Aging & Caring: A Guide for Families and Caregivers

Nutritional Issues Experienced by Older Adults

Poor Appetite

When older adults experience a decrease in the frequency and quantity of food intake, poor appetite may be a concern. Poor appetite can be caused by difficulty swallowing, changed sense of taste or smell, depression, or pain.

Indications of poor appetite:

  • Difficulty swallowing, weight loss, lack of interest in food.


  • Provide small, frequent meals of favorite foods. Try foods high in calories that are easy to eat (e.g., pudding, ice cream, or milk shakes). Encourage eating with friends and family. Provide beverages between meals instead of with meals since liquids may cause an early feeling of fullness.


Constipation can cause a great deal of discomfort for older adults. It may be influenced by age-related changes in the digestive
tract, a lack of activity, general weakness, pain medication, and decreased fluid intake.

Indication of Constipation:

  • Stomach ache or cramps, no regular bowel movement within the past three days, excessive gas, or feelings of


  • Increase the amount of high-fiber foods (e.g., whole grain breads, fresh raw fruits and vegetables, and prune juice. Avoid foods and beverages that cause gas (e.g., cabbage, broccoli, and carbonated drinks). Increase fluid intake, Warm fluids in the morning, for example, may be helpful.


Proper fluid intake is so inmportant for older adults. Decreases in hydration can contribute to confusion and unsteadiness. As we age, most people begin to lose the sensation of thirst. Therefore, have the older adult drink at regular intervals throughout the day, regardless of whether he or she feels thirsty. Experts recommend that all adults (unless instructed by a doctor
to limit intake of fluids) drink at least eight glasses of fluid, 8 ounces each, every day.

Indication of dehydration:

  • Dizziness, weakness, inability to swallow dry food, dry skin, weight loss, little or no urine, and fatigue.


  • Use ice chips for relief of dry mouth. Increase intake of foods that contain fluids (e.g., fruits and soups). Keep fluids near the individual at all times for easy access.

Swallowing Problems

Chewing and swallowing may be difficult for older adults with oral problems such as mouth sores, cavities, poorly fitting dentures, or untreated gum disease. This is a serious problem that can interfere with proper food intake and may put them at risk for medical complications related to aspiration of food or liquids into his or her lungs. If you notice changes in your loved
one’s ability to chew or swallow food, notify the doctor right away.

Indications of swallowing problems:

  • Gagging, coughing, or regurgitation of food, loss of weight, and food building up in the mouth.


  • Provide soft, moist foods. Mash or blenderize foods (e.g., meats, cereals, fresh fruits). Provide liquids that have some consistency (e.g., blenderized fruits or milk shakes) because they are easier to swallow than clear liquids. Give small bites (1 teaspoon at a time). Make sure that the older adult is in an upright position when eating and drinking.

When swallowing problems arise, a health professional may suggest a mechanical soft diet. The mechanical soft diet is made up of regular table foods that are soft, moist, and easy to chew and swallow. This diet decreases the amount of chewing that a person must do while eating; it also allows him or her to have better control over foods in the mouth. It has the name “mechanical” because household tools and machines, like a blender, meat grinder, or knife, are used to make food easier to
chew or swallow. The level of difficulty in swallowing should determine the consistency of the food.

Dysphagia Diet: 5 Levels For Difficulty In Swallowing

Level 1: Pureed Foods (smooth, mashed potato-like consistency 
Level 2: Minced Foods (very small flecks of food, 1/8 inch, similar to the size of a sesame seed)
 Level 3: Ground Foods (gorund/diced into 1/4 inch pieces, similar to the size of rice).
 Level 4:  Chopped Foods (cut into 1/2 inch pieces, similar to size of uncooked elbow macaroni).
Leve 5: Modified Regular Foods (soft, moist, regularly textured foods).


Alternative Methods of Nutrition

When someone is unable to chew or swallow because of oral radiation, jaw injury, or stroke, alternative methods of nutrition may be provided to maintain proper nutritional intake. Healthcare professionals will work closely with you and the older adult to ensure that these alternative methods are used correctly and safely. Whenever alternative feeding methods are used, watch very carefully for any signs of infection, such as pain, redness, swelling at the site of intravenous needle or feeding tube, or fever.

INTRAVENOUS FEEDING (Parenteral Nutrition):

Intravenous feeding is the process of providing nutrients directly into the blood stream. Intravenous fluid intake can be used as an eating substitute for short periods of time. It is the preferred alternative when adequate protein and calories cannot be provided by oral or other routes, or when the gastrointestinal system is not functioning. This is more commonly seen
in hospital settings, and less often in nursing care or in-home settings because of increased risk of complications.

TUBE FEEDING (Enteral Nutrition):

Tube feeding is the process of inserting a flexible, narrow tube into some portion of the digestive tract and placing liquid formulas or liquefied foods into the tube to meet the person’s nutritional needs. Tube feeding is used when food cannot be ingested through the mouth, but there may be a cleared passage in the esophagus and stomach, and even partial functioning of the gastrointestinal tract. Tube feeding is preferred over intravenous feeding to maintain the functioning of the intestines, provide for immunity to infection, and avoid complications related to intravenous feeding.