When we think of nutrition, our mind immediately turns to the issue of what foods we consume. We all know that fresh fruits and vegetables, as well as grains, are a good way to go. We know that getting enough protein whether through meats, beans, and legumes or via some substitute, is also critical. We know to avoid high fat and sugar laden diets and so forth. For the elderly however, another problem can creep into the picture. That problem is undernutrition which occurs as they begin to consume less food over time.

Certainly lower consumption is not always a negative thing, but in some instances, it can put their health at risk. In some situations, undernutrition and malnutrition can act to create a number of other health issues; from hair loss, to anemia, to B12 deficiency, and on into the realm of more serious ailments. Those who are undernourished also tend to heal from wounds slowly and have difficulty recovering from injuries and surgeries.

I am not a physician or nutritionist, I care for my elderly mother and was a therapist who dealt with eating/swallowing disorders for many years. Any problems with eating or nutrition should always be discussed/evaluated by a physician. However, I want to share a bit of my experience to provide information for individuals who care for the elderly to help them recognize when a need exists and how to respond.

There are a variety of reasons why some elderly individuals may have trouble maintaining adequate nutrition, many of which are still being studied, but here are some common thoughts on the topic:

1. Changes in our senses.
Taste changes, we enjoy food less, and therefore, we tend to eat less. We don't anticipate food, we don't enjoy it as much. Smell can also decrease. Our sense of smell is actually a large reason for why we enjoy food.

2. Less activity.
Typically, someone who is 70 or 80 years old isn't nearly as physically active as they once were. Activity is theorized to increase appetite.

3. Medications.
Many older individuals take an increasing number of medications. Ingesting several pills each day can be filling, but beyond that, is the appetite suppressing side effects of many medications.

4. Diseases and Disorders.
Many elderly individuals may be dealing with a disease or disorder that can reduce their appetite or make eating difficult. Swallowing difficulties can arise, digestive disorders can make eating unpleasant or painful, and so forth.

5. Dental problems.
Many elderly individuals have false teeth. If their dentures don't fit well, this can make chewing many foods difficult. They may avoid meat and other hard to chew foods.

6. Psychosocial issues.
Many elderly individuals may experience isolation, depression, or other psychosocial issues that effect appetite negatively. Many seniors have to deal with families who are distant, or too busy to socialize with them, friends may die, or health or financial issues can escalate leading to such problems.

Getting an elderly individual to increase their nutritional intake can be difficult and there are seldom easy answers. However, here are a few things that should help:

1. Decrease meal size and increase the frequency of meals.
An individual with reduced appetite will likely respond more positively to small meals and snacks versus an overflowing plate. Smaller meals can also benefit individuals who have certain digestive problems.

2. Increase variety.
Certainly, although taste and smell may be diminished, our appetite can be blunted somewhat by eating the same things over and over. This is something that isolated individuals tend to do. Thus, getting them to vary their diet more can help stimulate appetite and, in many instances, can improve the nutritional balance of their meals.

3. Increase socialization.
Eating is a social activity for most of us and we tend to eat more in social situations. If an elderly individual lives alone, they don't get this interaction. Eating can become a chore. Moving eating back into the realm of socialization can help. It can also enhance their overall mood.

4. Consider an appetite stimulant.
Appetite stimulants may be warranted in some cases. Inquire with the physician to see if it's appropriate.

5. Increase the level of activity.
Getting an elderly individual involved in more physical activity can help stimulate appetite and intake. From taking a walk around the block to participating in group exercise, any activity can be beneficial as long as a physician approves it.

6. Investigate oral medications.
Talk with the physician about which medications may be reducing appetite. Can the medication be changed to something with less of a negative effect on appetite? Can some medications be taken via other routes to reduce the number of oral medications taken each day? Some medications for instance, have an alternative that can be given less frequently or via a shot, a patch, nasal inhaler, or some other method.

7. Consider high calorie supplements.
There are a number of products available that provide more calories, more protein, and other nutrients that can be used to supplement meals. Products such as Boost, Ensure, and other shake like products are common. Again, check with the physician for recommendations.

8. Increase protein intake.
Although you want increased caloric intake, increasing carbohydrates primarily isn't often the best way to do it. Increasing protein intake will offer more benefits and should be a target as well.

9. Evaluate the need for assistive services.
Some elderly individuals may have difficulty preparing meals. Whether it is an issue of strength and endurance or something else, it is appropriate in some cases to have meals delivered or prepared ahead of time by a family member.

10. Consider their mental health.
An evaluation by a healthcare provider/physician is important. If depression, or perhaps cognitive problems exist, they need to be addressed.

11. Consider other physical problems.
If an elderly individual coughs during meals or seems to have difficulty getting their food chewed and swallowed, an evaluation is necessary. Certainly complaints of nausea, vomiting, bloating, and so forth could indicate digestive or other medical problems as well. Again, a medical evaluation should be pursued first in these cases. In addition, check their dentures to be sure they fit well. If there has already been significant weight loss, this will influence the fit of dentures as well.