To tempt older eaters, delight them with details

Mothers understand that little details inspire youngsters to clean their plates. Johnny likes the crust cut off of his PB&J; Pam eats oranges only if she can peel them herself.

Decades later, when Johnny and Pam have grown up, it’s their turn to return the favor. Not unlike youngsters, seniors benefit from the careful attention of their loved ones to stay well nourished. Experts in the field of feeding seniors offer these suggestions for successful, enjoyable meals.

HYDRATION AND NUTRITION

Older people often have smaller appetites, don’t remember to drink liquids and have difficulty swallowing. This makes proper hydration and nutrition a challenge.

Swallowing is a complicated process that involves moving the larynx, or voice box, up and forward to protect the airway and make room for whatever is coming into the throat, says Aaron Ziegler, a speech and language pathologist and assistant professor at the University of Hawaii’s Communication Sciences and Disorders Department.

When an elder’s ability to swallow is weak, food or liquid "residue" can remain in the throat. If residue gets into the lungs, the result could be pneumonia.

Ziegler recommends taking small bites and sips, chewing slowly and thoroughly, refraining from talking while eating, and swallowing multiple times for each bite — good advice regardless of age. After a meal, remaining upright for 15 minutes ensures everything has traveled down the throat.

The kinds of food and drink consumed and the ways they’re prepared also make a difference.

Thin liquid with the consistency of water may move too quickly down the throat. Nectar or honey can be added to make a drink more viscous, or serve smoothies and shakes that also provide nutrients, says Kay Hangai, certified dietary manager at Hale Ho Aloha nursing care facility in Pacific Heights, who’s been feeding seniors for more than 35 years.

If drinking is difficult, offer items that melt at room temperature, such as Jell-O, ice cream and pudding, along with gravies and sauces, she said.

Another option is fresh fruit, which provides water and nutrients, says Marcus Asa­hina, executive chef at Hale Ku‘ike, a Nuuanu care facility for those with Alzheimer’s and other dementia-related illnesses. Hangai also serves canned fruit packed in juice.

Solid food can be modified to various consistencies. For example, Hale Ku‘ike offers a "regular chopped-food diet where the food is cut into quarter- to half-inch pieces; fine-chopped to rice-grain size; and a puréed diet, where the food has a pudding consistency," Asa­hina said.

KEEP MEALS SIMPLE

Asahina says he serves only sliced food because seniors often have less dexterity, and trouble using a knife and fork could discourage them from eating.

Hangai serves food that is soft enough to cut with a fork.

For folks with smaller appetites or who become fatigued from swallowing, smaller, more frequent meals are a good option.

Keeping meals to a single course might be best for folks with memory problems, says Dr. Christina Bell, an assistant professor of geriatric medicine at UH’s John A. Burns School of Medicine.

"Sometimes it’s easier to keep meals simple — just a salad or dessert — because a person with dementia can be overwhelmed by too many choices," she said. "Often, a person will eat something and say they’re full, then half an hour later say they’re hungry because they don’t remember their meal. Each time, they can be served a different course."

KEEP FOOD INTERESTING

Taste buds diminish with age, but Asa­hina says it’s not a simple matter of dousing a dish with more salt and pepper to kick up the flavor. Seniors can be more sensitive to certain spices than others.

"Our staff will taste a soup that has a little bit white pepper, and we think it tastes good. But when we serve it, we might get complaints," he said. "We found that hot spiciness is OK, but pepper gets stuck at the back of some residents’ throats."

He also likes to layer flavors, using acids such as citrus juice as well as herbs, spices and a variety of vegetables.

Hangai says her main priority is getting residents to eat, so she isn’t a stickler when it comes to sodium intake.

"If something needs a little salt or shoyu, that’s fine. The elderly have small appetites, so you have to catch them when you can."

Asahina says that while he tries to expose residents to the occasional new dish, the menu at Hale Ku‘ike reflects the population.

"We like to serve what residents are familiar with, especially because they have memory issues. Certain items are nostalgic, so they eat more. If it’s not familiar, they might shy away from it," he said. "For example, saimin is one of the most popular items. But I have to make a separate item for Caucasian residents because they won’t touch it, so I’ll make soup and sandwiches."

Bell says keeping meals enjoyable is important.

"When you’re in your 90s, there are no rules. You can eat whatever you want," she said. "Food is one of the last pleasures older folks can enjoy. They can’t do most of the other things they used to do."

VISUALS MAKE A DIFFERENCE

A person can’t eat what they can’t see.

"Elderly vision is not always so great — think about what you’re putting the food on," said Asahina. "If you put white rice on a white plate, the food may get lost."

Bell suggests using dishware in contrasting colors to set the pieces apart from one another and from the table.

Stroke patients whose vision is affected sometimes can’t see the entire plate, "so it’s important to remind them to scan the plate or occasionally rotate the plate for them," she said.

"We’re always trying to preserve a person’s independence. It’s important to figure out tricks so they can eat on their own."

EATING IS A SOCIAL ACT

The social aspect of mealtime is commonly overlooked. "When seniors are alone and lonely, they generally don’t eat as well. Older folks who live alone tend to eat less and less," said Bell.

"My message to families is to try to celebrate mealtimes. It’s not enough to have Meals on Wheels deliver food. Someone needs to be around to eat with."

Bell advises taking advantage of social infrastructure already in place in elders’ lives, such as clubs, so they can eat with people they already know.

"In Hawaii, food means caring. It’s important for families to find ways to show they care."