Diet for elderly post-surgery weight gain
November 13, 2015 9:55 AM Subscribe
My father (in his 80s) has just finished a series of joint-related surgeries. His appetite has been diminishing for years, but between the surgeries and some problems with his meds -- now resolved -- he was nauseated for a period and his weight plummeted. He's got his appetite back, more or less, but we can't seem to put weight back on. YANOD, but his doctor's advice is appetite and med-related, and we'd like to know what foods (or meals?) would be best for sustained, healthy weight gain. Thank you!
Best answer: We had to deal with this with my grandfather with dysphagia, nausea, very little sense of taste, and diabetes so we had to watch the sugar.
Many of the few calories we got into him were some kind of natural fat. We mashed avocado into everything that would hold still, put olive oil into everything, nut butters, ground bacon into his meatballs* and spaghetti sauce. (And he only got a little spaghetti, mostly sauce.) We had to be moderate with dairy, but it was full-fat everything when he had it.
*Between head/neck radiation and weight/bone density loss and general discomfort and age, his ability to chew was heavily impaired, so we did a lot of stuff to feed him more or less soft foods that still had some kind of texture so he wasn't grossed out. We learned to make velvety-soft meatballs/loaves, lots of meat sauce (he was a real Strictly Betty Crocker eater, the freakiest thing he'd eat was meatballs with BBQ sauce), scrambled egg/omelettes when the thought of egg didn't put him off. Mashed potatoes with cream cheese, oatmeal with cream, green bean casserole, a creamed beef thing we invented with pot roast nearly pureed with cream cheese.
We avoided empty calories as much as possible - he loved dinner rolls so we offered those, but very little pasta, no rice, just the mashed potatoes.
My aunt's a PhD dietician who works in dialysis clinics, and she invented and/or blessed all that. He could also have all the neapolitan ice cream he wanted, though that might have been 1/4 cup a day on a good day.
You dad may have a more adventurous palate so you can branch out, but just watch out for the carbs. A little is fine but they basically fall right back off.
posted by Lyn Never at 10:21 AM on November 13, 2015
Many of the few calories we got into him were some kind of natural fat. We mashed avocado into everything that would hold still, put olive oil into everything, nut butters, ground bacon into his meatballs* and spaghetti sauce. (And he only got a little spaghetti, mostly sauce.) We had to be moderate with dairy, but it was full-fat everything when he had it.
*Between head/neck radiation and weight/bone density loss and general discomfort and age, his ability to chew was heavily impaired, so we did a lot of stuff to feed him more or less soft foods that still had some kind of texture so he wasn't grossed out. We learned to make velvety-soft meatballs/loaves, lots of meat sauce (he was a real Strictly Betty Crocker eater, the freakiest thing he'd eat was meatballs with BBQ sauce), scrambled egg/omelettes when the thought of egg didn't put him off. Mashed potatoes with cream cheese, oatmeal with cream, green bean casserole, a creamed beef thing we invented with pot roast nearly pureed with cream cheese.
We avoided empty calories as much as possible - he loved dinner rolls so we offered those, but very little pasta, no rice, just the mashed potatoes.
My aunt's a PhD dietician who works in dialysis clinics, and she invented and/or blessed all that. He could also have all the neapolitan ice cream he wanted, though that might have been 1/4 cup a day on a good day.
You dad may have a more adventurous palate so you can branch out, but just watch out for the carbs. A little is fine but they basically fall right back off.
posted by Lyn Never at 10:21 AM on November 13, 2015
My brother had the same need after a teenage surgery. Other than meal replacement drinks with meals, he also added cheese and nuts to anything to up fat and calories.
Lyn Never did much better than I at detailing options!
posted by Gor-ella at 10:23 AM on November 13, 2015
Lyn Never did much better than I at detailing options!
posted by Gor-ella at 10:23 AM on November 13, 2015
Best answer: We also made smoothies with Ensure, cream, avocado, peanut butter, and then we gave it a shot of a really tart juice, but that was because he couldn't taste much and pretty much tart was all he had left. Lots of grape juice, sweet-and-sour or BBQ sauce, tomato sauce that was basically ketchup. That may not be as much an issue for your dad, but the Ensure smoothie was a thing he would at least do shots of every half hour even when he wasn't hungry.
posted by Lyn Never at 10:24 AM on November 13, 2015
posted by Lyn Never at 10:24 AM on November 13, 2015
Best answer: Look into cancer cookbooks. I know your father doesn't have cancer, but one of the possible side effects of cancer treatment is nausea, which brings on weight loss.
Cancer.gov has a booklet about food (pdf) which includes advice and three recipes for weight loss (page 41). Summary: eat 5 or 6 small meals instead of 3 large ones. Eat at meal times, don't wait until you feel hungry. Look for high-protein high-calorie foods. Try milkshakes, smoothies, juices, soups. Cook with protein-fortified milk (whole milk + nonfact instant dry milk. recipe included).
posted by bentley at 10:34 AM on November 13, 2015
Cancer.gov has a booklet about food (pdf) which includes advice and three recipes for weight loss (page 41). Summary: eat 5 or 6 small meals instead of 3 large ones. Eat at meal times, don't wait until you feel hungry. Look for high-protein high-calorie foods. Try milkshakes, smoothies, juices, soups. Cook with protein-fortified milk (whole milk + nonfact instant dry milk. recipe included).
posted by bentley at 10:34 AM on November 13, 2015
Obviously things like Ensure--but at age 80+ I would not worry as much about what is "healthy" as what appeals to him and is sufficient calories. Ensure etc will supply most of the necessary nutrients--I would guess other dietary concerns are somewhat irrelevant unless he is managing specific illnesses/diseases that have direct dietary requirements. Ice cream and apple pie can be a great breakfast--especially if it is appetizing and attractive to him.
posted by rmhsinc at 11:05 AM on November 13, 2015
posted by rmhsinc at 11:05 AM on November 13, 2015
Ensure on ice cubes was most palatable for me during a brief period of hospitalization and nausea.
posted by Dashy at 11:07 AM on November 13, 2015
posted by Dashy at 11:07 AM on November 13, 2015
You can also make ice cream with Ensure. Most elderly folks love ice cream!
posted by raisingsand at 12:32 PM on November 13, 2015
posted by raisingsand at 12:32 PM on November 13, 2015
Sweet potatoes instead of normal potatoes - more calories, very nutritious, and more tasty.
Make it easy to eat - ALWAYS have snacks within arm's reach - high fat nuts like cashews are nice. And like other posters have mentioned, add oil/butter/bacon/avocado/cheese to everything you can.
Encourage an appetite with fresh air. Walking outside is best, but just sitting is good too. A little cannabis oil or other cannabis products also stimulate appetite well.
Draw attention away from the act of eating - eat with other people or while watching TV.
The appetite stuff is useful because overeating is a great way to gain weight!
posted by congen at 1:13 PM on November 13, 2015
Make it easy to eat - ALWAYS have snacks within arm's reach - high fat nuts like cashews are nice. And like other posters have mentioned, add oil/butter/bacon/avocado/cheese to everything you can.
Encourage an appetite with fresh air. Walking outside is best, but just sitting is good too. A little cannabis oil or other cannabis products also stimulate appetite well.
Draw attention away from the act of eating - eat with other people or while watching TV.
The appetite stuff is useful because overeating is a great way to gain weight!
posted by congen at 1:13 PM on November 13, 2015
Response by poster: (Thanks so much for this advice, everyone. This is very helpful!)
posted by Stevia Agave at 1:25 PM on November 13, 2015
posted by Stevia Agave at 1:25 PM on November 13, 2015
Half gallons of flavorful frozen yogurt, not sugar free or fat free. Half and half for oatmeal. Buy great, multi meat pizza. Wrap the pieces in parchment paper and freeze. One minute in the microwave still wrapped and a cew more in a conventional oven at 425 still wrapped and it is as good as new. Grilled cheese sandwiches on whole grain bread, no seeds, sometimes with avocado, and tomato. Chicken salad sandwiches on croissants. Beef stew with really tender meat. Cookies, oreos. Fresh spinach salad with what he likes on it. Peeled sliced apples. Cooked cabbage potato and sausage in the same pan. Then served drained. Baked potatoes, get single serve sour cream packets or the new Daisy one that has a squirt top so it doesn't spoil from spooning. make dinner the power meal and make it a pleasant social thing. Let breakfast and lunch be light. People who have gait problems get tired of toileting constantly. Make sure he gets plenty of water, and orange juice if he can tolerate it. Single serve Greek yogurts with fruit have good protein amounts.
Perhaps the most important thing is finding out what he likes. Make sure he gets it. Betos Carne Asada burritos are great or good breakfast burritos. A lot of older guys love the McDonalds little breakfast burritos.
All this I know from feeding and encouraging my elderly neighbor, and from formulating meals seventeen years for a neuro rehab unit. So anyway, what he loves is most likely what he will eat.
posted by Oyéah at 2:45 PM on November 13, 2015 [1 favorite]
Perhaps the most important thing is finding out what he likes. Make sure he gets it. Betos Carne Asada burritos are great or good breakfast burritos. A lot of older guys love the McDonalds little breakfast burritos.
All this I know from feeding and encouraging my elderly neighbor, and from formulating meals seventeen years for a neuro rehab unit. So anyway, what he loves is most likely what he will eat.
posted by Oyéah at 2:45 PM on November 13, 2015 [1 favorite]
One thing I haven't seen covered so far: use tiny portions to start, but served on regular sized dishes. Make it look not too challenging to eat. Then you can always go back to the kitchen and get a few more bites... And a few more. This technique worked really well with a terminally ill friend of mine.
Poached eggs were something he would almost always eat. They're high quality protein, easily digestible, and easy to make. Served one at a time. And he would often then be OK with a second.
I've also heard that because elderly people have a reduced sense of taste, over-spicing things (from the perspective of a younger person) can make them more appealing. So, maybe douse the eggs with some hot sauce.
The advice to not really care about nutrition anymore if someone is over 80 saddens me deeply. Someone is not expendable because they're old, and no, ice cream and pie do not make a nutritious breakfast for anyone. :(
posted by mysterious_stranger at 3:23 PM on November 13, 2015
Poached eggs were something he would almost always eat. They're high quality protein, easily digestible, and easy to make. Served one at a time. And he would often then be OK with a second.
I've also heard that because elderly people have a reduced sense of taste, over-spicing things (from the perspective of a younger person) can make them more appealing. So, maybe douse the eggs with some hot sauce.
The advice to not really care about nutrition anymore if someone is over 80 saddens me deeply. Someone is not expendable because they're old, and no, ice cream and pie do not make a nutritious breakfast for anyone. :(
posted by mysterious_stranger at 3:23 PM on November 13, 2015
Actual dieticians will advise that *ANY* calories that stick right now are good calories, and that an 80 year old person for real does not have enough time to develop heart disease from scratch. Nobody is saying to feed them ice cream to kill them, they're saying whatever keeps their heart stopping from not taking in enough calories is fine.
Nutrition can come from pills, but calories have to come from either food (very very preferable), a feeding tube, or parenteral nutrition, which comes with so many additional risks that are far more dangerous than eating calorie-rich nutritionally-poor food.
posted by Lyn Never at 5:17 PM on November 13, 2015 [3 favorites]
Nutrition can come from pills, but calories have to come from either food (very very preferable), a feeding tube, or parenteral nutrition, which comes with so many additional risks that are far more dangerous than eating calorie-rich nutritionally-poor food.
posted by Lyn Never at 5:17 PM on November 13, 2015 [3 favorites]
I deal with this client group a lot and I work with dietitians so I get to see their advice from the sidelines.
Loads of great advice so far.
The only thing I'd add is that protein is not as calorie dense as fat, but when you've lost a lot of weight, it's possibly more important in terms of rebuilding muscle, particularly if you are also trying to heal from surgery. Elderly people with weight loss are the only client group our dietitians push protein at (despite the current trend of everyone being obsessed with protein). Drinks like Ensure can help, but many people find them unpalatable. Make sure every meal contains protein and if you are fortifying food (adding foods high in calories), choose protein rich ones if you can.
Our dietitians push drinking full fat milk, adding cream and cheese to anything you can, eating nuts and biscuits if you can chew well enough. They do prescribe supplements (like Ensure) but you can get very similar nutrition from drinking a supplement drinks as you do from a single piece of toast with plenty of butter and jam.
Ice cream and sweets are great because although these wouldn't be considered healthy food for most people, the benefits of being able to get in that amount of calories outweigh the risks of those foods for someone who, realistically, will not live for 30-40 more years.
My personal experience with my grandfather is that he complains the care home makes him bland food, so we're making food that is more and more spiced, though we have to give it innocuous labels. He won't eat onion bhajis but he loves onion fritters, he won't eat curry but he'll eat spicy stew, and so on.
posted by kadia_a at 12:35 AM on November 14, 2015 [1 favorite]
Loads of great advice so far.
The only thing I'd add is that protein is not as calorie dense as fat, but when you've lost a lot of weight, it's possibly more important in terms of rebuilding muscle, particularly if you are also trying to heal from surgery. Elderly people with weight loss are the only client group our dietitians push protein at (despite the current trend of everyone being obsessed with protein). Drinks like Ensure can help, but many people find them unpalatable. Make sure every meal contains protein and if you are fortifying food (adding foods high in calories), choose protein rich ones if you can.
Our dietitians push drinking full fat milk, adding cream and cheese to anything you can, eating nuts and biscuits if you can chew well enough. They do prescribe supplements (like Ensure) but you can get very similar nutrition from drinking a supplement drinks as you do from a single piece of toast with plenty of butter and jam.
Ice cream and sweets are great because although these wouldn't be considered healthy food for most people, the benefits of being able to get in that amount of calories outweigh the risks of those foods for someone who, realistically, will not live for 30-40 more years.
My personal experience with my grandfather is that he complains the care home makes him bland food, so we're making food that is more and more spiced, though we have to give it innocuous labels. He won't eat onion bhajis but he loves onion fritters, he won't eat curry but he'll eat spicy stew, and so on.
posted by kadia_a at 12:35 AM on November 14, 2015 [1 favorite]
Nthing Ensure and healthy shakes, and tricks I was taught when my MIL had cancer:
put the drink in a smaller cup and stick a straw in it. The smaller cup being emptied frequently makes the calorie loading feel less daunting than looking at a big glass.
And the straw because It's easier to continually take sips than it is to drink from a glass and having a straw is fun because you can blow bubbles.
posted by kinetic at 5:46 AM on November 14, 2015
put the drink in a smaller cup and stick a straw in it. The smaller cup being emptied frequently makes the calorie loading feel less daunting than looking at a big glass.
And the straw because It's easier to continually take sips than it is to drink from a glass and having a straw is fun because you can blow bubbles.
posted by kinetic at 5:46 AM on November 14, 2015
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I am not a nutritionist, but this is the advice nutritionists offered when my father was struggling to put on some weight after enduring health-related challenges.
posted by DrGail at 10:12 AM on November 13, 2015 [2 favorites]