Choosing Snacks Seniors Will Eat and That Meet Their Nutrition Needs

Family caregivers visiting their senior loved ones enjoy bringing them something to eat, not only to show their love but also to encourage them to eat.

Many seniors begin to have diminished appetites — whether from boredom, lack of activity, or changes in their sensation of taste — making all foods taste unfamiliar.

When they are left to eat the food someone else makes for them, whether a family or paid caregiver or in a facility, they tend to eat less and less.

It doesn’t matter if they are home getting delivered meals from an organization, living in a facility that supplies their meals in a congregate dining area, or in their room, or trying to prepare their own convenience items at home. They aren’t getting all the nutrition they need.

For many that is a real problem that can affect their nutritional health, physical health, and even their mood.

Caregivers can help fill the gap!

When Aging Changes Nutritional Needs

Seniors nutritional needs change as they age and caregivers can help them meet their needs with a few interventions.

While aging often means fewer calories may be needed, all the nutrients are still in demand by their bodies and some are more essential than ever for bone health, heart health and brain health.

Here are some things that happen which can change what and how much your senior loved one eats:

  1. As they age, chronic diseases can impact their health and how and what they eat. They may be restricting their food intake based on what they have been told years ago about a particular disease, such as heart disease or diabetes, to the point that they are limiting the nutrients they include — many are over-restricting what they eat.
  2. Difficulty with their teeth and gums can affect what food choices they make. Meats are usually the first foods to go when chewing becomes a problem. Whether it is because of poor dentition, poorly fitting dentures, gum disease, mouth sores, dry mouth or missing teeth or due to cognitive loss, chewing nutrient rich foods can be difficult.
  3. Medications can result in increased nutritional needs or a change in eating. Some medications can inhibit their appetite or increase their appetite to the point of poor food choices out of convenience and speed. Some medications cause dry mouth. Some can cause whole groups of foods, such as leafy green vegetables, from being cut out of the diet.
  4. Intake of the nutrients of concern as people age are often under consumed (or poorly absorbed) including calcium, B vitamins, and protein.
  5. Aging skin is not as productive at producing Vitamin D to help keep bones strong. Added to a decrease in dairy intake, for those worried about lactose intolerance, a weakening of bones that lead to fractures can occur.
  6. Decreased ability to absorb specific nutrients like B12 due to gastric acid secretion and the effects of drugs, such as antacids and proton pump inhibitors (PPI), used to control stomach acid.
  7. Excessive alcohol intake can cause nutrients that are eaten not to be absorbed properly or the person to eat less, putting them at risk for malnutrition.
  8. Finances can also change what your senior feels comfortable buying when they grocery shop. Cheaper, less nutritious, foods may become staples instead of often more expensive fresh foods.
  9. Functional status can impact what seniors eat as they are less able to shop, prepare and even eat the meals they need for health. Fatigue can limit their ability to cook for themselves. Grief or depression can also impact their desire to make their own meals or eat alone.
  10. Lack of desire for the meals served in the facility or by home delivery. Some seniors are often uninterested in the foods they are given or just want to choose their meals. When this is not the case, they often refuse to eat. Many seniors just want foods they remember or grew up eating which may not be what’s on the menu where they live. They may even have lost some of their sense of taste or smell, which could make meals less than satisfying. Some may want to cook their own food as they once did.

Snacks for Seniors

Family caregivers can supplement the meals their senior’s choose to eat with nutrient dense snacks.

It is important to remember that some snacks should be tailored to their individual needs if they have a medical condition such as diabetes or trouble chewing, so be aware of any chronic condition they may have.

Snacks that are high in salt, sugar, fat or excess calories without nutrition should be avoided.

Here are some examples of nutritious snacks your senior may like:

  • Greek yogurt with fruit
  • Cheese and crackers
  • Sandwiches made with deli meat like chicken breast or salads like chicken salad
  • Granola bars especially softer varieties such as Nutrigrain or KIND nut butter bars or breakfast bars
  • Fruit or fruit/vegetable juice blend beverages
  • Nuts or trail mix
  • Vegetables (parboil the veggies if they have trouble chewing raw) and dip
  • Smoothie or milkshake with fruit/vegetables
  • Pudding or gelatin snack cups
  • Fruit cups packed in their own juice
  • String cheese sticks
  • Raisins, yogurt covered raisins, craisins, dates, or figs
  • Real fruit snacks
  • Peanut butter and crackers
  • Hard boiled eggs
  • Stewed prunes, dried fruit such as apricots
  • Fig newtons
  • Hummus and pita
  • Homemade leftover dinner (small portion)
  • Custard
  • Ice cream or fruit juice bar
  • Cottage cheese and fruit
  • Sunflower or pumpkin seeds
  • Wheat or fruit muffins
  • Glass of chocolate milk or buttermilk
  • Oatmeal cookies
  • Bowl of cereal or oatmeal with berries
  • Avocado on toast
  • Pate on crackers
  • Nutritional supplement including fortified fruit juice or clear supplement for a change

If you are bringing snacks to a facility, check ahead to be sure any perishable food can have refrigeration if they don’t eat it quickly.

Tips for Improved Nutrition In a Care Facility

When your senior loved one is living in a care facility and you are worried they may not be eating enough of the most nutritious foods, bringing some of these snacks with you whenever you visit will greatly increase their intake.

  1. The foods that are perishable should be eaten while you are there and disposed of by you to prevent food poisoning. Be sure the snacks you bring are healthy and will not spoil if left on the counter or bedside table until your next visit.
  2. Sit with your senior while they snack. Many seniors don’t eat as much because they are often eating by themselves and need someone with whom to socialize while they eat.
  3. Take the opportunity to observe them eating. Are they having a problem with the teeth or swallowing that might need an evaluation? Is the food consistency still appropriate or would soft, even chopped food be better tolerated?
  4. Are they drinking enough fluids? Offer them a beverage or simply a glass of water while you visit.
  5. Do they need a multivitamin or supplement to help them get all the nutrition they need or perhaps a short term appetite stimulant to get them back on the right track?
  6. It might be a good time to discuss their medical diet with the staff. Determine if it is still needed so that you can advocate for your senior to reducing their restrictive diet which might be inhibiting a good appetite. You can also discuss with the healthcare team if a possible drug review is appropriate to see if there are any changes that can be made to improve their appetite, eating or reduce any food-drug interactions.
  7. If your senior is not eating the facility food, perhaps it is time to talk with the staff to see what can be done to offer alternates at meals or find ways to increase the seasoning in the food to make it more palatable. Maybe the food isn’t as hot as they prefer and a change in meal time or location (in main dining room versus their room) would help. Perhaps they would eat better if their food could be prepared for them to pick up instead of using a utensil, this is known as finger foods.

Poor nutrition can lead to functional decline, increased falls, loss of muscle, weakened bones and a reduced quality of life for our seniors.

It couldn’t hurt to include bringing healthy snacks every visit to encourage your senior’s appetite and can potentially improve their well-being.

 

 




DNR Codes and Levels of Care – Understand Before They’re Needed

Many family caregivers of seniors will, at some point, have to answer the question “does your loved one have a DNR?

Too often that question will come at a stressful time, during a medical emergency.

What does that mean?” you may ask.

You won’t have to ask that, though, after you read this article.

DNR (Do Not Resuscitate), often referred to as “no code,” is an advance directive document that guides medical personnel to NOT perform CPR or otherwise try to revive your loved one if their heart is stopped.

If your senior loved one does not have a DNR in place, they are considered to be a full code and will receive all aggressive measures if their heart or breathing stops.

As a family caregiver you might be asked about their code status during an emergency — either full or no code or some level in-between.

A DNR advance directive is used only when the person is unable to communicate their own wishes and someone else needs to step in to direct their care, otherwise they will be asked to direct their care themselves.

CPR, cardiopulmonary resuscitation, is a technique that is used to reestablish a person’s heart rhythm and breathing, shocking the heart back to a normal beating rhythm. It can involve chest compressions, rescue breathing, defibrillation, medicine to stimulate the heart function, mask ventilation and intubation for mechanical breathing (also known as life support).

Details About DNR Orders

A doctor is required to sign a DNR advance directive to be placed in your senior loved ones medical record, unlike a living will which requires a signature of the person involved and possibly a witness. A new DNR is required upon each hospital admission, including transfers between facilities.

It is important to know that many EMS (emergency medical personnel) are not allowed to honor a DNR order unless specific to that state and properly executed. For example, some states have a DNR document for use by EMS and then another one for the hospital.

A physician order for life-sustaining treatment (POLST), which covers out of hospital DNR orders, may be available in your state. There are also bracelets or documents kept on the refrigerator to alert first responders or your senior’s wishes.

More and more people have created advance directives that will dictate what type of care they desire at the end of life. The number of older adults who are executing their advance directives, especially a DNR order, is increasing.

Unfortunately, many have not spelled out their wishes, leaving family caregivers to make these decisions.

DNR Expresses Wishes

A DNR tells the medical team that your senior loved one wants to die naturally without heroic measures of ventilation, intubation, or vasopressor support.

A DNR does not mean “do not treat” if a condition arises that could benefit from treatment such as IV fluids, antibiotics or oxygen.

While age should not be a determining factor in making a decision for a DNR order, for many older adults, particularly those who are already frail, performing CPR can be futile. Even if CPR is effective, the heart or lungs will potentially fail again.

Not only will it possibly not prolong their life, it can be damaging to an older person.

CPR can result in painful injuries or a loss of functional status after the CPR is performed. It is not unusual for fragile senior’s ribs to be broken and damage caused to internal organs during chest compressions. Adverse outcomes, such as hypoxic brain damage and increased physical disability, can result.

One report states that CPR is successful in only 20% of the cases.

Types and Levels of DNR Orders

There are different degrees of medical intervention, depending on the policy of the hospital or nursing home. It is a good idea to ask the facility for their policy regarding different levels of DNR care so you clearly understand the process when needed.

Some facilities use terms to describe how they handle DNR levels such as:

  • comfort care – only comfort will be given in the event a person’s heart stops beating
  • comfort care arrest – may use life-saving measures before the heart stops beating but only comfort measures once it stops
  • specified – written by doctor, dictates which methods can or can not be used, such as Do Not Intubate but can do chest compressions

Other facilities, especially long term care facilities, can define different levels of treatment in the event that a medical emergency occurs. You might see something like this in your care home.

Level 1:  Stay in the facility and be kept comfortable, but not given antibiotics or other medications to cure you.

Level 2:  Stay in the facility and receive all medications and treatments possible within the facility.

Level 3:  Be transferred to a hospital from a nursing facility but not given CPR or taken to intensive care.

Level 4:  Be taken to a hospital and given all possible medical interventions. Do everything possible.

Level 1 and 2 allow someone to die naturally in familiar surroundings.

Some states may use different terms such as these:

AND – Allow natural death, used in end of life situations to be clear that an end is anticipated and the natural consequences of the condition are allowed to proceed

DNAR – Do not attempt resuscitation, this should be accompanied by specifics of which forms of interventions can or can not be used if the heart ceases beating

We prepared a Types and Levels printable version for use in speaking with senior loved ones and to keep handy should it be needed in the nursing home or hospital.

Executing Advance Directives

These documents should be executed and a healthcare power of attorney designated well before they are needed. During a medical crisis our senior loved ones may not be able to communicate their wishes to the healthcare team or family members and it will be too late.

An established healthcare power of attorney can make these decisions on one’s behalf following their advance directives.

It is a good idea to be sure that any power of attorney has been briefed about wishes and has a copy of the advance directives.

All family members should know who the power of attorney is so that there will be no confusion when the times comes that decisions are needed.

Your senior’s advance directives can be changed at any point in time if there are changes in their desires or the person they wish to make decisions on their behalf.

This can be a sad and uncomfortable topic to think about and discuss with our loved ones, but dying with dignity can be achieved when our healthcare wishes are expressed, no matter what our senior loved ones decide.