Things to Look For

• Weight change
  Noticeable or sudden weight loss or weight gain could signal a serious physical or psychological problem. Weight loss and wasting can also signal severe nutritional deficiencies.
• Complaints of changes in taste and smell
  Loss of taste and smell (which enhances taste) is a major cause of weight loss in the elderly. Changes in taste and smell are a normal part of aging but the situation can be made worse by disease and medication.
• Loss of appetite/smaller appetite
  An aging digestive system may not be able to tolerate certain foods and spices. This may cause seniors to stop eating a balanced diet and limit themselves to only a few foods — the "tea and toast" scenario. Illness and medication can also adversely affect appetite. Chewing problems may also cause a person to shy away from eating solid foods.
• Constipation
  Food moves more slowly through an aging digestive tract. Constipation can also be caused by certain medications and not drinking enough fluids. An unbalanced diet (not enough friuts and vegetables, too much meat, etc.) can also cause constipation.
• Disease
  Disease can interfere with the body's ability to absorb and make use of nutrients. Seniors with illnesses such as heart disease, hypertension, and diabetes may find it difficult to switch or stick to low-cholesterol, low-sodium and other prescribed diets. Neurological diseases, particularly, affect a person's ability to chew and swallow.
• Medication
  Medications can interfere with the body's ability to absorb nutrients from food, and impair the body's ability to excrete minerals.
• Level of physical activity/exercise
  Strength training exercise combined with multivitamin supplements can help increase muscle strength and energy levels in very frail elderly people. Moderate activity and exercise help stimulate appetite.
• Mobility/dexterity problems
  A person who is not able to move around easily or have access to transportation may have difficulty preparing meals and shopping for groceries. Problems with handling eating utensils may cause frustration and lessen the enjoyment of meals.
• Loneliness/depression
  Eating is a social activity. Many people do not like to eat alone and will not make the effort to cook for one. The loss of a spouse or close friend may bring on feelings of isolation that could escalate to depression. A person who is depressed may lose interest in eating.
• Dining environment/food presentation
  A pleasant environment and appetizing-looking food increases a person's enjoyment of meals.

Medical conditions that affect the senses of taste or smell

Disorders affecting the nervous system

• Alzheimer's Disease
• Bell's palsy
• Damage to vocal chords
• Epilepsy
• Head trauma
• Korsakoff syndrome
• Multiple Sclerosis
• Parkinson Disease

Signs of chewing and swallowing problems

• Extra effort chewing or swallowing
• Eating very slowly
• Packing food into the cheeks
• Swallowing several times for a single mouthful of food
• Shortness of breath during eating
• Coughing or choking while eating or drinking
• Drooling
• Fluid leaking from the nose after swallowing
• A wet-sounding voice after eating
• Increased congestion in the chest after eating
• Repeated bouts of pneumonia

If a parent is coughing or choking too often when eating and you are getting worried, ask the following questions:

• What type of food or fluid was he eating when the choking occurred?
• If the person wears dentures, were they in at the time?
• Was the person walking around with food in his mouth?
• Was he laughing or talking?

Record this information for a visit to the doctor.

How to assist someone to eat and improve nutritional intake

• Ensure that foods are neither too hot nor too cold
• Feed attractive, tasty, pleasant-smelling foods to enhance appetite
• Use finger foods to encourage independence and safety
• Make sure he is ready to eat i.e. the dentures, eyeglasses and hearing aid are in place
• Try to make the eating environment quiet and inviting with as few distractions as possible. Try playing some quiet music.
• Make sure he is seated correctly i.e. as close to 90 degrees as possible
• Try to tuck the chin under so it points to the chest (if necessary have the person in a chair offering head support)
• Sit at eye level as you assist the person with eating
• Use a teaspoon to avoid putting too much food in the mouth at once
• Remind the person to chew each mouthful thoroughly
• Touch the person's lower lip to stimulate opening the mouth
• Massage the throat to stimulate the swallow reflex
• Take as much time as necessary to help the person enjoy the meal
• Ensure the person remains sitting in an upright position for at least 30 minutes after each meal
• Clean out the mouth after each meal

Complications associated with tube feeding

• Nausea, vomiting, diarrhea
• Constipation and cramping
• A swollen stomach
• Coughing, wet breathing, a feeling of having something caught in the throat
• Infection at the site where the feeding tube enters the body
• Clogged tubes
• Tubes pulled out by the person with dementia
• Aspiration pneumonia