Thanks to a large extent to Jamie Oliver’s School Dinners campaign, parents, politicians and food manufacturers now seem clearer about how important it is that children eat nourishing and healthy food — hooray! However, the same message doesn’t seem to have got through about elderly people. Malnutrition causes a variety of health problems — from pressure sores, to poor dental health, to constipation (which can lead to serious problems such as diverticulitis — inflammation of the colon), heart disease and diabetes (linked to old age and which can cause mobility issues).

Often an elderly person may not have much appetite, and some don’t have the energy to cook for themselves. Relatives may struggle to tempt them into eating something other than biscuits or cakes. In care homes, some people are on so much medication that their appetite either becomes quite voracious or, more commonly, dwindles. Even eating itself can be an effort and often not enough help is given by the staff — I’ve been horrified to see relatives and patients of mine left alone to try and feed themselves stodgy, cold meals. It can be a shock to see how food can make someone feel different on every level, physically and emotionally.

The first thing to focus on is quantity. Small and delicious are the key words. It is not easy cooking, say, a large pie and then having to deal with storing the leftovers. It’s a good idea to invest in individual cooking dishes; muffin trays, for example, can be used for making small freezable pies such as minced beef and apple. Although there’s an initial outlay, wastage will be less and food will defrost quicker.

One of the hardest aspects of elderly eating is perhaps the lack of flexibility — you may think they’ll like fish pie on a Friday, but the appetite wants something else. Having a few choices in the freezer gives welcome variety. Check if any waning in their appetite is caused by medication — for example, certain antibiotics can give low-level nausea. It’s worth asking if alternative medication can be used.

There’s a general low vitamin D status in elderly people because older bodies are less efficient at synthesising the vitamin D in the skin from sunlight and because elderly people may be housebound for weeks at a time, away from the sun’s rays. Lack of vitamin D can compromise bones (increasing risk of fracture and therefore disability) so older people should get as much safe exposure to the sun from May to September as they can, and should also take a daily 10mg vitamin D supplement. Encourage them to eat food rich in vitamins, such as dairy produce, butter, fortified margarines, oily fish — smoked salmon with cream cheese on a piece of pumpernickel bread perhaps, or smoked mackerel pâté on warm wholemeal toast.

Keep fibre intake up, as this helps a sluggish older gut to move. Porridge is good, maybe with a sprinkling of ground seeds (linseeds, hemp seeds, walnuts — grind them in a food processor and store them in a glass jar in the fridge ready to sprinkle on porridge or breakfast cereal). Prunes — now in yoghurts, desserts, even as juice — are classic gut-movers; make dates and figs into compotes with pears and apples. I wish doctors and some carers wouldn’t immediately turn to laxatives such as Fybogel, when with natural laxative foods, such as these fruits, plus wholegrain cereals and vegetables, the gut would move along on its own.

Poor hydration is one of the biggest problems in care homes, as the hassle factor of dealing with urinary care can make some carers inclined to keep residents’ fluid intake on the low side — and even if this isn’t the case, the skin becomes thinner with ageing and loses more water. The kidneys are less able to process urine and the thirst mechanism isn’t as accurate, so sometimes we don’t feel thirsty when we should. Dehydration can cause urinary tract infection and lead to confusion. You should encourage a good 1.5l to 2l of water a day. Water is the best hydrator but tea (although caffeine can have a minor dehydrating effect) is fine for reluctant water-drinkers. Add cordials to water for variety.

It’s important for elderly people to eat their five daily portions of fresh fruits or vegetables, to ensure they get enough fibre, vitamin C and other essential nutrients. Cooked vegetables can be easier to eat than raw, but try not to overcook — microwaving and steaming keep in more of the water-soluble nutrients, such as vitamin C. If swallowing isn’t easy, make vegetable purées, adding olive oil, butter or cream to make them more nourishing and energy-rich.

Classic dishes such as smoked mackerel pâté on toast, or smoked haddock and poached egg, are light but high-protein and easy to digest. You could make small shepherd’s pies, soups with beans and lentils, spinach and pea risotto, individual crumbles — apple, blackcurrant, rhubarb (serve with ready-made custard). And the cauliflower cheese recipe (right) always went down a treat with my nan.

Jane answers queries in times2 on Tuesdays. E-mail jane.clarke@thetimes.co.uk and visit jane.clarke.com

Simply irresistible in senior society

CAULIFLOWER CHEESE
Makes 1 large or 6 small dishes

1 cauliflower, trimmed, cut into 1cm pieces
300g cream cheese
1 tsp Dijon mustard
125g Lancashire, or other crumbly cheese
Salt and freshly ground black pepper
50g mature Cheddar cheese, grated

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