package instant pudding
• 3/4 cup dry milk powder (those with lactose intolerance can substitute protein powder)

Stir milk and oil. Add pudding mix and dry milk powder, and mix well. Pour into dishes for à cup servings. Makes 4 servings.

Amy Tousman is a registered dietitian at Straub Clinic & Hospital Inc. and a member of the Hawai'i Dietetic Association. Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.