Chapter 7: Meals, Drinks and Mealtimes

A Common Situation

A man in his sixties visits his mother every evening after work. For most of her life she cooked large meals for the whole family, and her kitchen was always full of good smells. Lately he has noticed that the food he leaves in her refrigerator comes back untouched, that the bread on the counter has gone stale, and that she seems to live on tea and biscuits. When he asks about it, she says she is simply not hungry and that cooking for one person is not worth the trouble. At dinner one evening he also notices that she coughs a little after drinking her soup. He is not sure whether these are small things or the beginning of something he should worry about, and he does not want to nag her about every bite.

Food and drink are about much more than staying alive. A meal can be a pleasure, a habit that gives shape to the day, a way of keeping old skills, and a time of company. In this chapter I will explain what care textbooks teach about eating and drinking in later life. We will look at why appetite and taste often change, what a balanced plate looks like in simple words, and why drinking enough matters so much. We will also look at the basics of safe swallowing, the care of the mouth and teeth, and the ways a mealtime can become a time to enjoy together again. Throughout, the idea is the same one that runs through this whole book: support what the person can still do, and keep the person's own wishes at the centre.

Appetite, Taste and a Balanced Plate

Many families notice that an older person eats less than before. Often there are ordinary reasons for this. A person who moves about less uses less energy, so the body may ask for smaller portions. The senses of taste and smell often become weaker with age, and since much of what we call flavour actually comes from smell, food can seem flat and uninteresting. Teeth that hurt or dentures that do not fit well can make chewing tiring. Some people feel full quickly. Living alone, feeling low, or simply finding it hard to stand at the stove can also take away the wish to eat. None of these reasons is anyone's fault, and knowing them helps you look for gentle solutions instead of arguing about food.

Small changes can bring back some of the pleasure. Food with more colour, a little more herb or spice the person likes, and dishes from the person's own past often taste better than plain food. Smaller portions on a smaller plate can look inviting rather than overwhelming. Some people do better with several small meals and snacks across the day than with three large ones. A warm drink and a favourite snack in the middle of the afternoon can add a surprising amount over a week. If the person has always enjoyed a certain dish on a certain day, keeping that habit can do more for appetite than any new idea from you.

A balanced plate can be described in simple words, the way most care textbooks do. It contains some vegetables and fruit, which give vitamins, minerals and fibre. It contains a starchy food such as rice, bread, noodles or potatoes, which gives energy. And it contains a food that gives protein, such as fish, eggs, meat, beans, tofu or dairy foods, which helps keep muscles and skin strong. Older people often need as much protein as younger adults, even when they eat less overall, so a little protein at each meal is a good habit. Foods with fibre, together with enough drinks, help the bowels stay regular. You do not need to weigh or count anything. Looking at the plate and asking "is there something from each group?" is enough for everyday home cooking.

Some people you care for will have been told by their doctor to eat in a particular way because of an illness. In that case, follow what the doctor, nurse or dietitian has said, and ask them when you are unsure what it means in daily cooking. What is right depends on the person and on the professionals who know their health. What every family can do is make the food that is allowed as tasty, attractive and easy to eat as possible. A dietitian is a professional who advises on food and nutrition, and if eating has become a worry, the person's doctor can often arrange for the person to speak with one.

Weight is one of the simplest signs that eating is going well or not. A slow, unplanned loss of weight, clothes or rings that have become loose, or a belt that needs a new hole are worth mentioning to the doctor or nurse, even if the person seems otherwise well. A clear loss of appetite that lasts, a sudden change in eating habits, or new difficulty with chewing are also worth telling them about. You do not have to find the reason yourself. Writing down what you have noticed, and since when, makes the conversation with the doctor much easier. Many carers keep a simple notebook for such changes, and Chapter 11 explains how this care notebook can help at appointments.

Drinking Enough Through the Day

Water is just as important as food, and in later life it is easy to drink too little without noticing. The body's sense of thirst often becomes weaker with age, so an older person may not feel thirsty even when the body needs water. Some people drink less on purpose because they worry about needing the toilet often, especially at night or when they are out. Others find it hard to reach a drink, to lift a heavy cup, or to remember whether they have already had something. Taking in too little fluid over time is called dehydration, and care textbooks treat preventing it as one of the basic tasks of everyday care.

When the body does not get enough fluid, many small problems can follow. A person may feel tired, dizzy or weak, which makes falls more likely. The mouth may become dry and uncomfortable. Urine may become darker and stronger in smell. Constipation becomes more common. Some older people become more confused than usual when they have not had enough to drink. Signs such as a very dry mouth, very dark urine, unusual sleepiness or sudden confusion are worth telling a doctor or nurse about promptly. Because the right amount of fluid differs from person to person, and some people have been given special instructions because of their health, it is a good idea to ask the doctor or nurse how much is right for the person you care for.

The most helpful approach is to make drinks easy, regular and pleasant. A drink offered with every meal, another between meals and one with any medicines builds a steady pattern without anyone having to count. A cup or glass that is light, easy to hold and placed within reach makes a real difference. Some people prefer a cup with two handles or a cup that does not tip over easily. Water does not have to be the only choice. Tea, milk, soups, fruit with a lot of juice, jellies and other moist foods all add fluid. Many carers find that sitting down and having a drink together works better than reminding the person again and again. A jug or bottle filled in the morning and placed where the person can see it also shows, at a glance, how much has been drunk by the afternoon.

A common moment is when the person refuses a drink because of the toilet. This worry deserves respect, not argument. It often helps to explain gently that drinking too little can make the bladder more sensitive and constipation more likely, so it does not truly protect against accidents. You can suggest having more drinks earlier in the day and fewer in the hour or two before bed, if the doctor or nurse agrees that this suits the person. Making the path to the toilet easy and safe, which Chapter 9 explains, also takes away much of the worry. When people feel sure they can reach the toilet in time, they usually feel freer to drink.

Hot weather and illness both increase the body's need for fluid. On a hot day, or when the person has a fever, vomiting or loose stools, the body loses water faster than usual, and an older person can become dehydrated quickly. On such days offer drinks more often, keep the room cool, and watch for the signs described above. If the person cannot keep drinks down, or seems very unwell, contact the doctor or nurse without waiting. If the person becomes very drowsy, very confused or difficult to wake, call the emergency number. These are not everyday events, but knowing what to look for helps you stay calm if they happen.

Safe Swallowing and a Healthy Mouth

Swallowing is something most of us never think about, yet it is a careful piece of work done by many small muscles. As people age, swallowing can become a little slower and weaker, and some health conditions can affect it further. When swallowing does not work well, food or drink may go the wrong way, towards the airway instead of the stomach. Care textbooks teach a few simple habits that make swallowing safer for everyone, and these habits are worth using at every meal, whether or not the person has any known difficulty.

The first habit is position. The person should sit upright for eating and drinking, ideally in a chair at a table, with feet resting flat on the floor and the head tilted slightly forward rather than back. If the person must eat in bed, help the person to sit as upright as possible, well supported with pillows. Eating while lying back or half lying down makes it much easier for food to go the wrong way. After the meal, it helps if the person stays sitting upright for a while instead of lying down straight away, because this lets the food move down properly.

The second habit is pace. Small mouthfuls and small sips, taken slowly, are safer than large ones. Let the person finish swallowing one mouthful before the next is offered, and never hurry a meal because time is short. If you help the person to eat, sit at the same level as the person, face to face, rather than standing above, so that the person does not have to tip the head back. A quiet room without a loud television helps the person concentrate on eating. Talking is part of a pleasant meal, but it is best not to ask questions just as the person is about to swallow.

It helps to know which signs suggest that swallowing is becoming difficult. Coughing or choking during or after meals, a wet or gurgling voice after swallowing, food left in the mouth or the cheeks, needing to swallow several times for one mouthful, meals that take much longer than before, or chest infections that keep coming back are all worth telling a doctor or nurse about. They can arrange for a closer look at swallowing, often by a therapist who specialises in it, and may suggest changes in how food and drinks are prepared. Follow their advice exactly, and ask them when anything is unclear. If someone is choking and cannot breathe, speak or cough, call the emergency number at once. A first aid course is a good way for carers to learn what to do in that moment.

Care of the mouth and teeth is closely connected to eating. A clean, comfortable mouth makes food taste better, makes chewing easier and helps prevent infections. Care textbooks teach that natural teeth should be brushed gently twice a day with a soft toothbrush, including the gum line, and that the tongue and gums need gentle care too. Dentures should be taken out and cleaned every day, the mouth rinsed underneath them, and the dentures stored as the dentist advises. Encourage the person to do as much of this as possible, perhaps with you handing over the brush or standing nearby. A toothbrush with a thicker handle can be easier to grip for hands that have become stiff.

Regular visits to the dentist remain important in later life, including for people who wear full dentures, because the mouth and gums change over time and dentures may stop fitting well. Sore spots in the mouth, bleeding gums, loose or broken teeth, dentures that rub or slip, a mouth that is often very dry, or a sudden refusal to eat that may come from pain are all worth mentioning to the dentist, doctor or nurse. A person with memory problems may not be able to say that the mouth hurts, so changes in eating can be the first sign. Looking gently into the mouth from time to time, with the person's permission, is a kind and useful part of care.

Mealtimes as Shared Time

For many people, the hardest part of eating in later life is not the food but the loneliness. A meal eaten alone, in silence, often ends after a few bites. The same food eaten with someone else, with a little conversation, often disappears. If you live with the person you care for, sitting down together for at least one meal a day, even if you only have a cup of tea while the person eats, can be one of the most valuable things you do. If you live apart, a shared meal on a visit, a regular phone or video call at lunchtime, or an invitation from a neighbour or a community meal can bring company to the table.

The setting of a meal matters too. A table with a cloth, the person's own favourite cup, good light so that the food can be seen, and a calm, unhurried feeling all invite eating. Plates in a colour that stands out from the food and the table help people whose eyesight is weaker see what is on the plate. Some people manage better with cutlery that has thicker handles, a plate with a raised edge, or a non-slip mat under the plate. These are simple, generic aids, and an occupational therapist can suggest which ones fit the person's hands and needs. The aim is always to help the person eat independently for as long as possible.

Respect for the person's own choices belongs at the table as much as anywhere else. The person you care for has eaten in a certain way for a whole lifetime, and those habits often carry memories, family customs and, for some people, religious or cultural meaning. Asking what the person would like to eat, offering two choices rather than a long list, and serving food at the times the person is used to all show that respect. A man who has always eaten his main meal at midday may not want a large dinner in the evening, however convenient that would be for the household. When a choice seems unwise to you, it is still worth listening first, and it is the doctor or nurse who can advise if a choice truly affects the person's health.

Shopping and cooking can be part of the care rather than only tasks you take over. The person you care for may still enjoy choosing the vegetables, writing the shopping list, washing the rice, stirring a pot or setting the table. A woman whose hands have become weak may no longer be able to chop onions, but she may still be the best judge of when the soup tastes right. Doing these things together keeps old skills alive, gives the person a real role in the home, and makes the food feel like the person's own. The smell of cooking can also wake up appetite long before the meal is ready. It takes longer than doing everything yourself, and on busy days that is fine, but when there is time, the shared work is worth it.

Sometimes a person with memory changes forgets to eat, forgets having eaten, or no longer recognises certain foods. Gentle, practical help usually works best. Putting food on the table where it can be seen, offering one dish at a time, showing how to begin by taking a first bite together, and finger foods that can be eaten without cutlery can all help. Leaving a healthy snack and a drink in a place the person passes often can fill gaps between meals. If the person refuses food, try again a little later, offer a different choice, or check whether something is causing discomfort. Never force food or drink into anyone's mouth; refusal is a message, and it is worth understanding. If refusals continue, talk to the doctor or nurse.

Finally, remember that you do not have to be a perfect cook to give good care at mealtimes. Simple dishes made with care, a ready meal warmed and served on a nice plate, or soup shared from a flask on a visit can all be good meals. What matters most is that the person eats and drinks enough, that eating is safe, and that mealtimes remain moments of pleasure and dignity rather than battles. If you are ever worried about the person's eating, drinking or swallowing, the doctor, nurse or dietitian can help you. You do not need to carry that worry alone.

A Question to Think About

Which meal of the day, or which favourite dish, carries the most meaning for the person you care for, and how could you make room for it in the coming week? You might ask the person directly over a cup of tea, or share old memories of family meals and listen for the dish that brings a smile.