Monday, August 24, 2015

Combating Appetite Loss in Seniors

It is not surprising to find that seniors almost unanimously name meals when asked what is the single most important aspect of their daily life in a retirement community. Mealtime brings seniors together for socialization and companionship, and for many it represents the only time during their day when they can share their frustrations about the effects of their own aging process with others who can relate to them. This is particularly true for new seniors or those with serious medical conditions or ailments. Although many seniors readily accept most of the effects of aging, they can be very challenging for others. Most people understand that as we age, the way in which we experience our world through our senses of sight, hearing, touch, taste, and smell changes as those senses deteriorate over time. As our visual acuity diminishes, we wear corrective lenses; with auditory loss, we wear hearing aids. However, the least accepted and least understood deprivations are those of taste and smell, the two senses that primarily control the body’s ability to experience food. Disorders of taste and smell are viewed as affecting the “lower” senses—those involved with sensual and emotional life—rather than the “higher” senses that serve the intellect.
The taste and smell of food have a major effect on levels of food intake and the maintenance of good nutrition. Losses and distortions in these chemosensory mechanisms contribute to a significant degree to anorexia in the elderly. Taste and smell are considered chemical senses because they are stimulated by molecules that contact receptors in the mouth, throat, and nasal cavity. The sense of taste is mediated by taste buds located on the dorsal surface of the tongue and on the epiglottis, the larynx, and the first third of the esophagus. Olfactory receptors are bipolar neurons located in the upper portion of the nasal cavity that project into the limbic system of the brain. The limbic system also processes information associated with emotions, so there is, in fact, a medical explanation for the emotional response we have to food. The olfactory bulb shows considerable degenerative changes during aging, and cross-sections of the bulb often look “moth-eaten” owing to losses in the number of cell bodies of neurons. Those losses are especially profound in patients with Alzheimer’s disease.
Because of reduced function in these key chemosensory systems, the natural biochemical responses designed to break down food as it enters the body are consequently also less active. When the body smells, tastes, or simply sees appetizing food, a number of biochemical responses are set in motion to aid subsequent digestion. For example, saliva builds up in the mouth, gastrointestinal juices are released into the stomach, plasma insulin is released into the bloodstream, and the pancreatic system is engaged. All these responses have the combined effect of aiding absorption of food and promoting overall nutrition. As the aging process affects the body’s internal response to food, seniors do not enjoy food as much or absorb it as well, and as a result they can become vulnerable to malnutrition, which can contribute further to health problems.
Taste and smell decrements arise not only from the normal aging process, but also from certain disease states, pharmacological and surgical interventions, the effects of radiation, and environmental exposure. Similar medical conditions and drugs affect the sense of smell. For example, most people have experienced the metallic taste of orange juice after brushing their teeth; the chemical in toothpaste responsible for this effect is sodium lauryl sulfate, which is also used to help fat-soluble drugs dissolve. Most elderly persons take their medications with their meals to offset the potentially harmful effects of the drugs on the stomach lining, which in turn affects their ability to taste and smell their food. Their senses are inhibited by these drugs, as is their digestive system, and this effect can at times induce a negative reaction and in severe cases lead to malnutrition.
Many medications commonly taken by the elderly are prescribed to be taken with food. Typically, seniors in a retirement community will take their medications in the privacy of their rooms before coming down to the dining room for a meal. By the time their meals actually arrive at the table 30 minutes or more could have passed, giving the medication taken on an empty stomach ample time to be absorbed into the bloodstream and the opportunity to adversely affect the seniors’ ability to taste and smell their food. Simply advising seniors to take their medications after they eat rather than before can have a profound effect on their overall dining satisfaction. In fact, at one community, after the seniors were educated about this concept, senior satisfaction in food and beverage service increased by 10 percent over the previous survey, while perceptions of all other conditions remained constant.
Measurements of taste and smell dysfunction in older adults reveal a progressive decline with age. Those losses tend to begin around 60 years of age and become more severe in persons over 70 years of age. In most retirement communities, the chef and cooking staff have an ability to taste and smell that is more than twice as acute as that of the people for whom they are cooking. In one study, persons between the ages of 20 and 70 had approximately 206 taste buds each. This number was reduced to 88 taste buds for persons between the ages of 74 and 88 years. The average age of seniors in retirement communities today is about 82 years. Therefore even the best-qualified chefs working with the freshest natural ingredients are working at a considerable disadvantage, and they will express their frustration in trying to address this problem using conventional methods. Seniors may inadvertently harm themselves by trying to amplify the flavors of their food by using too much salt at the table, or by eating too much dessert because they can still enjoy the sweet taste of many of these offerings. Compensating in these ways, however, only leads to nutritional imbalances and could be in direct conflict with doctor-prescribed dietary guidelines.
 Recent studies suggest that the amplification of foods and beverages with naturally produced flavors can increase preference ratings as well as subsequent intake and absorption in elderly persons with known chemosensory losses. These commercially produced flavor enhancers, which are inexpensive (adding less than a penny to the per-meal cost), are made by reducing food such as chicken and capturing and concentrating natural flavor and odor molecules. The concentrate can then be attached to a “carrier” (such as water, oil, or flour) and added to the food. This added flavor contains no fat, salt, or other harmful products traditionally associated with flavor enhancement. Table 8.6 gives the percentage of elderly persons who preferred flavor-enhanced foods in one study at Duke University Medical Center.
Flavor-amplified foods not only are preferred from a sensory standpoint, but also can influence the body’s natural biochemical response to food, actually promoting better absorption and, as a result, improving the immune status of elderly persons. In a study by Schiffman and Warwick in 1993, elderly persons were offered regular food for three weeks, then flavor-enhanced versions of the same food. Blood samples were taken before and after the use of the flavor enhancement. They showed an increase in levels of T and B cells (white blood cells), the body’s natural defense agents against disease and injury. Schiffman’s research confirms that as the body’s biochemical absorption of food improves, so do nutrition and immune status. This research suggests that the addition to recipes of natural flavors that increase the perceived flavor intensity would improve satisfaction with the food and compensate for chemosensory losses due to normal aging, diseases, and prescription drugs. It can be argued that the use of flavor enhancements can actually promote better health as well as improve senior satisfaction.
Learning that deprivation of taste and smell is a normal part of their aging process and that changes can be made to compensate for it becomes as natural to seniors as wearing glasses to augment failing eyesight. Additionally, seniors become aware that their enjoyment of food is enhanced by this flavor-amplification technique. It is also gratifying for them to see that management is willing to combine this knowledge with its culinary expertise to create a more tailored and flavorful dining experience.
The increased preference for flavor-enhanced food is extraordinary. In fact, many manufacturers of convenience products, such as Stouffers and Tyson, now list natural flavors among their ingredients. When a convenience product and its scratch-made counterpart are served, the convenience product is often better received than the homemade one. This is simply because the commercial product is higher in flavor than the homemade product as a result of added natural flavor. Certainly natural products are important and should represent the primary ingredient source. The addition of fresh herbs and spices and pretreating with marinades should not be abandoned. We walk a fine line, however: for if too many herbs and spices are added, the seasoning then overpowers the main ingredients. Often seniors’ delicate digestive systems become agitated when aromatic herbs and spices are not used in moderation.
Flavor enhancement improved food intake in 20 out of 30 foods tested. Research has confirmed an improved immune status as measured by the total level of blood lymphocytes, which help to fight diseases inherent in the elderly population. In addition, seniors feel better about their dining experience, and opioid (endorphin) levels increase as seniors’ ability to sense their food improves. It has actually been proven that seniors become physically stronger as well. With flavor enhancement, seniors are less interested in fatty foods and in adding salt to their entrees, and thus they are better able to adhere to their doctor-prescribed dietary guidelines.

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