Many older people may experience conditions that reduce their ability or desire to eat. Stress, depression and even loneliness can reduce the appetite and the desire to cook. Cognitive impairment, physical illness, pain, fatigue and infections are further risks to appetite. Some drugs may cause nausea and discomfort. Physical disability can prevent people from going shopping and preparing foods, and might lead to difficulties with eating. Dental problems, decreased salivation, dry mouth and tooth decay may make it difficult to absorb nutrients. Swallowing may become more difficult. This is known as dysphagia. Atrophy of the gastrointestinal mucosa may mean that the body digests and utilises less of the food, whilst reduced muscle strength in the gut can lead to the risk of constipation.
In addition, several diseases that are more common in older people can make good nutrition more challenging. Patients with Parkinson’s disease, for example, need more time to eat, because the food is transported slowly through the oesophagus. They can also be affected by tremors in the hands, which in turn can lead difficulties eating. Between 50-80% of patients who have suffered a stroke have eating problems. This may involve problems with swallowing or paralysis in the muscles of the body leading to problems with posture or the use of the arms.
Patients with dementia and a stroke may experience several challenges including agnosia and apraxia. Agnosia is an impaired ability to interpret sensations such as smell, taste and touch. Patients with agnosia do not understand what they should eat and what they should not eat. They can put inedible things in their mouths, and they often have problems with using cutlery. Apraxia is a reduced ability to perform practical actions despite being able to hear and understand. A patient can be seated ready for a meal without being able to begin to eat, because they are not able to or can’t remember how to use the cutlery, for example.
Some patients with dementia can have a low tolerance to stress. Too much stimulation at once can be confusing. Mealtimes can be very confusing, especially if they are noisy, involve a lot of conversation, brightly coloured tableware and so on. Carers should strive to develop a sense of tranquillity around mealtimes.