USA: Many seniors don't eat enough

Loss of appetite is often a sign of problems

TUCSON, ARIZONA (The Arizona Daily Star), June 13, 2005:

Madeline Thompson was a home economist who cooked three square meals a day for her family in Springfield, Ill. But as she and her husband aged, they began losing their appetites. Denture problems made it hard for John Thompson to chew his food. Depression, dementia and other health problems followed. The couple, now 89 and 90, didn't complain, but their daughter noticed.

"They started out with a great breakfast, but as the day wore on, they'd eat very little, half a sandwich, half a banana, a glass of milk. They were not eating healthy," said Jan Winter, who eventually moved her parents to a nursing home near her in St. Louis, according to the Associated Press, reporting today from St. Louis. They are better nourished now with round-the-clock care, and are more interested in eating when Winter brings them to her house for Sunday dinners or takes them out to an ice cream parlor. But proper nutrition and hydration continue to be a challenge. The Thompsons are typical of elderly people who curtail eating for reasons as varied as poor-fitting dentures to pain to loneliness. Depression is the leading cause of poor nutrition, experts say, and should be treated. Loss of appetite is often an early warning sign of something gone wrong. "There's a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you'll have a higher chance of dying," said Dr. John Morley, geriatrics director at Saint Louis University Hospital, and a professor of medicine. Despite conventional wisdom, weight loss is not a normal part of aging. "They're not supposed to wither before they die," said Dr. Margaret-Mary Wilson, who teaches and researches geriatric medicine at Saint Louis University, and has a practice. Older adults are more susceptible to malnutrition because the stomach empties more slowly in later years, and the sight, smell and taste that used to make eating so enjoyable are diminished. "The battle to maintain nutritional status is uphill," Wilson said. "And restrictive diets only make the problem worse." Registered dietitian Ann Gallagher, a Fort Wayne, Ind., dietary consultant to nursing homes, estimated that half of new admissions to long-term-care facilities are malnourished and it's difficult to recover from that.

Recommendations * Experts advise helping elderly people buy foods that pack as much nutrition as possible in small servings. Here are some recommendations: * Fortified, ready-to-eat cereals and powdered instant breakfast drinks mixed with milk. Liquid supplements are nutritionally comparable, but often have a medicinal taste. * Tablespoon or two of nonfat dry milk powder added to yogurt, cottage cheese, creamed soup, hot cereals and even a glass of milk to add extra protein and creaminess. Blend the dry milk well to avoid graininess. * Baked or microwaved potatoes. * Colorful fruits like watermelon, mandarins, apples, oranges, mangos cut into bite-size chunks, the brighter in color the better. * Dark green spinach, green beans and tender lettuce, as well as beans. * Casseroles over meat-and-potato entrees for easy storage and chewing. Other ideas:  Serve liquid supplements, if at all, between, rather than with, meals. A Saint Louis University study showed seniors fill up too much on supplements and eat less of the meal.  Time visits during mealtime. Research shows older adults eat more in the company of others.