Sandra Irwin pops in for her dad's prescription. You ask after Alfred, who you have not seen since his wife Colette passed away a few months ago. "He's not that great actually," says Sandra. "Health-wise he seems OK, but every time I see him he looks thinner and thinner. My husband was working away for a couple of weeks and he said he could see a real difference when he got back. It's like he's wasting away in front of our eyes." You talk to Sandra about it a little more, and find out that Alfred isn't much of a cook and doesn't have a very big appetite. Sandra takes him food at the weekend and has arranged meals to be delivered during the week when she is at work, but she says he often doesn't finish what he is given. "He worries about getting his five a day, which was mum's thing, so he snacks on fruit and vegetables," adds Sandra. "I wonder whether he's just not getting enough calories."
What should Sandra do?
Sandra's first port of call should be Alfred's GP, who can arrange an assessment. If Alfred has lost more than 5 to 10 per cent of his body weight in the last few months, or his BMI is less than 18.5, he is likely to be diagnosed as malnourished. He will need to undergo tests to check whether there is a medical condition that is contributing to the problem, but it may well be as simple as the fact that Alfred is now living alone.
Are there any changes she can make that might help?
Assuming there is not a health problem that is causing the malnutrition, there are some simple steps that Sandra can take to increase the calorific content of Alfred's meals. This needs to be tailored to his requirements; for example, if his appetite is largest in the morning, a cooked breakfast such as beans on toast plus a milkshake will be a better option than cereal and a glass of juice. Little and often may be a good approach if he likes snacking, making sure Alfred gets high energy, protein rich foods (for example, swapping his fruit for a handful of nuts) and enriching food with fats, such as cream, butter and cheese, to boost the calorie content. Other suggestions Sandra can make are for her father to stop drinking when he eats, as fluids can reduce appetite, and instead have drinks in between mealtimes. Exercise can stimulate appetite, so a short walk in the evening before dinner may make a difference. If Alfred is unwilling to make these changes, the GP may consider prescribing oral nutritional supplements.
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