By Liz Carey

Dietary needs change with age and health condition.

In late January 2018, Dr. Mehrdad Ayati of Stanford University School of Medicine and board certified in family and geriatric medicine, spoke before the U.S. Senate Special Committee on Aging about aging challenges.

“As we age, we lose bone mass, muscle and water content while increasing fat content. Other physiological factors such as losing taste buds and sense of smell, dental issues, lack of companionship, medical and psychological illness and stress all result in weight loss,” Ayati said on the topic of nutrition. “Medical and social education for this group should put emphasis on proper hydration, maintaining a balanced diet, practicing mindful eating, avoiding fad diets and not relying on over-the-counter supplements and herbal remedies." And, the doctor added, "Social support programs are crucial.”

Studied and noted are appetite and taste preferences that change with aging. The desire and ability to cook square meals can diminish with declined mobility, hand dexterity and the loss of energy and ability that comes especially with the difficulties of heart, kidney or lung disease. Additionally, getting to the grocery store gets more difficult, so there are fewer opportunities to stock the pantry and refrigerator.

In-Home Care Company’s Training Approach

To support better nutrition, Home Care Assistance, a national provider of non-medical personal care services with 180 offices in North America, added a new layer to its caregiver training programs. Katie Roper, vice president of health care strategy and partnerships, describes the program as a win-win for one of its unique qualities: The company trains its caregivers on healthy cooking—a self-care skill caregivers will retain for themselves and use to benefit their children and families.

“Many of our employees who provide hands-on care are not used to cooking and eating fresh organic vegetables and sustainably-caught fish—yet that’s what our clients expect, and what we want to provide them for optimal health,” Roper said. “We looked at the longest-lived people on the planet, those who live in Okinawa, Japan, and hired experts to put together a care program based on their lifestyle. We call our approach the Balanced Care Method.”

Home Care Assistance conducts in-house cooking training classes for caregivers.

“What’s been great is that once they learn how to cook this way, many of them end up applying the same techniques to the meals they make for their families, so they get healthier, too,” Roper said. The company uses its “Balanced Care” cookbook, which includes recipes designed by a nutritionist to have the nutritional profile that older adults need, she said.

Proper nutrition for older adults is considered a challenge. While the 2015–2020 U.S. Dietary Guidelines for Americans specify age, sex, socioeconomic status, race and ethnicity and disability among the individual factors shaping a person’s food choices, this resource offers little as nutrition relates to seniors, the elderly and the chronically ill, which may suggest a gap where local, patient- and condition-specific programs are filling a need.

Ann Darcy, MS, RDN, CDN, has been working with seniors for over 30 years, most of those years overseeing the congregate dining and home-delivered meals programs, nutrition education and in-home nutrition counseling services provided to seniors throughout Westchester County, New York. Homecare and all the dynamics are integrated into Darcy’s daily work, and the nutrition counseling and education provided to seniors can also benefit home health aides, homecare agencies, families and caregivers.

Community Programs “More Than a Meal”

For some seniors, the home-delivered meal is their only source of human contact for the day. Similar to other services that fall under the state-funded Area Agency on Aging, home delivered meal services are need based. They support larger efforts to address isolation, patient safety and wellness, in addition to the main role of providing balanced hot meals daily.

“Over 65 percent have multiple chronic diseases,” Darcy said, adding that the service does not provide therapeutic diets but, in addition to following the overall dietary guidelines, can offer individual counseling for higher risk chronic patients, those with renal disease for example. “The biggest challenge is the vast number of symptoms,” she said—from difficulty swallowing, to the nausea from chemotherapy, to dental problems. “Counselors know who is at heightened nutrition risk, and they can provide the resources or information to help them.”

CMS realizes that nutrition is an aspect of patient-focused care, and we’re starting to see changes in health care, Darcy said. However, today’s fiscal environment is threatening community nutrition programs such as this. Raising awareness to the general public and legislators can help. The average age of people in Westchester County receiving nutrition services is 82 years old.

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