This article was originally published on The Nutrition Press.
Over 75? Forget counting calories, and make sure you take a second slice of cake!
This probably contradicts what you’ve been taught your whole life—to focus on eating a variety of fruit, veg, dairy, protein and whole grains, and to eat ‘sometimes foods’ sometimes. We know that too many sweets and snacks can be bad for our health over the long term. Is this just another case of health professionals changing their minds? And more importantly, why can grandma have twice as much cake as me?
Let’s compare a newborn baby to a fourteen-year-old boy. Both need to eat to survive, but it would be ridiculous to impose one way of eating upon both of them. Imagine how ridiculous it would be telling a teenage boy to drink six bottles of baby formula a day, and then imagine trying to fit everything a teenage boy eats into a three-week old child’s stomach! Everyone has different dietary requirements—there is no ‘one size fits all’ eating style.
Why should our elderly loved ones be any different?
Imagine a frail old lady. She doesn’t have much of an appetite, so while some days she can manage three small meals, often she settles for a cup of tea and a biscuit. Imagine an elderly man with a fading memory, who skips meals accidentally as he loses track of the time.
I’ve had the privilege, during my clinical placements, of hearing many stories like these from elderly patients. Some patients are widows and have lost the motivation to cook. Others struggle with the physical task of grocery shopping. Some are simply lonely. For others struggling with dementia, cooking can become a hazard—a hot plate gets left on, food is left in the microwave, meals are not stored safely, and the electric kettle melts on the stove top.
Whatever the reason may be, eating can be challenging.
For ageing patients, the focus is not necessarily on counting their serves of fruit and veg, or encouraging them to cut out gluten, or challenging them to adopt a paleo, sugar-free or low carb, high-fat diet. The starting point is ensuring they’re eating.
Get them to eat anything!
Take our first elderly lady for example. She often skips meals and is satisfied with tea and a biscuit. Is she really eating enough to maintain her weight? Is she consuming enough protein to maintain her muscles? Is she getting enough calcium to keep her bones strong?
These are important questions. If she doesn’t get enough food and becomes malnourished her immune system drops, her muscles waste, and she loses her fat stores. If she gets an infection, her recovery will take a lot longer.
Before a dietitian starts analysing and changing what an elderly patient is eating, they will make sure that their patient is eating in the first place.
Get them eating more!
It’s better for the elderly to weigh more. This is the obesity paradox. Recent evidence has shown that the elderly who weigh more have lower mortality rates. For an average adult, health professionals recommend a healthy weight (that is lowest associated risk of disease), with a BMI range of 18.5-25kg/m2. But for the elderly, a healthy weight range has a BMI range of 22-27kg/m2.
In some cases, it is healthier to weigh more.
The priority is to maintain this weight. There is no point in worrying about the health complications that come from forty years of eating burgers and ice cream when the patient is over eighty.
Health professionals are more concerned about conquering the barriers to eating and fighting against malnutrition.
Let the grandmas and grandpas eat cake, and whatever else they want. At Christmas, serve up a big slice of pudding with cream. At Easter, spoil her with the biggest chocolate egg you can find. Having a higher weight in the twilight years is healthier.
NOTE: This post addresses malnutrition and does not factor in other co-morbidities.
 Oreopolous, A, Kalantar-Zadeh, K, Sharma, AM & Fonarow, GC 2009. ‘The obesity paradox in the elderly: potential mechanisms and clinical implications.’ Clinics in Geriatrics Medicine, vol. 25, no. 4, pp. 643-659. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19944265