What are the best foods to help sick elderly people maintain weight?
May 6, 2020 12:18 PM   Subscribe

My grandfather has been pretty ill over the last few months with mild heart failure. He has stabilized for now and his doctors are treating him with medication. He has really lost his appetite and we don't want him to lose anymore weight then he has already. The doctors haven't give much diet advice other than protein shakes like ensure. I'm looking for any other good quality food sources that are calorie dense that can help him maintain his weight, and are relatively easy to make.

I know some of the answers to this question based on my own experience and, common sense I guess - peanut butter, shakes, beans, animal products, etc. He likes peanut butter and has been eating that but the issue is he just isn't eating that much period.

I was hoping to get some tips from anyone else who has looked after elderly relatives. Like we are getting him the shakes, but should I just get a tub of protein powder so he can add that to milk? Or maybe I should get some protein bars? He likes to eat breakfast the most and for the rest of the day its hard to get him to eat a lot.

Thank you.
posted by ajax287 to Health & Fitness (30 answers total) 1 user marked this as a favorite
I don’t think you can do too much really. Towards the end of life the person just wants less food. I remember my mother trying to please us by eating scrambled eggs and she just moved them around her mouth. It was very sad. Her doctor advised that she should eat whatever she liked, milk shakes- Starbucks frapaccinos... French fries. So I would bring tasty treats but there are no real hacks for this: this is how it goes.
posted by pairofshades at 12:26 PM on May 6, 2020 [12 favorites]

When my father was in final stages of dementia, he really went for sweets. He'd pick at the bland food that they served at the care facility but he went to town on apple bread pudding with caramel sauce. He would happily drink a Coke though getting him to drink generally was harder.

I know those aren't good quality, but if the balance is "not eating" vs. "get calories any way you can" you may want to look to sweets or whatever really motivates him to eat.

As pairofshades said, as people reach near end of life they tend to want to eat less. This is normal and part of the process.
posted by jzb at 12:38 PM on May 6, 2020 [5 favorites]

the doctor also recommended to us that we just give my grandma whatever she liked that she might eat a bit of - she had a couple milkshakes a week and we got her lots of snacks and greek yogurts and things that if you even have a tiny whim to eat you can open up and are pretty calorie dense.

My grandma was a fan of cheddar cheese melted on french bread with a vanilla milkshake.
posted by euphoria066 at 12:40 PM on May 6, 2020 [2 favorites]

Best answer: This may not be an option now, but we tend to eat more when we are eating with others. If possible, have him eat with others; if in person isn't an option, perhaps by video?

And yes, it's generally easier to drink calories than eat them, which is why shakes/smoothies are often recommended. Also, getting an adequate amount of protein is important, but protein is also filling, which is why high protein diets are often recommended for weight loss. Sugary drinks aren't generally healthy, but they are a very efficient way of getting calories without feeling full. On the other hand, fiber is an important nutrient but is very filling, so maybe eat higher fiber.protein foods (oatmeal, fruits and vegetables) after having the high-calorie "junk" food, like soda or sweets.

Here's a useful list of foods from r/gainit, though it's aimed more at young healthy people who are trying to bulk up than older people with health issues. But any of the foods listed there are good options if they appeal to him.

Finally, have you asked for a referral to a nutritionist? Even a single session might be helpful, both for practical advice and to motivate him.
posted by Mr.Know-it-some at 12:45 PM on May 6, 2020 [2 favorites]

Ice cream. Ice cream in coffee if they drink coffee.
posted by WeekendJen at 12:53 PM on May 6, 2020 [6 favorites]

My dad would eat pretty much anything sweet, so we just went with it. He was in a nursing home so we couldn't control his other food, but Mum would bring in eclairs, donuts, pies etc. We kept his drawer full of chocolate and Flakies. He also loved pudding cups. So those with a squirt of canned whipping cream. As for nutritional value, I figure eating junk food was better than not eating at all.

I have very fond memories of his smile, surrounded by his big beard covered in whipped cream. It made him happy. (Yes to the others above, people stop eating, its just is what it is)
posted by Ftsqg at 1:06 PM on May 6, 2020 [3 favorites]

At the nursing care facility where my dad was before his death, the nurses had access to something like an sure but it had supposedly twice as many calories. At least that’s what one of the nurses told me. So you might consider finding out if there is a more caloric version of something like Ensure that you can get. Echoing the advice about milkshakes and similar high-calorie food. One of the last things my dad was able to eat with any pleasure was cupcakes with lots of frosting. But it turned out he only wanted one and a half once. And after that he just wasn’t interested. Good luck!
posted by Bella Donna at 1:12 PM on May 6, 2020

My step-mom loved pancakes and syrup, pumpkin pie and rice pudding. Easy to chew and swallow, very tasty. I found a recipe for a protein-enriched jello that I thought she might like but never did manage to try it out.
posted by goodsearch at 1:24 PM on May 6, 2020

I used to make my dad baked custard to help keep his weight up. You can use half and half or cream to increase the calories.
posted by corey flood at 1:31 PM on May 6, 2020

With my own elderly relatives, their doctors were fairly useless when it came to advice on diet and nutrition. However, our province has a free phone service to connect people with a dietician, and the dieticians were SUPER helpful. Does your region have a similar service you could call?
posted by hurdy gurdy girl at 1:35 PM on May 6, 2020 [2 favorites]

We had good luck with the Mighty Shakes instead of Ensure. You get 200 calorie in just a half-cup serving. That's a lot of calories in a serving that is small enough that it can be served alongside of other food. It ships frozen and has more of shake quality and better flavor than Ensure. (Downside - we had to buy it in a carton of 50)
posted by metahawk at 1:41 PM on May 6, 2020 [1 favorite]

Any chance he likes cheese? It might not be great for his heart, but it's easy to get a lot of calories in a few bites and to mix it in with almost anything.

Are there any textures he enjoys? Some foods can be enjoyable to eat less for their taste than for their texture.
posted by trig at 1:57 PM on May 6, 2020

Maybe try something savory/salty-- if salt is not a problem-- to break up the round of protein drinks and ice cream and stuff. Some spaghetti with meat sauce or anything that is tasty for them. Frozen Stauffer's can work wonders.
posted by BibiRose at 2:03 PM on May 6, 2020

At end of life, a lot of people just aren't hungry or don't want to eat. Has he expressed that he wishes he were hungry, or that he wishes he were interested in eating? If so, you can put him on medications that will up his appetite, like Reglan or Marinol, both of which my mom prescribed when she was a nurse practitioner working in hospice.
posted by juniperesque at 2:04 PM on May 6, 2020

Best answer: When we had to do this for my grandfather, my dietitian aunt had us go full-fat everything. Whatever he had an interest in (we were also dealing with difficulty chewing and swallowing, so we were additionally limited to soft foods, plus almost no sense of taste so texture was a real challenge ) we gave him, in small servings and easy ability to get seconds, absolutely maxed out with as much fat as we could get into it.

If he wanted mashed potatoes, we made them (from dehydrated, so they were quick) with heavy cream and real butter, lots of it. He liked a little meatloaf or meatballs, which my mom made with beef and pork and chopped bacon + breadcrumbs soaked in heavy cream + brown gravy made with at least half and half if not cream. He liked green bean casserole, the recipe from the back of the French's Fried Onion package, so we used the cans of soup but also sour cream and heavy cream. His protein shakes were made with premium vanilla ice cream (we'd make a batch and pour into Dixie cups so they were barely more than a shot, and he could slam a couple of those every so often).

It helped that we got my grandfather to agree to eat on a schedule (half his meds had to be taken with food and half on an empty stomach so it was kind of a scheduling nightmare anyway) whether he "felt hungry" or not. We kept portions tiny but tried to pump each one to ~150 calories, so if he'd just eat 8-10 portions of whatever was tolerable over the course of a day, whether it was fun or not, he'd get enough to at least maintain his weight and maybe get a pound or two up if he had a good week. A whole lot of it was kept in Dixie cups, or tiny jars or storage containers, everything was marked with a calorie count so he just had to leave the container next to the sink and we'd tally it and do the dishes.

Don't worry about the fat content as long as it's fat from real plant and animal sources with minimal processing. Try to avoid packaged snacks, as much as that is going to make more work for somebody, as they're so often fat-minimized or use frankenfats for shelf stability.

My grandfather got tired of sweet stuff very quickly, and that was partially his personality but also most humans crave savory food for at least some of their daily meals. The shakes are not terribly appealing when it's all day every day. So if you can dial in what kind of flavor profiles are still appealing to him - is it umami, is it carby, is it a very specific brand of fish stick? - and keep that feedback loop open so you're not boring him with too much meatloaf or spaghetti or whatever. Just work on maximizing a mini-portion to about 150 or 200 calories (that's like 1/3 to 1/2 cup cooked pasta, so with enough cheese or meat you can get literally a few bites to 150ish calories), make it super easy for him to heat if it's self-service, pick stuff that's easy for you or someone to meal prep for him (you really can't put it on him to cook, just reheat), and this is the time you get a free pass to use disposable containers if that's how it needs to be.
posted by Lyn Never at 2:27 PM on May 6, 2020 [2 favorites]

My grandfather eats an unflavored protein powder (Unjury) that we add to whatever he’s in the mood for. He never took to Ensure.
posted by inevitability at 3:25 PM on May 6, 2020

My dad enjoyed the individual pre-made pudding cups (Jello?) when he wouldn't eat anything else.
posted by uncaken at 3:29 PM on May 6, 2020

A lot of older people have extreme difficulty swallowing. This is unfortunately often ignored by doctors or caregivers. So it might help to determine first if he’s having trouble swallowing so you can decide what to get him to eat.

I agree that the calories in whatever form are more important than what he’s eating specifically. My mom loved her Ensure and Yoplait, probably because they were sweet, so I loaded her up with that. Are there certain smells he doesn’t like? That’s another thing that might affect what he eats—either he smells something unpleasant or he’s lost his sense of smell, which really affected my dad’s appetite.

What about breakfast does he like? Some older generation folks believe you’re only supposed to eat breakfast in the morning and maybe he would like whatever makes up his breakfast later in the day. My dad loved oatmeal and I taught him to dump a bunch of Trader Joe’s toasted sliced almonds and some craisins and raisins in, along with half and half, until his doctors convinced him to go on this hideously restrictive diet. Maybe he likes it just because it’s morning and he’s hungrier, but it might be worth a shot to see if he’d eat that for dinner.
posted by kitten kaboodle at 3:31 PM on May 6, 2020

Ensure is gross. My dad squirrelled it away in careful stacks under his hospital bed so they wouldn't know he wasn't drinking it. Definitely get a tasty protein powder. Isopure Dutch Chocolate for example is legitimately really good when combined with a bit of milk. I've only ever used heavy whipping cream or coconut cream, but I'm sure any others would be fine too. If he doesn't mind a slightly fiddly recipe, it also can be made into hot chocolate by microwaving it at 40% in 30-second bursts, stirring in between.
posted by teremala at 3:41 PM on May 6, 2020

My grandfather subsisted on Klondike bars, coffee and high quality dark chocolate for years.
posted by Sassyfras at 5:03 PM on May 6, 2020 [1 favorite]

I wish I would have have asked my grandmother about the foods she liked to eat when she was younger. She had little to no interest in food but the association to a memory may have helped. Her sense of taste diminished as others have mentioned.

Guaranteed she wouldn't have touched a protein bar and near the end despised Ensure with every fibre of her being.
posted by nathaole at 5:12 PM on May 6, 2020 [2 favorites]

I used a counter-top ice cream maker to make batches of soft serve ice cream out of ensure. Also froze it in ice cube trays and used for smoothies. Add peanut butter, protein powder, heavy cream, whatever combo you can find that he likes.
posted by raisingsand at 7:36 PM on May 6, 2020 [1 favorite]

Whole milk yogurt
posted by pinochiette at 8:03 PM on May 6, 2020

I used to make my mother milkshake/frappuccino’s with decaf coffee, ice cream, cocoa powder, hazelnut syrup, and whatever else seemed like it would be good. You could add heavy cream or protein powder, too.
posted by MexicanYenta at 8:36 PM on May 6, 2020

here’s some of what I do to keep my weight up: (caveat, I am not elderly)
-Cook with plenty of butter.
-Add cheese whenever I want.
-Alpenrose 6% Chocolate milk
-Croissant sandwich instead of regular bread
-Full fat yogurt
-Whole Milk
-fresh avocados & tomato slices as a snack with salt n pepper
-telling people who comment on my food choices to mind their own business
-scrambled egg cooked with plenty of butter and cheese on top
posted by HMSSM at 9:36 PM on May 6, 2020 [2 favorites]

For my stepdad, when he lost his appetite and got more limited in what he could eat, he expressed an interest in puddings. (He couldn't swallow well and was tired of ensure.) I got some in non-chocolate flavors and also made bread pudding and tapioca pudding. I had heavy cream for pouring on anything, though he wasn't keen on that.

For your grandpa, I'd see how many meals of breakfast you can have in a day. Would he like French toast, pancakes, or waffles with jam and whipped cream on top? Would he like eggs, hash browns, and bacon? These all seem like high calorie, high flavor foods, so they might help with whatever interest he had in food right now. Whatever you try, can you add cream or butter to it? Syrup? Gravy?
posted by Margalo Epps at 10:03 PM on May 6, 2020

Nutella was very helpful in similar situations - lots of not too bad calories, lower glycemic index if he feels bad after eating straight sugary things. Fancy interesting sodas (raspberry shandy was a hit). And yes on ice cream.

Do ask about his dental health and mood. I've seen multiple cases of sudden weight loss caused by ill-fitting dentures that people "didn't want to make a fuss about" and depression. A generalist-geriatrician put that latter person on a small dose of mild antidepressants and it's been night and day.
posted by I claim sanctuary at 2:34 AM on May 7, 2020

For a distant family member in his 90s, unlimited deserts and encouragement not to avoid them proved valuable. "High quality" is a challenge, but ice cream is calorie dense and imperfect nutrition is better than none, especially if he's also getting some protein and vitamins elsewhere. Best wishes.
posted by eotvos at 9:49 AM on May 7, 2020

We are living in this world too with my dad. He LOVES jello and vanilla pudding and shortbread cookies and coffee and usually nothing else. We've gotten creative about what we mix into the staples.
posted by dpx.mfx at 11:32 AM on May 7, 2020

Take a look at this FPP about recipes tested and recommended to help stave off aids-related wasting.
posted by Lawn Beaver at 5:01 PM on May 7, 2020 [1 favorite]

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