Eating less than usual is an early sign of undernutrition, which is often associated with decline in physical function, poor quality of life and increased risk of death.

It is common for older adults and individuals with medical conditions such as cancer, chronic obstructive pulmonary disease (COPD), dementia and liver cirrhosis to experience poor appetite due to change in taste, reduced smell sensitivity and/or early satiety.

Satiety is the feeling of fullness and loss of appetite that happens after eating.

A useful tip to manage poor appetite is to offer individuals small portions of food and drinks every two to three hours. Apart from their favourite foods and drinks, it is equally important to include a variety of foods from these food groups in their diets:

1. Whole grains (e.g. brown rice) and starchy vegetables (e.g. sweet potato)
2. Lean meat, fish, legumes (e.g. beans, peas, lentils)
3. Fruits
4. Vegetables 

Here are some quick and easy tips to help address poor appetite, and manage your loved ones’ diets to ensure that their nutritional needs are met. 

Breakfast

• Oatmeal does not have to taste bland. Mix oats with flavoured milk (e.g. chocolate milk), a teaspoon or tablespoon of berries (e.g. goji berries, blueberries), and some nuts (e.g. almond slices, chopped walnuts).
• French toasts with nut butter (e.g. almond butter, peanut butter). 

The goodness in this

• Oats are a type of whole grain that contain prebiotics which can help in maintaining our gut health.
• Berries provide antioxidants, fibre and natural sweetness. 
• Almonds and walnuts provide unsaturated fats (good fats) and protein while adding extra crunch and flavour to the oats. 
• Nut butters (without added sugar and additives) are a great source of vegetable protein. 

Morning Tea

• A small glass of smoothie made with fruits and soy milk or full cream milk
• Protein snacks such as red bean pancake, chicken pau, and soy beancurd dessert. 

The goodness in this

• Smoothie is a nourishing beverage that combines vitamins, minerals and protein from fruits and milk.
• Adequate protein helps to prevent sarcopenia, which is a condition characterised by loss of muscle, reduced muscle strength and increase in body fat.
• For individuals who are underweight or have very poor appetite, they need to have food with higher calories and protein such as chicken pau, full cream milk. 

Lunch

• Rice vermicelli in tomato egg drop soup. Fish or minced meat, garlic, onions, lemongrass and ikan bilis can be added to the soup for enhanced flavour.
• High-fibre white sandwich with avocado spread and a small bowl of salad mixed with frozen vegetables (e.g. corn, peas, carrots) with protein food (e.g. egg, chicken, tuna).

The goodness in this

• Rice vermicelli is a source of carbohydrate, which provides fuel for our brain and muscles.
• Eggs provide extra protein without adding much food volume. 
• Mixed salad with vegetables and protein can be a no-frill, nutritious and flavourful food item that you can make easily. 
• High-fibre white bread is an alternative choice for people who do not like wholemeal/multigrain bread.

Afternoon Tea

• Lemon tart, lemon custard or a soft cake plus a glass of lemonade or ginger tea or sour plum drink. 

The goodness in this

• Acidic fruits like lemon and lime can help stimulate taste buds. 

Dinner

• Fried rice with minced cauliflower, chopped carrots, ikan bilis, prawns, cashew nuts and pineapple. Spices (e.g. curry powder, turmeric powder), herbs (e.g. parsley), sauces (e.g. vinegar, fish sauce, ketchup) or cheese can be added for flavouring.  
• A lighter option would be rice porridge with small cubes of sweet potato, shredded chicken or fish, and mushrooms.

The goodness in this

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• Home-cooked fried rice with fruit, assorted vegetables and protein food (e.g. prawn, ikan bilis, cashew nuts) make a balanced meal.
• Minced or chopped vegetables make it easier to chew and digest. 
• Cheese provides extra calories and protein without adding much volume, making it easier for individuals with reduced appetite to manage. 
• Spices, herbs and sauces serve to enhance taste of foods. 
• Sweet potato and mushrooms are packed with fibre and antioxidants. Sweet potato is also rich in vitamin A while mushrooms are rich in vitamin Bs.

Supper

• A small tub of yogurt with dried fruits
• Red bean soup or Chinese black sesame paste

The goodness in this

• Yogurt is a good source of probiotics and protein. 
• Dried fruits offer more calories and fibre in a smaller volume. 
• Bean-based desserts offer protein and fibre. 

There’s a lot of room for creativity when it comes to managing the diets of people with poor appetite. What we have proposed here are meal ideas, not actual meal plans. Personalised meal plans are usually designed by dieticians to meet individuals’ personal nutritional needs based on their medical conditions, lifestyle, weight and health goals. If you struggle in getting your loved ones to obtain adequate nutrients from food or wish to get advice on personalised meal plans, please consult a dietician. Poor appetite can be managed! 

Reference: 

Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., … Calder, P. C. (2014). Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical Nutrition, 33(6), 929–936. 

About the Author:
This article is written by Ong Sik Yin for Jaga-Me. Sik Yin holds a Master’s degree in Nutrition and Dietetics from Flinders University. She is an Accredited Dietitian of Singapore (Singapore Nutrition and Dietetics Association) and an Accredited Practising Dietitian (Dietitians Association of Australia). She is an advocate of building a supportive ecosystem and conducive environment to promote health and wellness. She has over 10 years of experience providing nutritional advice and sharing her knowledge in hospital settings and public forums. 

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Undernutrition is not just about being underweight. It refers to an inadequate intake of calories, protein, vitamins and minerals to meet an individual’s needs to maintain good health. Undernutrition in older adults can lead to poor wound healing, decline in physical function and poor quality of life. It is also linked with increased risk of infection, prolonged stay in hospital and increased risk of death. 

Which groups of older adults are more likely to develop undernutrition? 

• Those who stay and eat alone.

They may lack motivation and interest to prepare meals for themselves. Loneliness will also further reduce their desire to eat. 

• Those who have swallowing difficulty/dysphagia.

They may have limited access to nutritious texture-modified meals. Lack of food variety can also lead to poor appetite. 

• Those who have limited or no income.

Financially-challenged elderly individuals, especially those who have multiple medical conditions that require numerous medications, can be forced to choose between paying for medication and food.

• Those with physical mobility constraints

This may limit their ability to buy food or groceries, as well as participate in social activities. Reduced participation in social activities is linked to increased risk of death among older adults. 

• Those who are on multiple dietary restrictions or medications 

Over-restrictive diets may cause older adults to develop poor appetite. Medications such as erythromycin (antibiotic) and metformin (medication for diabetes) can also lead to poor appetite. 

What are some early signs of undernutrition?

• Unintentional Weight loss 
• Eating less than usual
• Fatigue
• Body weakness and frequent falls
• Longer healing times for wounds

Identifying early signs of undernutrition can help to prevent complications such as infections and hospitalisation. 

• If your loved one is experiencing any of the above symptoms, please consult a doctor. Some of these symptoms may be due to underlying medical conditions such as cancer, dementia and kidney failure. 
• If you have concerns about managing poor appetite as a side effect of a particular medication, please seek professional advice from a pharmacist and/or doctor. 

Some tips on improving older adults’ food intake: 

• Encourage them to have 5 to 6 small meals a day.
• Arrange meal delivery for those who are unable to purchase meals on their own. 
• Provide budget-friendly, healthy balanced meal ideas e.g. instant oatmeal with banana for breakfast, rice with barley, stir fried vegetables, steamed egg for lunch, wholemeal bee hoon soup with vegetables and tofu or chicken fillet for dinner. Some snack ideas include fruit, yogurt, red bean soup and soy beancurd dessert.
• Encourage them to dine with family and friends. 

References: 

1. Mann, J., & Truswell, S. (Eds.). (2017). Essentials of Human Nutrition(5th edition). Oxford: Oxford University Press.
2. Robnett, R. H., & Chop, W. C. (2013). Gerontology for the Health Care Professional(3^rdedition). Jones & Bartlett Learning.
3. Wei, K., Nyunt, M. S. Z., Gao, Q., Wee, S. L., & Ng, T.-P. (2017). Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies. Journal of the American Medical Directors Association, 18(12), 1019–1028. https://doi.org/10.1016/j.jamda.2017.06.017

About the Author:
This article is written by Ong Sik Yin for Jaga-Me. Sik Yin holds a Master’s degree in Nutrition and Dietetics from Flinders University. She is an Accredited Dietitian of Singapore (Singapore Nutrition and Dietetics Association) and an Accredited Practising Dietitian (Dietitians Association of Australia). She is an advocate of building a supportive ecosystem and conducive environment to promote health and wellness. She has over 10 years of experience providing nutritional advice and sharing her knowledge in hospital settings and public forums. 

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

Mr Khaw, who is 66 years old reminded fellow seniors never to jump out of bed. “At our age, it’s important to get up, pump the heart, stand up, feel that you are steady before taking the first step.” He added.

In this article, we take a look at the leading factors that increases elderly fall risks at home.

Insomnia

Insomnia exists in various forms and generally refers to a difficulty of falling or staying asleep. This typically contributes to a perception of unrefreshed sleep and inability to focus on tasks during the day. An estimated 10% to 15% of the adult population have chronic sleep problem and an additional 25% to 35% of the population have transient or occasional sleep difficulties.

A 2014 US Study concluded that sleep duration and fragmentation were associated with greater risk of recurrent falls among older men. Within this group, the elderly are more susceptible and vulnerable because they experience a more fragmented sleep pattern. Sufferers of Alzheimer’s, Dementia and Restless Legs Syndrome (RLS) also have an increased risk of problems sleeping. RLS affects more than 20% of people 80 years and older and contributing factors include low iron levels, Parkinson’s disease, Kidney Failures, Diabetes and Arthritis.

Mobility Struggles

Elderly who have recently had a stroke or surgery are also at increased risk of falling from their beds. A lot of these falls are more likely to happen in the process of getting in and out of bed. Contributing factors include weak footing, poor eyesight or lighting and a recurrent unfamiliarity with space.

Orthostatic Hypotension

Common in those age 65 and older, Orthostatic Hypotension occurs when something interrupts the body’s natural process of counteracting low blood pressure when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.

For the Elderly, conditions like heart valve problems, Bradycardia(low heart rate) can cause Orthostatic Hypotension. These conditions leads to low blood pressure thus preventing your body from responding rapidly enough to pump more blood when standing up.

Hypoglycemia or low blood sugar can also cause Orthostatic Hypotension, as can diabetes — which can damage the nerves that help send signals regulating blood pressure. Parkinson’s disease can also disrupt your body’s normal blood pressure regulation.

Bed Rest

Elderly that have been on bed rest due to illness or medication may be weaker due to muscle atrophy and at a higher risk of falls when getting in and out of bed. They may also be suffering from Orthostatic Hypotension.

Reducing fall risks for the Elderly

Encourage simple, safe and regular exercise.

Simple exercises done regularly enough build strength, balance, limb coordination and mental alertness.

Promote a safe and conducive living environment.

Apply the KonMari treatment! Make the home safer by decluttering and install elderly friendly features such as railings and consistent lighting.

Keep noise to a minimum and ensure commonly used items like canes are within reach. Always keep floors dry.

Regular check ups

Catch and treat problems early by going for regular checkups. Especially with vision related conditions.

Never jump out of bed

We couldn’t agree more with Mr Khaw Boon Wan, who advised seniors to never jump out of bed. Do allow the heart ample time to counteract changes in blood pressure by turning your body and placing both feet firmly on the ground, pause for a few seconds before lifting yourself off the bed slowly.

Caregiver support

Minimise unnecessary movement for the elderly by having someone to care for them. Delegating a family member to help out or even just check in periodically to converse with the elderly will dramatically improve their quality of life.

At Jaga-Me we believe in making healthcare accessible and available to everyone. We provide personalised and curated care for your loved ones. If you need a trained nurse to do professional medical procedures or a trained nurse to do nursing procedures at the convenience of your home, you can engage our care services.

If you found this article helpful, we recommend reading Budget 2019: CHAS Enhancements, Long Term Care Support Funds, MediSave top-ups and The Silver Lining Subsidies: Daily Living & Outpatient

Award winning Home Care trusted by health professionals – Jaga-Me

Growing up, our parents might have jokingly asked us if we would keep them by our sides and care for them in their old age.  We always responded with a resounding yes because our young minds could not fathom why this was even a question.

Fast forward to today, we might suddenly be faced with a conundrum. Should we send our elderly parent with growing medical needs and physical dependency to a nursing home? Or do we keep them by our sides and let them age in place?

Some adult children have little choice but to opt for the former arrangement because they feel inadequate to be effective caregivers, due to limited medical sensibility. Others insist on keeping their parents at home. However, they struggle to cope with the demands of caregiving, suffering from compassion fatigue as a result.

We do not have to dwell in these extremes when home care is becoming an increasingly accessible option. Even then, not many of us readily opting for home care. Could this be due to limited understanding of home care?  

Here we look into some of the pros and cons of home care to help you make a more informed decision:

Best of Both Worlds

With home care, your elderly parents do not have to trade the comforts of home for the safety of medical care. They can receive expert medical attention even while enjoying the ease of recovering in familiar surroundings. This lessens the mental and emotional load of having to adapt to their new situation and allows them to direct all their energy towards recovery.

Cons: Based on your elderly parent’s needs, your house might need to be outfitted with additional elderly-friendly facilities. There are additional monetary and spatial costs to consider for this.

There are also instances whereby an elderly patient might be suffering from special conditions. Ones that require medical specialists’ attention and it may go beyond the scope of the caregivers’ expertise.

To make an informed decision, first, assess your elderly parents’ needs. Secondly, discuss with home care providers to find out more about the suitability of home care for you.

Flexibility in Approach

The needs and level of dependence of an elderly individual vary from time to time. This means that you might find yourself being able to cope with caring for your elderly parent in some aspects but not others. At times, you might just want a short respite from caregiving responsibilities. Since home care services are available on demand, you enjoy the luxury of choosing when and where you would like to employ the help of a caregiver.

Personalised Care

When you opt for home care, your elderly parent will be assigned dedicated care coordinators. They are able to commit the time and effort to fully understand your elderly parents’ unique needs and cater accordingly, rather than using a homogeneous approach. You should also take the opportunity to assess the suitability of caregivers, identify what works best for you and what needs to change.

Cons: While your elderly parent stands to gain from personalised care, they could be forgoing the interactions and friendships that they may develop with counterparts in a nursing or day care facility. There is great value in the sense of community that arises from the shared experiences of elderly folks living together.

Nevertheless, home care providers these days are moving towards a culture of combining both caregiving and companionship. There are many heartfelt stories of caregivers and patients developing unique bonds and friendships. Meaning which, your elderly parent need not necessarily be missing out on that aspect.

To find out about home care services for yourself or someone you know, click here now! If you are not sure of how you can go about home care, give our Customer Service team a call at 6717 3737.

Award winning Home Care trusted by health professionals – Jaga-Me

Despite these body changes, we can modify our diet and lifestyle to help combat these changes, enabling us to maintain a healthy and active life in our golden years. There are four main areas that older adults can focus on to stay healthy and active: 

1. Maintain a healthy weight
2. Prevent muscle loss and build muscle strength
3. Protect your bones
4. Eat well for your memory

Maintain a healthy weight

It is a common belief that older adults should eat less due to their lower metabolic rates. While it is true that adults aged 65 and above do not need as much calories compared to their younger days, they need more of other vitamins and minerals due to slower digestion and reduced absorption by the body. A balanced diet including a variety of wholegrains, fresh fruit and vegetables, lean meat and legumes/lentils can provide the necessary nutrients for optimal health. 

Inadequate food intake will result in weight loss. Unintentional weight loss in older adults increases the risk of malnutrition, infections and fractures. 

However, those who are obese should gradually reduce their weight through making dietary changes and increasing physical activity level to reduce body fat and maintain muscle mass. 

Prevent muscle loss and build muscle strength

Sarcopenia is a common condition among older adults. This condition is characterised by loss of muscle, reduced muscle strength and increase in body fat. Some people may lose as much as 40% of their muscle in late adulthood. To fight against sarcopenia, older adults need to have adequate protein intake. Fish, lean meat, low fat dairy products and legumes are great protein food. Protein food should be coupled with physical activity to prevent muscle loss and maintain muscle strength. 

Protect your bones

Our bone mass starts to decline between 35 and 40 years of age. For women, the rate of bone loss increases during menopause. Bone loss increases risk of osteoporosis (loss of bone mass) and fractures. Having regular intake of calcium-rich foods (e.g. green leafy vegetables, tofu, sardines), regular sunlight exposure (which helps to stimulate your body’s production of vitamin D), and regular physical activity will help to maintain your bone mass and reduce risk of fractures. Health Promotion Board recommends that adults aged 51 years and above consume 1g of calcium per day. 

Eat well for your memory

You may have come across supplements and food products that claim to delay memory loss. Research on nutrition and memory suggest that omega-3 fatty acids and foods rich in antioxidants may have beneficial effect on brain health and delay memory loss, but the results are not conclusive. What is known, however, is that 30 minutes of moderate aerobic activity for at least 2-3 times a week can improve brain function. Incorporating a variety of vegetables, berries and oily fish as part of a balanced diet also helps to promote general well-being. 

What can I do? 

• Have a balanced diet: Include a variety of fruit and vegetables, lean meat, some oily fish, wholegrains and calcium-rich foods (e.g. dairy products, tofu) in your daily meal.
• Maintain moderate levels of physical activity. Consider brisk walking, cycling, Taichi and swimming. 

References: 

1. Mann, J., & Truswell, S. (Eds.). (2017). Essentials of Human Nutrition(5 edition). Oxford: Oxford University Press.
2. Medina, J. (2017). Brain Rules for Aging Well: 10 Principles for Staying Vital, Happy, and Sharp. Pear Press.

We also recommend reading Your Guide to Oral Nutritional Supplements (ONS) and Apps For Diabetics: 5 Aspects To Look Out For.

About the Author:
This article is written by Ong Sik Yin for Jaga-Me. Sik Yin holds a Master’s degree in Nutrition and Dietetics from Flinders University. She is an Accredited Dietitian of Singapore (Singapore Nutrition and Dietetics Association) and an Accredited Practising Dietitian (Dietitians Association of Australia). She is an advocate of building a supportive ecosystem and conducive environment to promote health and wellness. She has over 10 years of experience providing nutritional advice and sharing her knowledge in hospital settings and public forums. 

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional