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Diet and Nutrition
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Diet and Nutrition

1. Feeding Essentials
2. Principles of Healthy Diet for the Elderly
3. General Diet
4. Special Meals
5. Tips for eating out

Feeding Essentials

Introduction

Diet is essential to life. A balanced diet with proper intake of nutrition maintains good health. The elderly may need special diet care as they often suffer from diseases or deterioration in swallowing. Any specially designed diet or nutritional therapy must meet the elder's nutritional needs to maintain body health and function, plus minimize the possibility of fatigue, weakened immunity, higher susceptibility to diseases and chronic wound, all led by malnutrition and dietary deficiency.

Objectives:

1. To prevent choking during food consumption
2. To maintain sufficient nutrition

(1) Principles of Healthy Diet for the Elderly

  1. Make a combination of various foods; consume grains, vegetables, fruits, meats, beans, milk and other high-calcium food daily
  2. Maintain a regular intake of constant amount of food; three daily meals (breakfast, lunch and dinner) is a must, while afternoon snack is optional
  3. Choose foods rich in fibre with a combination of colours
  4. Avoid fatty meat and preserved food
  5. Consume at least six glasses of fluid daily including water, soup, tea, fruit juice, soy milk and regular milk

(2) Choice of Food

  • Avoid too much intake of saturated fat and cholesterol
  • Choose lean meat over bones as soup/broth ingredient; bone broth should not be consumed more than once per week
  • Fried dishes should not be consumed more than thrice per week
  • Dishes featuring eggs as main ingredient should not be consumed more than twice per week
  • Avoid food high in sodium
  • Dishes with preserved vegetables like mustard tuber and cabbages, or seasoning such as fermented red bean curd and fermented soybeans, should not be consumed more than thrice per week
  • Processed meats such as ham, luncheon meat, bacon, roasted pork (char Siu) and Chinese sausages should not be consumed more than thrice per week
  • Avoid MSG
  • Consider natural spices like onion, garlic and coriander
  • ATTENTION: it is advised to follow your doctor's or dietician's advice for the elderly in need of therapeutic diet to cope with conditions like diabetes, anticoagulant usage and chronic renal dysfunction, or with special nutritional goals such as low blood lipids, low sodium and low purine. Consult your doctor and dietician as soon as possible for abnormalities
  • Elderly with swallowing difficulties
  • Choose food (e.g. chopped or pureed … ) and beverage with suitable texture (nectar-like, honey-like or pudding-like)

(3) Feeding

  1. The Normal Swallowing Process:
  • Oral phase --- Food is broken down to form bolus through the chewing and holding actions of the teeth and the tongue respectively, then moved to the back of the oral cavity
  • Pharyngeal phase --- Once food enters the pharyngeal cavity, swallowing reflex kicks to push food into the larynx; at the same time, respiration ceases as the epiglottis covers the trachea to prevent food from entering
  • Esophageal phase --- As food enters esophagus, it is then pushed into the stomach by esophageal peristalsis for digestion

i) Preparations before Feeding the Elderly

  • A pleasant environment
  • The availability of proper tools
  • The elder
  • The feeder's assistance (if necessary)
  • Appropriate food and beverage

ii) Steps In Feeding The Elderly
Feeding techniques

  • Elders able to feed by themselves
  • Elders in need of feeding assistance
  • Elders unable to feed by themselves

Procedures:

  1. Elders able to feed by themselves
  • Place the utensils and food on the table in front of the elder
  • Debone and mince the food beforehand if necessary 
  • Serve at proper temperature
  • Encourage careful chewing and swallowing
  1. Elders in need of feeding assistance
  • Place the utensils and food on the table in front of the elder
  • Cover the clothes with dining apron
  • The feeder should sit on the side at the elder's height to monitor his or her swallowing process
  • Debone and mince the food beforehand if necessary
  • Assist the elder to take small bites of one teaspoonful per time; encourage careful chewing and swallowing; feed another teaspoonful after the previous one is completely swallowed
  1. Elders unable to feed by themselves
  • The elder must remained properly seated when eating; never eat lying down
  • The feeder should sit on the side at the elder's height to monitor his or her swallowing process
  • Slow down when eating
  • Place the food into proper position in the mouth
  • Monitor swallowing ability
  • Supply small amount of water once a while
  • Perform oral care after meal; get rid of food residue in the mouth immediately
  • Clean the mouth and hands with wet towel; wash dentures and tableware
  • Wait for at least an hour after feeding before letting the elder to lie down to prevent food reflux

(2) Swallowing Difficulty

a) Factors contributing to risk of choking:

  • Rapid food intake
  • Loose dentures leading to chewing difficulties
  • Food being too chewy, big, dry, slippery, or sticky to swallow
  • Eat lying down
  • Absent-mindedness
  • Affected by diseases, e.g. stroke, Parkinson's disease and late-stage dementia
b) Symptoms
  • Food/beverage dripping from the corners of the mouth
  • Cough or throat clearing before or after swallowing
  • Swallowing with multiple attempts
  • Drooling
  • Smelly breath
  • Panting and abundance of phlegm before and after feeding
  • Hoarse voice after feeding
  • Fever
  • Pneumonia
  • Refuse to eat
  • Weight loss
c) Choking symptoms
  • The patient holds his or her neck with both hands
  • Inability to speak
  • Breathing difficulties
  • Hard to cough
  • Vascular engorgement
  • Lips turning blue and unconsciousness
d) Choking treatment
  • Encourage coughing and vomiting
  • Let the patient stand or sit; assist him or her to bend down until the head is below lung level
  • Hit between the shoulder blades for five times; perform five times
  • Allow the choking object to be released; help take the object or denture out of the patient's mouth if it is visible
  • If unsuccessful, call for ambulance as soon as possible

(4) Tips and Techniques on Feeding the Elderly

  1. Remain relaxed and focused while feeding; avoid feeding under unpleasant mental condition
  2. Maintain a quiet environment for concentration; do not speak when eating
  3. Nutrition should come in balanced combination and portion
  4. Keep an eye on malnutrition symptoms
  5. Choose the right cooking methods and utensils; swallow carefully
  6. Help the elder rinse his or her mouth to get rid of food residue
  7. Keep the environment lit
  8. Stimulate appetite with pleasant food presentation
  9. Choose suitable utensils in smaller size to control the amount of each mouthful of food
  10. Avoid feeding food that may more likely lead to choking, e.g. sticky rice, rice dumplings (tang yuan) and peanuts
  11. Wear suitable accessories before feeding, e.g. denture and glasses
  12. Maintain correct posture and avoid facing upward when feeding; encourage sitting for 30-60 minutes after meal before going to sleep
  13. The feeder must remained seated at the elder's level to reduce the risk of choking
  14. Each mouthful should not consist of foods with difference texture, for example: Avoid feeding rice in soup
  15. Give enough time in between each mouthful; do not hurry
  16. Elderly people with swallowing difficulties should only be fed food with soft texture

(5) Principles of Healthy Diet for the Elderly:

  1. Make a combination of various foods; consume grains, vegetables, fruits, meats, beans, milk and other high-calcium food daily
  2. Maintain a regular intake of constant amount of food; three daily meals (breakfast, lunch and dinner) is a must, while afternoon snack is optional
  3. Choose foods rich in fibre with a combination of colours
  4. Avoid fatty meat and preserved food
  5. Consume at least six glasses of fluid daily including water, soup, tea, fruit juice, soy milk and regular milk

(6) Choice of Food:

  1. Avoid too much intake of saturated fat and cholesterol
  • Choose lean meat over bones as soup/broth ingredient; bone broth should not be consumed more than once per week
  • Fried dishes should not be consumed more than thrice per week
  • Dishes featuring eggs as main ingredient should not be consumed more than twice per week
  1. Avoid food high in sodium
  • Dishes with preserved vegetables like mustard tuber and cabbages, or seasoning such as fermented red bean curd and fermented soybeans, should not be consumed more than thrice per week
  • Processed meats such as ham, luncheon meat, bacon, roasted pork (char Siu) and Chinese sausages should not be consumed more than thrice per week
  1. Avoid MSG
  • It is advised to follow your doctor's or dietician's advice for the elderly in need of therapeutic diet to cope with conditions like diabetes, anticoagulant usage and chronic renal dysfunction, or with special nutritional goals such as low blood lipids, low sodium and low purine. The elder should consult doctor and dietician as soon as possible for abnormalities

(7) Feeding devices

 

Principles of diet and food choices (Chinese Version Only)

General Diet (Chinese Version only)

Fat

 

Dietary fiber

 

Salt

 

Sugar

Calcium

Special Meals (Chinese Version only)

Tips for eating out (Chinese Version only)