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Balancing quality of life and elder nutrition

by Isabel Fawcett

Eating well is vital to good health. For some elders, good nutrition can be complicated by reduced appetite, difficulty chewing, swallowing, and less than optimum oral health. Family caregivers may hold the key that will unlock their elders' eating pleasure. Medically restricted diets will only work if followed. Therein lies the rub.

In 2005, the American Dietetic Association (ADA) *published Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-Term Care. ADA recommended that elder nutrition in nursing homes be evaluated by qualified dietetic professionals to balance elders' medical issues, individual needs, desires, and rights. The ideal goal in elder nutrition is maintenance of health and enhancing quality of life in elders in nursing homes. As a caregiver, I embrace the practical wisdom of balancing nutrition with quality of life for elders.

Elder Nutrition In-Home

The list of things I did not eat as a child was formidable. Some taboo foods were related to suspected or known food allergies. Other foods on my childhood list simply failed my brief smell or taste test. Had I been allowed, I would have eaten spaghetti and meatballs daily. I understand finicky eaters.

Now that I am a caregiver to an octogenarian, payback is a monster. It's my mother's turn to pick at foods she may not like or may not find appetizing. Dried herbs sometimes appear to be tiny ants needing to be removed from her plate. Never mind that the 'ants' are herbs like thyme leaves or oregano. As Mom did when I was a child, I camouflage herbs in food presentation for aesthetic reasons.

Mom enjoys my homemade meatballs, especially turkey meatballs, though she avoids cooked ground beef as a stand-alone category. I can only hope we will, one day, be in sync.

I have always enjoyed cooking, creative endeavors and challenges such as the one posed in being a caregiver to a diabetic. Nutrition practices and bad eating habits can make or break a diabetic's blood glucose levels, leading to extreme highs or lows. Regardless, there are days I wonder whether there is enough time and creativity, in my lifetime, to satisfy an elder nouveau food gourmand such as my mother.

Not unlike the American Dietetic Association's stance in 2005, my food service care goal is for my mother to enjoy what she eats, maintain her weight, and, retain as much control over what she eats as reasonably possible. Portion control, more frequent meals (smaller portioned), actively monitoring sugary food content, and consistent blood glucose testing are a few of the ways I strive to help Mom's diabetic body strike a healthy nutrition and blood glucose balance.

Mom parts ways with therapeutic diabetic nutrition guidelines in her fondness for vanilla ice cream. Instead of being caught with her hand in a cookie jar, I catch Mom with her head in the freezer, ice cream scoop in hand, looking like a deer in headlights. "What are YOU doing here," she asks, smiling. (Uh, I live here?)

By testing and evaluating her blood glucose levels throughout the day and being aware of her food and fluid intake, I am doing my caregiving best by balancing nutrition, chronic illnesses, lifestyle preferences and Mom's advancing age. At 84, Mom has enjoyed a full, productive and overwhelmingly happy life. I will not pull quality of life food preferences away from my mother, relegating her to a strictly healthy therapeutic diet. Such a drastic life shift would unquestionably negatively affect her appetite and make mealtimes unpleasant for both elder and caregiver. She is 84, soon to be 85. Let balance and reason prevail.

Occasionally sneaking ice cream means that my mother retains a measure of control within her home environment. Quality of life and an elder having fun at home are compelling reasons to live at 84+. Mom never asks for anything these days. Ice cream adventures are a simple pleasure enhancing her quality of life, freedom of choice and adventures living her life on the lam from her caregiver police.

Elder Nutrition and Life Quality

Mom enjoys breakfast. Her signature style breakfast is one she created in retirement. Spicy omelets or scrambled eggs, with chopped deli meats (ham or bologna) sautéed with onions, V8 juice, or tomato juice make her come alive each morning.


Her known breakfast history makes it easy to prepare egg beaters, low-fat shaved ham, V8 juice with fresh spinach. I occasionally add a slice of cheese, fresh red, yellow, and green peppers or diced tomatoes to Mom's jazzy breakfast. A glass of chilled diet cranberry juice, hot tea, applesauce or yogurt, and Mom is in breakfast or brunch heaven. At 84, quality of life trumps all.

Softer foods are part of my caregiver food service repertoire. Not mushy or pureed, unless we truly need to go there. Italian-style polenta is soft. So is southern-style spoon bread, served with broiled red snapper topped topped with wheat germ. Crock-pot (non-fried) turkey meatballs also make great sandwiches. Finger sandwiches are also popular. Salads are not as popular with Mom as they once were. I suspect that raw greens are harder to chew, swallow and digest. Broiled tomatoes topped with parmesan cheese and wheat germ are a substitute.

My mother remains in control of her food and choices for as long as she is able to safely do so. Food presentation offers elders psychological motivation to eat or a real bummer. Medically restricted or therapeutic diets are healthy, and just as often, picked at or set aside by elders who refuse to eat.

Poor appetite can be influenced by chronic disease, depression, loss of control over one's environment, isolation, loss of smell or taste, oral problems and more. Family caregivers are encouraged to keep meal times simple, non-stressful and fun.
References for the American Dietetic Association

Official Website: http://www.webdietitians.org/cps/rde/xchg/ada/hs.xsl/index.html,

Position Papers (Life Span; Older Adults)
http://www.webdietitians.org/cps/rde/xchg/ada/hs.xsl/advocacy_514_ENU_HTML.htm
[Volume 105, Issue 12, Pages 1955-1965 (December 2005)]