nutrition for the older communityIn the last 40 years, the population demographic of the UK has changed dramatically. Since 1974 to 2014, the percentage of those aged 65 and over grew by 47 per cent, to account for nearly 18 per cent of the total population.

During the same period, people aged 75 and over increased by 89 per cent, making up a further 8 per cent of the British populace.[1]

This steady move toward an overall ‘older’ population, has seen an increase in the occurrence of medical conditions which can affect both the way, and the amount older members of British society eat.

Conditions including; dementia, Parkinson’s and strokes can lead to dysphagia (eating, drinking and swallowing difficulties), thus seriously affecting a person’s ability to safely consume food, and equally importantly, enough food to remain healthy.

While dysphagia can impact anyone, unfortunately, it often strikes those who are older. Up to 30 per cent of over 65s are living with some form of dysphagia and there are many reasons behind this.[2] Ultimately, it is this age group which is most likely to suffer from the most common underlying causes of dysphagia; strokes, motor neurone diseases and multiple sclerosis for example.

Furthermore, the muscles used for swallowing can become weaker with age, so much so that older adults can struggle to eat. It is little surprise then between 50 and 75 per cent of nursing home residents in the UK are living with dysphagia.[3]

It is precisely for these reasons why time and careful consideration must be taken when planning the nutritional intake of those with dysphagia. The preparation of a nutrition plan for an elderly person is incredibly important at the best of times and when conditions such as dysphagia become a factor, this can become even more important and can present more of a challenge.

For those living with dysphagia, mealtimes can become daunting; an overwhelming experience which can become a burden. With many losing their appetites in later life, only consuming a fraction of what they use to, it is critical to make mealtimes as comfortable and easy as possible. A failure to do so can lead to issues such as malnutrition and dehydration, bringing with it serious health consequences.

Another consideration for those living in care facilities is that dining can potentially offer their only chance for social interaction that day. If this time becomes a challenge and seen as an unenjoyable experience, it can lead to social isolation, occasionally bringing with it damaging psychological effects. It is of paramount importance therefore, that care is taken to ensure dining experiences for those living with conditions such as dysphagia, are as enjoyable as possible.

Social interaction, at any age, is crucial to maintaining a sense of wellbeing and is not something that should be taken for granted. It is estimated over 1 million people aged 65 or over have, or are at risk of developing malnutrition, bringing with it an additional cost of over a billion pounds to treat.[4] This, coupled with the rising number of elderly citizens living in the UK, means nutrition has never been more important.

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A critical part of ensuring those suffering from dysphagia continue to eat, is allowing them to continue to eat with dignity. Poorly produced texture modified food can end up simply looking like slop. An inedible plate of food, which neither you, nor they would want to consume. Providing safe, nutritious and appealing texture modified meals is a challenge, but it is of paramount importance.

Retaining nutritional value within these meals is crucial, they must be made subject to strict dietary requirements, as specified by a collection of independent nutrition experts. Outside of specially produced meals, home blending can often be a cheaper alternative. Yet this form of production doesn’t guarantee the level of safety or consistent nutrition required, with the process of home texture modification often leading to diluted meals, stripped of valuable nutrition.

Producing meals which look, as well as taste, like the real thing plays a big role for those with conditions such as dementia, who will often refuse to eat food they don’t recognise. With technology now available to shape pureed food to closely resemble its true form brings dignity back to dining. A right every person should have. The old cliché of ‘eating with your eyes first’ shouldn’t be overlooked. Maintaining visual appeal, especially when looking to feed someone with eating difficulties is a vital first step.

There are many challenges when looking to feed an elderly person, especially those with conditions like dysphagia. There is a lack of information and support for those involved with the care and well-being of these people. Some of those within the healthcare professional industry and those in the care home industry are often undertrained and not properly equipped to tackle this issue and the challenges it brings.

It is imperative that the profile of dysphagia is raised, to be pushed to the forefront of the dietary agenda and tackled head-on. Best practice guidelines should focus on safety and nutritional adequacy, but also on the importance of retaining the dignity that should always come with dining.

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates

[2] https://www.qcs.co.uk/patient-safety-alert-when-inappropriate-nutritional-care-may-prove-deadly/

[3] Swallowing Problems in the Nursing Home: A Novel Training Response (O’Loughlin G, Shanley C) Dysphagia 1998; 13,172-183

[4] https://www.ageuk.org.uk/our-impact/programmes/malnutrition-task-force/

Author: Helen Willis, Dietitian at apetito and Wiltshire Farm Foods

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