The Anatomy of an Appetite: Aging and Our Relationship to Food

The Anatomy of an Appetite: Aging and Our Relationship to Food

Many of life’s events involve food. From the grandest of celebrations to the smallest of gatherings, there is always a place for food. As an Aging Life Care Professional®, I recall a wonderful get together this care manager had organized to celebrate a client’s birthday, her ninetieth… I thought.  She so enjoyed her birthday cake. It was only after I re-did the math that I realized my enthusiasm was premature; Dorothy had another twelve months to go to before she reached her 90th year.

Dorothy took great pleasure in eating her birthday cake. But such enthusiasm for food is not shared by all adult seniors.  There are a variety of factors that may contribute to a decrease in appetite: the side effects of a medication, dentures that do not fit, loss of taste, feelings of loneliness as a senior sits down to a table for one and a myriad of medical conditions.  A wince as an older adult bites into an apple or a change in appetite after the start of a new medication are symptoms that may require a visit to the dentist or a call to the prescribing doctor.

The potential for resolving the nutritional problem described above are far more likely than the changes an adult senior experiences as the end of life approaches.  He or she may lessen their food intake and ultimately refuse all nourishment. Family members are justly concerned, confused and frequently feel guilty.  Often, they fear they are starving a loved one to death if food, liquid or some form of artificial nutrition is not provided.  For an adult senior with advanced dementia, the scenario is made more complex.  As the dementia progresses it impacts on that part of the brain that controls swallowing. The chance of choking increases. In either of these scenarios it is important to recognize as the end of life nears the body adjusts to the slowing down process and minimal amounts of nutrition or liquids are needed, if at all. Now the focus becomes comfort care. Moistening the mouth with a special sponge, applying lip balm or offering a small amount of water through a straw, teaspoon or syringe.

Aging Life Care Professionals understand that while parents may have left specific directives for no heroic measures, a daughter may find it too cruel to discontinue nourishment or fluids. A son may hope for a last-minute miracle or a spouse may feel that only time will dictate when to say the last good-bye.  As Aging Life Care Professionals, it is our role to hold the hand of our client and reach out our other hand to support the family in whatever their decision may be.


Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in New Rochelle, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of older adults. She has recently been appointed to the board of directors of New Rochelle Cares, a non-for profit organization devoted to helping senior adults live safely and fully at home.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Although American Heart Month is about to end, heart disease among adult seniors shows no signs of letting up. In fact, it is the number one cause of death in older adults and has been for the last two decades.

According to Dr. Jeannette Yuen, a cardiologist in the Scarsdale Medical Group in Harrison, New York, the most common types of cardiac disease are: Coronary heart disease, where plaque builds up in the arteries that inhibits blood flow; Arrhythmia, an abnormal heart rhythm that develops due to changes in the electrical impulses through the heart; Heart attack, which occurs when the blood flow to a part of the heart is blocked by a blood clot; and heart failure, when the heart’s muscle becomes too damaged to pump blood to the heart.

While chest pain is one of the prominent symptoms associated with heart disease, there are other symptoms not to be ignored: pressure and/or heaviness in the chest that can be mistaken for indigestion, shortness of breath, palpitations, a rapid heartbeat, sweating and nausea.  For women, there can be a group of unique symptoms: extreme fatigue, pain in one or both arms, back, neck or jaws. Also, there may be shortness of breath without chest pain.

As Aging Life Care Professionals®, we recognize that in the senior population heart disease may co-exist with other chronic conditions. Treatment for one condition may have a negative effect on another condition. It is for this reason that we obtain a full medical history, such as medications that are currently being taken and ones that have resulted in adverse reactions. We guide the caregivers so that they are aware of the symptoms that are out of the norm and recognize the importance of having open channels of communication between our clients and their physicians.

For both the family and the Aging Life Care Professional, there are no sweeter words than to hear a family member “is stable.” To that goal, if, for example, a pacemaker has been implanted, it is important to have it tested at regular intervals. It is also important to take medications as directed, not skip a dose, or abruptly stop a medication without consulting with a cardiologist.  While the importance of exercise has always been touted to strengthen the heart and improve circulation, as care managers, we must question if such expectations are realistic based on the physical and cognitive conditions of our clients.

Finally, there is the inevitable recommendation to eat a healthy diet. While this is certainly important, it is also important to include moments that are simply for the joy of them. I choose to go with poet Jenny Joseph, who wrote: “When I am old I will wear purple with a red hat that doesn’t go, and doesn’t suit me.”  To which I add, while wearing purple with a red hat, I will eat ice-cream, whenever the urge comes over me. If not now, then when?


About the Author: Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in Westchester County, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of senior adults.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Tea with a Purpose

Tea with a Purpose

Too much coffee and tea can be a good thing. Let me explain. A few days ago, after visiting a client at White Plains Hospital Center, I stopped by their recently opened café for a cup of coffee and a freshly made gluten free blueberry tea cake. The hospital is known for its good care and the café is now following in that tradition, albeit gastronomically.  As for the tea cake, it was delicious. I do not have food allergies, but a weakness for a good piece of plain cake.

Twenty minutes later, I arrived in Harrison, New York at the home of a nearby client.  The taste of the coffee was clinging to my palette and I secretly wished I had bought another of those sweet treats for later. Hearing the bell, Helena reluctantly opened the door, always suspicious of who is knocking (not a bad thing). Recognizing my name, she let me in. Sometimes I am sequestered in her foyer for the visit and other days I am escorted into the kitchen. Today was a kitchen day. We started our conversation and then, as it progressed, she asked if I wanted a cup of tea. Did I really want to forgo that lingering taste of coffee for tea?  Truthfully, no, but I happily accepted.

Why did I say, “Yes” when I could have just as well said “No?”  It all has to do with purpose in one’s being. It’s a life quality that starts to wane as one gets older. You’re told to stop driving because you had a couple of fender benders. So now you can’t visit your home bound friend or be a volunteer driver for Meals on Wheels. And then the greatest upset of all, your spouse passes away. No one to cook that special dish which brought such accolades despite its simplicity.  Such was the case with Helena. There was no longer anybody to make that cup of tea for, so how could I ever think of saying, “No.” I sat at the kitchen table and watched her take the crackled and stained mug out of the cabinet.  Water boiled, she carefully handed me my tea, mystified as always, that I take it plain.

The act of making the cup of tea for this geriatric care manager, was both an act of kindness and the momentary gift of purpose. As for the taste of the coffee no longer lingering on my palette, it was surpassed by the opportunity to return to Helena a memory of time sweet, if not sweeter, than my blueberry teacake. It was a very good visit.

Tea and Toast? Not Even for the Queen

Tea and Toast? Not Even for the Queen

Recently I met with a family here in Westchester to do a geriatric assessment. The trigger for the assessment was the many falls their father was having. The son told me his father had Tea and Toast Syndrome. I chuckled.  He didn’t. I thought he was kidding. He wasn’t. We both knew his father wasn’t English.

Tea and Toast Syndrome is real.  It describes the poor eating habits sometimes seen in older adults.  There are genuine reasons for this syndrome to exist. There is a change in appetite with age. This may be the result of lifestyle changes, the side effects of particular medications or difficulty with chewing. Depression can also cause a lack of interest in eating.  Further, a dulling of the senses including changes in vision which makes meal preparation challenging. Finances may be limiting what a senior adult is buying. I vividly recall Adrienne. In retrospect, I suppose she had the apple variation of this syndrome.  She would buy packages of apples that had gone bad. Eating six apples a day and little else would make up a substantial part of her daily food intake. She got the fiber but where was the protein? Adding to these reasons is the effect of memory loss on senior adults who are living alone. They may think they have eaten, but truly they haven’t. Other times, that part of the brain which serves as the thermostat for satiation, is on the fritz. While some older adults with dementia may overeat, others may not feel hunger.

The results of such a limited diet?  Chronic ailments become exacerbated. There may be changes in liver and kidney functions. Blood chemistries may go askew. Blood pressure may be affected. When this happens it can cause dizziness which may result in falls as with the gentleman mentioned above.

To lessen the chances of this syndrome occurring, the use of Meals on Wheels, dietary supplements such as Ensure or Boost and working out an interventional plan with family members are some of the approaches I use. If there is home health aide, I will recommend that she make a nutritionally rich soup which is blended for easier consumption.

So now when this geriatric care manager hears Tea and Toast Syndrome, there is not a chuckle, but a call to action. Long live the Queen and all elders on a diet rich in nutrients accompanied by a good piece of chocolate.