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Winter is a challenging time for the NHS. Exposure to cold temperatures can have a range of physiological effects, particularly for older adults, leading to increased hospitalisations. Living in cold temperatures can suppress the immune system and worsen respiratory and circulatory conditions.1 The UK cold weather plan highlights the importance of access to adequate nutrition for vulnerable adults. In this article we aim to explore the risks of malnutrition and how to help older patients keep well-nourished during the winter months.
Malnutrition in older people
One in ten people aged over 65 are either malnourished or at risk of becoming malnourished.2 Malnutrition can significantly affect the health and wellbeing of older adults. It can lead to a weaker immune system, increased risk of infections, poor wound healing, increased falls and low mood.3
Factors that contribute to malnutrition in older people
Weight loss is not an inevitable part of ageing, however many of the common causes of malnutrition can affect older people more frequently.4 These include:
Practical tips to help keep your patients well-nourished this winter
Nutrition can make a significant difference to an older person’s wellbeing, especially during the winter months. We have put together our top tips to help support your patients to optimise their nutritional intake.
Get a little help
Food shopping can be difficult for some older adults. Remind patients to ask their family and friends to help with food shopping. Fatigue or feeling unwell can make food preparation difficult. Signpost your patients to check out our favourite recipes to help with meal inspiration.
Batch cooking can make eating a nutritious meal less challenging during periods of fatigue or illness. Chilli, Bolognese, stews and casseroles are easy to portion and freeze. Simply thaw a meal in the fridge overnight and pop it in the microwave for a quick and fuss-free meal.
For older adults with small appetites, every mouthful should be nutrient dense. Adding pulses (e.g. lentils or beans) to soups and stews can increase the protein content which supports maintenance of muscle mass and wound healing.8 Energy dense foods (e.g. olive oil, cream, cheese, condensed milk, coconut cream) can significantly increase the energy content of meals without increasing the volume.9,10 Adding savoury oral nutritional supplements (ONS) to sauces and stews can be an effective way of helping older adults meet their energy and protein requirements.
Boost the flavour!
In later life, the sensitivity of taste buds declines, which can be a barrier to adequate nutritional intake. Research suggests that intense tastes are preferred amongst older adults with taste alterations.11 Making food as flavourful as possible is important to stimulate appetite. Our favourite winter warming spices include ginger, cinnamon and allspice.
Don’t forget dessert! Older adults who experience taste changes can develop an increased preference for sweet foods as recognition of sweet taste is less altered.12 Hot desserts (e.g. custard, rice pudding and fruit crumbles) are an easy way to provide additional calories and protein when an individual’s appetite is low.
Low energy cooking
Microwaves, slow cookers and air fryers all consume significantly less energy than ovens and can help to keep food and energy costs low. Slow cookers use less energy than a traditional oven making them cheaper to run.13 Simply adding a few ingredients to a slow cooker can be an easy way for older adults to prepare a nutritious meal.
Get creative - add savoury oral nutritional supplements for a calorie boost or use toaster bags for a quick and low-cost way to make a cheese toastie!
Pumpkins aren’t just for Halloween and Brussels sprouts aren’t just for Christmas! Eating with the seasons means enjoying foods as they become ready to harvest at different times of the year, helping to keep food costs low. Butternut squash soup, chicken and leek pie or beef and vegetable casserole are our favourite winter warmers.
Hydrate, even when it’s not hot
It’s important to encourage older adults to drink, even during cold weather. Hot drinks (e.g. malted drinks, hot chocolate, milky coffee and soup) can provide energy and protein alongside vitamins and minerals.10 During winter months, savoury oral nutritional supplements are an effective way of increasing patients’ nutritional requirements whilst keeping warm. A serving of a savoury ONS provides approximately double the energy content and five times the protein content of an equivalent shop-bought packet soup. 14,15
Isolation and loneliness can limit a person’s motivation to cook and eat well. Signpost patients to local day centres, lunch clubs and befriending services. Community meals have been found not only to be cost effective, but can have a positive impact on the amount an older person eats at mealtimes.3
It's true, we do eat with our eyes! Making food visually appealing using colourful vegetables and contrasting crockery can help to increase older adults' intake at mealtimes.16
The sunshine vitamin
In the UK sunshine is scarce during winter months. Certain food sources contain small amounts of vitamin D (e.g. oily fish, red meat, liver and egg yolks). However, it’s best to advise all older adults to take a daily 10ug Vitamin D supplement between October and March.17
Meal and snack ideas packed with energy and protein
Older adults with poor appetites may find it difficult, or lack the motivation to prepare food. We have put together our favourite high energy, high protein meal and snack ideas to help optimise your patients’ nutritional intake.
Breakfast can often be overlooked but it’s a good opportunity to stimulate appetite.
Main meals can be overwhelming for people with small appetites.18 Swap large meals with smaller, more regular meals.
Regular snacks are an effective way of preventing long periods of time with no nutritional intake. Not eating can further limit a person’s appetite.18
Don’t forget fluids! Drinks can be an easy way to increase a person’s nutritional intake. Older adults should aim for 6-8 drinks daily and should be advised to drink after eating to avoid early satiety.