What are the most important factors in helping older patients maintain a healthy diet?
When Kelly Strogen, MS, RD, LDN, sees a new patient, in many cases she’s working to help that person utilize proper nutrition in order to lose weight.
When Strogen, a registered dietitian at Wayne Nutrition LLC in Wayne, PA, sees one of her patients in the geriatric population—here defined as patients age 65 or older—she often finds herself changing approaches.
“Their concern,” Strogen said of her patients in their 70s, “is that they are losing weight. They’re trying to gain back the weight they’ve lost.”
As a dietitian, Strogen’s focus turns towards protein, a critical source of calories for a population concerned with loss of muscle mass. “Sarcopenia, or the breakdown of muscle, happens at a much faster rate in older people,” she said. “So, protein gains importance with age.”
Indeed, research finds that after the age of 50, the degenerative loss of skeletal muscle occurs at a rate of 0.5–1 percent annually, with the rate increasing with age. Strogen readily admits that the majority of her time is spent with people looking to lose weight; however, that doesn’t mean there aren’t effective, healthy strategies for weight gain through proper nutrition.
“I’m not going to have people eating Big Macs and milkshakes to gain weight,” she emphasized. “I want to promote oils, healthy fats, nuts—I want them gaining weight, but not belly fat.”
The strategy is most effective when combined with exercise, specifically resistance training to aid in the development or maintenance of muscle. For the older population, this can be as simple as push-ups against a wall. But while the concerns of the population may change, the recommendations are largely consistent with those any adult would receive.
“Try to get some form of cardio,” Strogen summarized. “30 minutes a day is a great guideline. As for food, I really stress avoidance of processed foods, refined grains and added sugars. And I really push vegetables.
“If you can’t break down what food group something belongs to, you probably shouldn’t be eating it.”
Eating Healthy on a Budget
The rise of specialized ‘healthy’ grocery stores gave birth to the idea that eating healthy is an expensive proposition, one that requires deep pockets.
Carol Myers, OTR, has a Health and Wellness coaching certification and has aided several clients in addressing their nutritional concerns. She says that costly healthy eating is a myth—it just requires careful planning to stay within a budget.
“If you know what you’re going to cook, you’re not wasting money on things you won’t eat,” she reasoned. “Menu planning will save you lots of money.”
What goes on the menu? The answers vary for everyone, but Myers was glad to share her approach—reduce meat intake. “Lots of Americans love to eat meat, but not me,” she said. “when I stopped buying meat, I realized my grocery bill had gone way down. At one point, I was almost a vegetarian!”
Of course, this requires finding alternative sources of protein. “We have this Western idea as a society that animal proteins are the only option,” said Myers. “It’s just not true. Lentils, for example, are a complete protein, and they’re very inexpensive.”
“Beans are one of the healthiest foods,” Strogen concurred, “and they’re very cheap. You can get a pound of beans for a dollar or so, and that’ll feed you for several meals.”
Strogen added that when she lived alone, she was able to eat on $50 a week, but like Myers she was quick to add that it required careful planning.
“Look at the supermarkets,” she advised. “What’s on sale? Stock up on those things, especially yogurt and produce. Frozen vegetables are very nutritious and can be inexpensive. Bulk bins are a great place to buy nuts, for example.”
Adjustments and Modifications
Of course, for some people, shopping at the grocery store at all is a luxury. So is cooking. Unfortunately, when working with the geriatric population, practitioners must occasionally confront the reality that a patient or client lacks the ability to fend for themselves in the kitchen.
For people with mild limitations—or even just a lack of willingness to cook—both Strogen and Myers had one main recommendation.
“The crockpot,” said Strogen, “is a great resource. You don’t have to stir or add anything. You can literally put food into the pot and just let it cook”.
“You don’t have to use a stove,” agreed Myers. “You chop things up, put them in the crockpot…and then you can freeze what’s left over.
“People seem to like that idea. They’re very open to that approach.”
Myers added that purchasing pre-packaged lettuce or other foods cuts down on preparation time and simplifies the entire process.
Aside from crockpots, Strogen says she’s spent time finding the right restaurants for take-out meals (in many cases, this requires the help of a caregiver.) Although she’s not typically a proponent of frozen meals due to the high sodium content, she says she will look to find some healthier options from this category, and then supplement with additional servings of vegetables.
“Some people might be surprised at the amount of vegetables I have my clients eating,” she laughed. “We’re talking cups and cups of vegetables.”
Strogen says the attraction of frozen meals is easy to see—they’re easy to prepare, and relatively inexpensive. But again, it’s a matter of perspective. “For the cost of a Lean Cuisine, you could probably buy foods to make yourself a couple of healthy meals,” she said. “But I realize there’s a motivation issue there as well.”
In the end, that question of motivation is the hardest one for Strogen, Myers, or any other professional to answer. Ensuring clients listen to advice and follow proper nutritional habits certainly isn’t exclusive to the geriatric population. But if the client is in your office or your practice, they’ve already done half the work.