Family Caregiving Tips: Cooking for Your Loved One

Three in four adults more than 65 years of age have two or more chronic conditions that can limit day-to-day functioning. If an older adult is not able to grocery shop or cook meals, these tasks fall on the caregiver. In 2015, 76% of caregivers helped their loved one with grocery shopping and 61% helped with cooking meals. As a result, the caregiver’s dietary habits will impact their loved one’s diet. In other words, if the caregiver eats poorly (non-nutritious foods), so will their loved one, typically resulting in poorer health.

 

Changing Nutritional Needs

Older adults have about the same nutritional needs as a young adult, but with some differences:

Older adults need fewer calories. Too many calories can result in weight gain. It is important that older adults eat nutrient-dense foods, which are foods with fewer calories, but more nutrients. These include fruits, vegetables, whole grains, low-fat or fat-free milk products, seafood, lean meats, eggs, beans, peas, lentils and nuts. The amount of calories an older adult consumes on a daily basis is dependent on their activity level: individuals who are not that active should consume between 1,600 and 2,000 calories daily.

Choose carbohydrates wisely. The main role of carbohydrates is to provide energy. Carbohydrates also contain fiber that can help protect against heart disease and promote regularity. The best carbohydrate-containing foods are whole grains, vegetables, fruits beans, peas and lentils. It is important to be careful in how you choose your carbohydrates. Sugars can be naturally present in foods, but some processed foods may have added sugars (high in calories, low in nutrients). Some tips for choosing your carbohydrates: eat a variety of fruits, more dark green or orange vegetables and beans, peas and lentils several times a week. Half of your grains should be whole grains.

How might this look in food portions? For a 1,600 calorie diet, older adults will need approximately 1 ½ cups of fruit each day; 2 cups of vegetables each day, with 1 cup being beans, peas and lentils each week; and 5 ounces of grains each day (at least 3 ounces should be whole grains). A 2,000 calorie diet will need approximately 2 cups of fruit each day, 2 ½ cups of vegetables each day with 1 ½ cups being beans, peas and lentls each week, and 6 ounces of grains each day (at least 3 ounces should be whole grains).

 

The best carbohydrate-containing foods are whole grains, vegetables, fruits and legumes.

 

Fiber is more important than ever. Dietary fiber is helpful with constipation, cholesterol, diarrhea and heart disease. Unlike other nutrients, fiber cannot be digested. It is recommended that older adults consume 20 to 35 grams of fiber per day. Older adults should consume a combination of soluble and insoluble fiber, since both types provide various benefits. Soluble fiber dissolves in water and helps lower cholesterol and moderate glucose-blood levels. Good sources of soluble fiber are oats, oatmeal, legumes (peas and beans), barley and fruits. Insoluble fiber does not dissolve in water. It passes through the digestive system pretty much in its original form, helping reduce the risk of constipation. Good sources of insoluble fiber are whole-wheat flour, wheat bran, nuts, beans and vegetables (cauliflower, green beans and potatoes). If the dietary fiber is low and needs to be increased, it is important to increase it slowly to avoid gas or pain. Be sure that your loved one is drinking enough water as fiber absorbs fluids. Table 1 shows how many grams of fiber are in specific portion sizes. You can find the amount of fiber in specific foods on the Nutrition Facts label.

 

Table 1. Grams of Dietary Fiber in Specific Portion Sizes.

Don’t forget proteins. One-third of older adults do not eat enough protein. The cause can be a reduced appetite, dental issues, change in food preferences, swallowing problems or limited financial resources. Research has shown that older adults who consume an adequate amount of protein are more likely to be in better health. Protein helps keep muscles strong and is important for balance, mobility, wound healing and fighting infections. Experts recommend that older adults consume 0.8 grams of protein per 2.2 pounds of body weight. A good way to calculate how much protein is needed is: 

 

Weight divided by 2.2, then multiply that answer by 0.8

 

150 pounds ÷ 2.2 = 68.18 x 0.8 = 54.5 ≈ 55 grams protein daily

 

Example:
Choose lean, high-quality protein foods such as fish, poultry, lean meats, eggs, low-fat dairy beans, peas, lentils, nuts and seeds. Table 2 shows how many grams of protein are in a specific portion sizes. The amount of protein in foods can be found on the Nutrition Facts label.

 

Table 2. Grams of Protein in Specific Portion Sizes

 

Watch the fat intake. Dietary fat is a major source of energy and helps absorb important vitamins and provides taste and helps you feel full. Even though fats are important, many people consume too much fat in their diet. High fat diets can lead to a wide range of health problems such as heart disease, high cholesterol, obesity, high blood pressure and type 2 diabetes. There are different types of fats – some provide health benefits in small amounts, while others do not.

 

• Unsaturated fats are the “good” fats. These are healthy when eaten in moderation and can help lower cholesterol. Best sources of saturated fats are plant-based oils, such as sunflower, corn, olive, canola or peanut oils and nuts.
• Saturated and Trans fats are “undesirable” fats. These can raise cholesterol levels. Common sources are meats, poultry, fish, butter, ice cream, cheese and solid shortenings. Meats supply protein so be sure your loved one consumes lean, low-fat or fat-free meats. Removing the skin can also limit “undesirable” fat. Trans fats are made when manufacturers “hydrogenize” liquid oils, turning them into solid fats, such as shortenings. Trans fats are commonly found in crackers, cookies and snack foods.

 

It is recommended that older adults try to consume unsaturated fats – keeping their total fat intake between 20% to 35% of their total calories (320 calories to 560 calories). Look at the Nutrition Facts Label to see the total percent daily value per serving, which may be written as %DV.

 

Nutritional Problems in Caregiving Families

Despite knowing about good nutrition, many people do not eat a healthy diet. This can result in health problems due to poor diet. Barriers to healthy eating include:

• Lack of shopping and cooking skills.
• High cost and lack of access to healthy foods.
• Low family support for healthy eating.
• Lack of knowledge of older adult nutritional needs.

 

Shopping & Cooking Skills

We all know we should eat healthy, but sometimes we do not know how to shop or prepare healthy meals. Having the knowledge and ability to shop for and prepare healthy meals equips us to make nutritious foods. By making our own meals, we can rely less on “ready-made” meals, which are typically unhealthy. However, caregivers think they are too busy to eat healthy or do not know how to shop for healthy foods. Many caregivers feel that it takes more time to create a healthy meal than heating a “ready-made” meal. Caregivers typically buy unhealthy foods out of impulse or habit – quickly choosing foods to get out of the store faster instead of spending time reading food labels. Several large supermarkets have made grocery shopping easier by allowing you to pre-order groceries online and pick-up them at a convenient time. This may be a viable option for caregivers who feel rushed during grocery shopping.

 

Cost and Access to Healthy Foods

It is not surprising that price is a deciding factor in food choices. Healthy foods can cost more than unhealthy food – an average of $1.48 per day per person. Families may purchase energy-dense foods (more calories per gram, often with added fats and sugars) in order to extend their food dollars. Unfortunately, these provide excess calories and can lead to weight gain. While “ready-made” meals or fast food may seem cheap, they may actually cost more per meal than simple home-cooked dishes. Remember, when buying groceries, there are multiple ingredients that can be used for several meals (such as olive oil or spices) and some meals may have food left over for future consumption.

 

Rural and some urban areas have fewer supermarkets that offer wide varieties of affordable, healthy foods. These areas may rely on smaller convenience stores that have little to no healthy food options. Some ideas for accessing a wide variety of foods could be visiting a local food pantry. Some small grocery stores may offer delivery for individuals who have difficulty shopping or do not have reliable transportation. Individuals may also be able to rely on their care team for help with transportation (see our fact sheet entitled Family Caregiving Tips: Creating a Care Team for more information). Local faith-based organizations also can be a resource by acting as a local food pantry or helping in transportation.

 

Low Family Support for Healthy Eating

Cooking for several people with different tastes can be difficult. Like other families, caregivers often must consider each family member’s tastes when making meals. It is difficult to make healthful meals everyone enjoys. To avoid problems, most often families will stick to “old tried and true” recipes everyone likes– instead of having a wide variety of foods for a well-balanced diet. However, the individual who prepares the food has considerable influence over what the family eats. Research has shown that the individual who makes the meal can change their family’s eating behaviors. Some helpful strategies can include buying and preparing healthy foods and setting a good example by eating healthy foods yourself. Avoid pressuring family members to eat healthy foods.

 

Uncertain about Older Adult Nutrition

As people age, their nutritional needs change (discussed in the next section). However, caregivers know very little about proper nutrition for older adults. This could put their loved one at risk for malnutrition. The good news is that there are programs that provide education about the nutritional needs for older adults. Nutritional education programs are provided for free through Oklahoma Department of Human Services and the Oklahoma Cooperative Extension Service. Contact your local Area Agency on Aging (call 2-1-1) or county Extension office to find a nutrition education program! With the right knowledge about proper nutrition, caregivers can make informed decisions about dietary choices.

 

Food Intake Changes with Age

Appetite. Many older adults have decreased appetite — leading to reduced food intake and increased risk of weight loss. Bodily changes that occur with getting older can affect your loved one’s appetite. How much food your loved one eats is based on their energy needs. Most older adults lose fat-free mass (muscle, bones and organs) at about 1% per year and may be less active – resulting in lower energy requirements, thus a reduced appetite. Other issues could be medication side effects, diminished smell and taste, depression, lack of independence and social isolation can make food less appealing.

 

Eating healthy food does not just help with a person’s physical needs. It also helps with social and emotional needs. Family members can help promote others to eat healthy, especially at meal times. Eating with someone can increase the amount of food another person eats. The presence of a second person can extend mealtime, which can allow more time to eat. Another person also can help encourage a person to keep eating.

 

Thirst. Dehydration occurs when you use or lose more fluid than you take in. Older adults are at a higher risk for de-hydration due to lower water volume in their bodies. The thirst sensation tends to decline with age, which lowers your loved one’s awareness that they are thirsty. Other factors include diarrhea, vomiting and excessive sweating. Some common signs include weakness, dry mouth, constipation, headache, irritability, sleepiness and confusion. Consuming adequate fluids becomes increasingly important. Daily recommendations are 12 cups fluid for males and 9 cups for females. You can help remind your loved one to drink more fluids and keep pitchers of water handy. Be sure to seek medical attention if your loved one is experiencing diarrhea for 24 hours or more, or if they are more irritable or disoriented than normal, cannot keep fluid downs or has bloody or black stool.

 

Older adults are at a higher risk for dehydration due to lower water volume in their bodies.

 

Chewing and Swallowing. Much like appetite, bodily changes can impact your loved one’s ability to chew and swallow. Mouth problems such as tooth loss or decay can impact food texture choices, leading them to choose softer foods. This can limit the variety of foods that older adults are able to eat. Enriched soups or drinks can help ensure that your loved one gets the nutrients they need. Saliva helps to soften foods, so decreased production of saliva can make it difficult for older adults to chew or swallow foods. Dry mouth can be helped by regular sips of water, avoiding hard dry foods and using saliva replacement products.

 

Dementia and Food Choices

Older adults with dementia may not be able to understand and/or express their needs and wants. As a result, you may decide what to cook. While it may seem easier, taking away your loved one’s choices actually takes away his or her sense of power and control. People like to maintain their independence, even individuals with dementia. Provide your loved one with some choices. You can ask, “Of these options, which sounds better to you?” Allowing your loved one to decide what they like can increase their quality of life. 

 

General Tips for Healthy Nutrition

Each family situation is different. Below are some general tips to help improve your loved one’s nutrition.

• Have meals at regular times and provide ample time for eating.
• Serve a variety at meals.
• Invite others over for meals.
• Promote physical activity to increase appetite and maintain strength
• Be aware of medication side effects.
• Promote safety in the kitchen and allow your loved one to help.
• Have plenty of fluids available at meals and throughout the day to promote hydration.
• Keep a supply of healthy foods on hand for days you do not feel like shopping.
• If feeding someone, remember to feed small amounts of food and allow ample time for chewing.
• Be sure to maintain your loved one’s dignity!
• Talk with your doctor if you believe your loved one is not getting the nutrition they need.

 

References

Alexy, U., Libuda, L., Mersmann, S., & Kersting, M. (2011). Convenience foods in children’s diet and association with dietary quality and body weight status. European Journal of Clinical Nutrition, 65, 160-166. doi:10.1038/ejcn.2010.254

 

Bourcier, E., Bowen, D. J., Meischke, H., & Moinpour, C. 2003). Evaluation of strategies used by family food pre-parers to influence healthy eating. Appetite, 41, 265-272. doi:10.1016/S0195-6663(03)00104-1

 

Cichero, J. A. Y. (2018). Age-related changes to eating and swallowing impact frailty: Aspiration, choking risk, modi-fied food texture and autonomy of choice. Geriatrics, 3, 69. doi:10.3390/geriatrics3040069

 

Daniel, C. (2016). Economic constraints on taste formation and the true cost of healthy eating. Social Science & Medicine, 148, 34-41. doi:10.1016/j.socscimed.2015.11.025

DiMaria-Ghalili, R. A., & Amella, E. (2005). Nutrition in older adults: Intervention and assessment can help curb the growing threat of malnutrition. American Journal of
Nursing, 105, 40-50. doi:10.1097/00000446-200503000-00020

 

Hermann, J., & Struckmeyer, K. M. (2018). Resilience through nutrition: Nutrition and dietary opportunities and challenges for caregiving families. In W. A. Bailey & A.W. Harrist (Eds.), Family caregiving: Fostering resilience across the life course (Series Editors: S. M. Wilson & A. W. Harrist: pp. 45-62). New York, NY: Springer.

 

Mayo Clinic. (2019). Dehydration. Retrieved from https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086?p=1

 

MyFoodDiary.com. (2019). Soluble & insoluble fiber: What is the difference? Retrieved fromhttps://www.myfooddiary.com/resources/ask_the_expert/soluble_insoluble_fiber.asp

 

Pilgrim, A., Robinson, S., Sayer, A. A., & Roberts, H. (2015). An overview of appetite decline in older people. Nursing Older People, 25, 29-35. doi:10.7748/nop.27.5.29.e697

 

Rao, M., Afshin, A., Singh, G., & Mozaffarian, D. (2013). Do healthier foods and diet patterns cost more than less healthy options? A systematic review and metaanalysis. BMJ Open, 3, e004277. doi:10.1136/bmjopen-2013-004277

 

Ternier, S. (2010). Understanding and measuring cooking skills and knowledge as factors influencing convenience food purchases and consumption. Studies by Undergraduate Researchers at Guelph, 3, 69-76. doi:10.21083/surg.v3i2.1122

 

US Department of Health and Human Services., & US Department of Agriculture. (2015). 2015-2020 Dietary guidelines for Americans (8th ed.). Retrieved from https://health.
gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

 

US Centers for Disease Control and Prevention. (2016). Multiple chronic conditions. Retrieved from https://www.cdc.gov/chronicdisease/about/multiple-chronic.htm

 

Kristopher M. Struckmeyer
Assistant State Specialist for Caregiving

 

Janice Hermann
Adult and Older Adult Nutrition Specialist