The prize for a life well-lived over the age of 90 means you get to eat whatever you want, right? You’ve obviously done something right to be in the position to even ask the question. So, when my 96-year-old grandfather asked me to stop buying that “fancy, overpriced, hippie soup,” and just bring him some “plain ol’ Campbell’s,” I began to explain the nutritional value of the organic, locally-grown, hand-tilled, pasture-raised, antibiotic-free (you get the picture) ingredients of the so-called “hippie soup.” He was kind enough to let me finish my dialogue, but countered with a highly effective, “I don’t care. I am 96 years old, and I think I will eat what I want.” The story could certainly end here as I did not have much ground to stand on at that point, but the conversation brought up some important questions and learnings.
What is most important for our elder loved ones – enjoying a comforting bowl of a familiar meal that may have little nutritious value and high levels of sodium or being presented with the meal that ticks all the nutrient boxes, but does not taste like you want or may even be difficult to eat? The answer lies somewhere in the middle and may depend greatly on your loved one’s wishes as much as their medical requirements. My grandfather, Elmer, had relatively no medical issues and remained living independently until the last couple of months of his long life. He had no shortage of ladies dropping by with cups of coffee, mini cheesecakes, prepared meals, and homemade soup. Because he was well-looked after by his female fan club, I decided to drop the “hippie soup” and give him his familiar friend in the Campbell’s can.
While maintaining respect for the wishes of our loved ones is always a priority, there are real concerns about malnutrition within adults over 65. An article by the Mayo Clinic states that “malnutrition in older adults can lead to various health concerns”, including:
A weak immune system, which increases the risk of infection
Poor wound healing
Muscle weakness and decreased bone mass, which can lead to falls and fractures
A higher risk of hospitalization
An increased risk of death
But how does malnutrition happen in the first place? You may be preparing meals daily or paying for a meal plan as part of your loved one’s residency in an assisted living home. Surely you have set your loved one up for their basic food needs. Unfortunately, malnutrition can be caused by many factors -physiologically, mentally, emotionally - and can go undetected until there is real risk. Some of the factors cited by the Mayo Clinic are:
Normal age-related changes. Changes in taste, smell and appetite generally decline with age, making it more difficult to enjoy eating and keep regular eating habits.
Illness. Disease-related inflammation and illnesses can contribute to declines in appetite and changes in how the body processes nutrients.
Impairment in ability to eat. Difficulty chewing or swallowing, poor dental health, or limited ability in handling tableware can contribute to malnutrition.
Dementia. Behavioral or memory problems from Alzheimer's disease or a related dementia can result in forgetting to eat, not buying groceries or other irregular food habits.
Medications. Some medications can affect appetite or the ability to absorb nutrients.
Restricted diets. Dietary restrictions for managing medical conditions — such as limits on salt, fat or sugar — might also contribute to inadequate eating.
Limited income. Older adults may have trouble affording groceries, especially if they are taking expensive medications.
Reduced social contact. Older adults who eat alone might not enjoy meals as before and lose interest in cooking and eating.
Limited access to food. Adults with limited mobility may not have access to food or the right types of food.
Depression. Grief, loneliness, failing health, lack of mobility and other factors might contribute to depression — causing loss of appetite.
Alcoholism. Too much alcohol can interfere with the digestion and absorption of nutrients. Misuse of alcohol may result in poor eating habits and poor decisions about nutrition.
With a list that extensive of factors contributing to malnutrition, where does one start to make sure that the food our loved ones are getting gets the most bang for the buck? An article on Aging.com provides some simple, helpful guidance and a handy breakdown of some key nutrients to focus on depending on unique needs.
When you know what foods and nutrients to focus on for meal prep and consumption, how do we get our loved ones to eat them if all they really want is a bowl of something comforting? This is where the challenge and creativity collide. I could not have gotten my grandfather to eat a vegetable to save his life. But I did find out that he liked some of the fruit juices or smoothies that had vegetables in them without him ever noticing. Part of the problem was that none of us that were bringing him food had slowed down enough to ask him what he liked or did not. And so, we saw fresh produce spoil, complex, prepared meals go bad, and well-intentioned groceries go unopened. Once I sat with him for lunch and got him talking about what feels good to eat, what does not, what upsets his stomach, what is too strong of flavor, and what meals that my grandmother made he missed most, I not only learned better about what to shop and cook for him, but I also gained a priceless hour and half of connection with him. He felt heard and included in the decisions that were being made for him and I was able to shop for foods that would be eaten rather than spoil.
Possibly more than the clarity gained on the best meals for my grandfather was the connection and sense of control he gained through the conversation. As an “old, older person” living alone, he relied heavily on others for looking after him. And while the best of intentions were always present, it is understandable how he could see what was being done and decided for him rather than with him. This sense of dependence and loss of control over one’s life is a central theme in elder mental health. The Centers for Disease Control (CDC) cites that ~20% of adults over age 50 struggles with mental health concerns and that men over the age of 85 have the highest suicide rates of any population. Certainly, there are many contributing factors to elder mental health concerns and, not surprisingly, many are also factors on the list above contributing to malnutrition.
And so, it seems clear that the best intended kale, tofu, and fat-free vinaigrette salad you made your loved one for lunch may find itself rotten in the back of the refrigerator during your next visit. But maybe your next visit now includes a salad but with their favorite bacon bits on top. And you sit down with them and listen to their story of how special it was to have bacon on Sunday mornings when they were a kid. And how this salad, and spending the time with you, gave them the same warm and comforting feeling as the bowl of “plain ol’ Campbells.”
Time is finite. Love is eternal. Forgiveness is everything.
By, Laura Olson