Caring for an Older Relative in My Home

1. Note to presenter: In these notes pages, instructions to you are set in italic type, while the “script” of what you might say as you show each slide is set in Roman type. Introductory remarks: Introduce yourself and the agency you represent. Explain that this session will focus on assessing whether an older relative who has retained most cognitive ability still is able to remain independent or requires care in the home of the family as well as nutritional requirements and meal plan for older adults. Distribute packet containing three handouts, pretest, and post-test. Request that audience members choose a 4-digit code number that is personal to them (such as the last four digits of their phone number, their street address, or the month and date of their birthday) and write it in the space provided on both the pretest and post-test. Allow 10 minutes for audience to fill out pretest. You should collect the pretest and post-test in some way designed to assure the anonymity of the participants, such as having them put the completed tests in a designated spot or pass them forward when the 10 minutes are up.Note to presenter: In these notes pages, instructions to you are set in italic type, while the “script” of what you might say as you show each slide is set in Roman type. Introductory remarks: Introduce yourself and the agency you represent. Explain that this session will focus on assessing whether an older relative who has retained most cognitive ability still is able to remain independent or requires care in the home of the family as well as nutritional requirements and meal plan for older adults. Distribute packet containing three handouts, pretest, and post-test. Request that audience members choose a 4-digit code number that is personal to them (such as the last four digits of their phone number, their street address, or the month and date of their birthday) and write it in the space provided on both the pretest and post-test. Allow 10 minutes for audience to fill out pretest. You should collect the pretest and post-test in some way designed to assure the anonymity of the participants, such as having them put the completed tests in a designated spot or pass them forward when the 10 minutes are up.

2. Bringing an older relative into your home ideally would occur after much planning between your family and the older relative, but it often comes about after an emergency situation. For example, the person may have had few or no problems living alone until he or she falls and breaks a hip or has a stroke or experiences an unexpected hospital stay. When any of those events occur, there might be a quick and informal assessment of the ability of the older relative to remain independent, and the family may decide to bring the person into their home and care for them there. The objectives of this presentation are: Explore the demographics of aging. Learn how to identify signs of inability to live independently. Consider benefits and challenges of living with family. Explore challenges presented to caregiver. Understand the nutritional needs of an older adult in your home. Identify changes in the body that affect nutrition in older adults. Bringing an older relative into your home ideally would occur after much planning between your family and the older relative, but it often comes about after an emergency situation. For example, the person may have had few or no problems living alone until he or she falls and breaks a hip or has a stroke or experiences an unexpected hospital stay. When any of those events occur, there might be a quick and informal assessment of the ability of the older relative to remain independent, and the family may decide to bring the person into their home and care for them there. The objectives of this presentation are: Explore the demographics of aging. Learn how to identify signs of inability to live independently. Consider benefits and challenges of living with family. Explore challenges presented to caregiver. Understand the nutritional needs of an older adult in your home. Identify changes in the body that affect nutrition in older adults.

3. As we look at the demographics of aging, we realize that people are living longer than ever before. In the United States, the population has been steadily aging for many decades. For example, in 1900, roughly 4 percent of the population was 65 and older. By 1990, the number of elderly persons had reached 31.2 million, or 12.6 percent of the total population. By 2030, 20 percent of the total U.S. population is projected to be 65 and older. The fastest-growing group is the oldest segment of society, the people who are 85 and older, which has increased 200 percent since 1960. This is the group that will require the greatest care. As we look at the demographics of aging, we realize that people are living longer than ever before. In the United States, the population has been steadily aging for many decades. For example, in 1900, roughly 4 percent of the population was 65 and older. By 1990, the number of elderly persons had reached 31.2 million, or 12.6 percent of the total population. By 2030, 20 percent of the total U.S. population is projected to be 65 and older. The fastest-growing group is the oldest segment of society, the people who are 85 and older, which has increased 200 percent since 1960. This is the group that will require the greatest care.

4. It is important to assess the dependency level of an older relative, preferably before bringing that person into your home. Dependency is defined as lack of independence or self-sufficiency. Losing one’s independence is a major life change. Ideally, such a change in living arrangements should be done after much thought and planning. It is important to assess the dependency level of an older relative, preferably before bringing that person into your home. Dependency is defined as lack of independence or self-sufficiency. Losing one’s independence is a major life change. Ideally, such a change in living arrangements should be done after much thought and planning.

5. This slide shows some general signs that a person may not be able to live independently. This slide shows some general signs that a person may not be able to live independently.

6. The single most important factor for someone who lives alone is mobility (how well the person can move about). If a person is immobile, it is nearly impossible to perform the basic activities of daily living.The single most important factor for someone who lives alone is mobility (how well the person can move about). If a person is immobile, it is nearly impossible to perform the basic activities of daily living.

7. A number of assessment tools are available. The Activities of Daily Living has been adapted from Katz and co-workers published in 1970 in The Gerontologist. This tool focuses on the basic skills an older adult needs to attend to everyday necessities. In some cases, not all of the basic skills are lacking, and there may be opportunities to bring in outside help (such as a visiting nurse to assist with bathing) so that the older relative can remain in his or her own home. When a person lacks many of these skills, it may be time to move the person into the home of the family or into a nursing home. Dependency can be determined through assessing activities of daily living. The activities are: Bathing • Dressing Toileting • Transferring to or from bed or chair Continence • FeedingA number of assessment tools are available. The Activities of Daily Living has been adapted from Katz and co-workers published in 1970 in The Gerontologist. This tool focuses on the basic skills an older adult needs to attend to everyday necessities. In some cases, not all of the basic skills are lacking, and there may be opportunities to bring in outside help (such as a visiting nurse to assist with bathing) so that the older relative can remain in his or her own home. When a person lacks many of these skills, it may be time to move the person into the home of the family or into a nursing home. Dependency can be determined through assessing activities of daily living. The activities are: Bathing • Dressing Toileting • Transferring to or from bed or chair Continence • Feeding

8. This slide corresponds to the handout that was distributed in the packet. This slide is the same as the handout that is in the packet that you received earlier today. You can use this guide to rate a person for their ability to live independently. The second page of the handout explains how to assign a score for each of the Activities of Daily Living. This tool does not have a “pass or fail” number. You must look critically at the score for each item, as well the total score, to determine in which categories the person requires assistance. Providing some help with some activities might allow the person to remain somewhat independent. Take this handout home and use it to assess the needs of your older elative. Your family may feel more comfortable if an outside clinical person, such as the older relative’s primary care physician, assists with the assessment.This slide corresponds to the handout that was distributed in the packet. This slide is the same as the handout that is in the packet that you received earlier today. You can use this guide to rate a person for their ability to live independently. The second page of the handout explains how to assign a score for each of the Activities of Daily Living. This tool does not have a “pass or fail” number. You must look critically at the score for each item, as well the total score, to determine in which categories the person requires assistance. Providing some help with some activities might allow the person to remain somewhat independent. Take this handout home and use it to assess the needs of your older elative. Your family may feel more comfortable if an outside clinical person, such as the older relative’s primary care physician, assists with the assessment.

9. Another assessment that can help to determine dependence is the Instrumental Activities of Daily Living. This tool assesses whether the person can use the telephone, shop for groceries, prepare meals, keep the house in order, do the laundry, attend to correct and timely use of medications, and manage his or her finances.Another assessment that can help to determine dependence is the Instrumental Activities of Daily Living. This tool assesses whether the person can use the telephone, shop for groceries, prepare meals, keep the house in order, do the laundry, attend to correct and timely use of medications, and manage his or her finances.

10. This slide corresponds to the handout that was distributed in the packet. This slide is the same as the handout in the packet that you received at the beginning of this program. Once again, the second page of the handout explains how to assign a score for each of the activities. You can take the handout home and fill it out with your family or with the help of an outside clinical person. This tool, like the first one we looked at, does not have a “pass or fail” number. You must look critically at the score for each item, as well the total score, to determine where your relative needs help. Providing some help with some activities might allow the person to remain somewhat independent. Poor scores in some categories could still allow a certain degree of independence in the home of a relative. However, a problem could occur if the caregiver is away during the day and the older adult person is alone in the home.This slide corresponds to the handout that was distributed in the packet. This slide is the same as the handout in the packet that you received at the beginning of this program. Once again, the second page of the handout explains how to assign a score for each of the activities. You can take the handout home and fill it out with your family or with the help of an outside clinical person. This tool, like the first one we looked at, does not have a “pass or fail” number. You must look critically at the score for each item, as well the total score, to determine where your relative needs help. Providing some help with some activities might allow the person to remain somewhat independent. Poor scores in some categories could still allow a certain degree of independence in the home of a relative. However, a problem could occur if the caregiver is away during the day and the older adult person is alone in the home.

11. Losing one’s independence is a major life change. Ideally, such a change in living arrangements should be done after much thought and planning. Most older adults who move into the home of a relative will have some misgivings. They may feel that they no longer will have any freedom, and will be constantly subject to the whims of their children caregivers. Also, they may have to move away from friends and peers with whom they shared many experiences. Their attempts to help with household chores or financially may not be accepted by the family, which may contribute to their perception that their presence is a burden to the family. Discussions about on how their presence is valued can diminish such feelings. Involvement in any activities in which the person can feel useful is important. Examples of "useful" activities include setting the table for dinner, watching the baby while a meal is being prepared, or feeding the dog or cat. Some older adults are embarrassed when they observe that a role reversal has occurred. They are being cared for by their children, when it was their job to care for their children in earlier years.Losing one’s independence is a major life change. Ideally, such a change in living arrangements should be done after much thought and planning. Most older adults who move into the home of a relative will have some misgivings. They may feel that they no longer will have any freedom, and will be constantly subject to the whims of their children caregivers. Also, they may have to move away from friends and peers with whom they shared many experiences. Their attempts to help with household chores or financially may not be accepted by the family, which may contribute to their perception that their presence is a burden to the family. Discussions about on how their presence is valued can diminish such feelings. Involvement in any activities in which the person can feel useful is important. Examples of "useful" activities include setting the table for dinner, watching the baby while a meal is being prepared, or feeding the dog or cat. Some older adults are embarrassed when they observe that a role reversal has occurred. They are being cared for by their children, when it was their job to care for their children in earlier years.

12. There are numerous advantages for the older adult living in the home of a relative. Familiar surroundings: In many cases, the older relative will have been close enough to the family that they will be going into a familiar environment. Feeling of security: The older adult may have a much greater feeling of security in the family environment. As people age and their functions begin to decline, it is not uncommon for them to become more aware of being alone. Their feeling of security may diminish. For example, fear of crime or fear of falling or of a stroke or other health problems are very pervasive among older individuals. Season of loss: As people age, they begin to experience increasing levels of the “season of loss.” They may have lost their career, their health, their standard of living, and their friends, spouse, and members of their family. Frequently, an older individual will say that it becomes more lonely as friends and acquaintances die. Sometimes they question why they are left behind. Living with a family may take away some of the stress of dealing with these losses.There are numerous advantages for the older adult living in the home of a relative. Familiar surroundings: In many cases, the older relative will have been close enough to the family that they will be going into a familiar environment. Feeling of security: The older adult may have a much greater feeling of security in the family environment. As people age and their functions begin to decline, it is not uncommon for them to become more aware of being alone. Their feeling of security may diminish. For example, fear of crime or fear of falling or of a stroke or other health problems are very pervasive among older individuals. Season of loss: As people age, they begin to experience increasing levels of the “season of loss.” They may have lost their career, their health, their standard of living, and their friends, spouse, and members of their family. Frequently, an older individual will say that it becomes more lonely as friends and acquaintances die. Sometimes they question why they are left behind. Living with a family may take away some of the stress of dealing with these losses.

13. Contributes to socialization: Living and sharing, if able, in the activities in the home of a relative can provide a family-centered, multi-generational atmosphere that allows the person to feel needed. On the other hand, living alone in social isolation is one of the factors that increases the risk of depression in older adults Aids in meeting nutritional needs: An older adult may eat better when he or she participates in shopping, cooking, and eating with the family. Active families motivate participation in physical activity: Exercise can improve a person’s physical and mental health. It also helps to maintain flexibility, which is important in preventing falls, and it improves cardiorespiratory endurance. But before an older person undertakes any increase in physical activity, they should check with their healthcare provider.Contributes to socialization: Living and sharing, if able, in the activities in the home of a relative can provide a family-centered, multi-generational atmosphere that allows the person to feel needed. On the other hand, living alone in social isolation is one of the factors that increases the risk of depression in older adults Aids in meeting nutritional needs: An older adult may eat better when he or she participates in shopping, cooking, and eating with the family. Active families motivate participation in physical activity: Exercise can improve a person’s physical and mental health. It also helps to maintain flexibility, which is important in preventing falls, and it improves cardiorespiratory endurance. But before an older person undertakes any increase in physical activity, they should check with their healthcare provider.

14. Family members provide approximately 80 percent of the necessary care for the elderly. References: Thompson, L., Long-term care: Support for family caregivers [Issue Brief]. Washington, DC: Georgetown University, 2004, and Long-Term Care Financing Project, Long-term Care Users Range in Age and Most Do Not Live in Nursing Homes. U.S. Agency for Healthcare Research and Quality, 2000. Usually there is one primary caregiver, and most often this is an adult daughter or spouse. The primary caregiver frequently must provide this care under complex circumstances. Often the caregiver must balance the concerns of the immediate family, work outside the home, and care for an older person. More than 50 percent of all informal caregivers are women. Many of these women, because they are married and having children later, frequently find themselves caring for their children and elders at the same time. Reference: Brody, E.M. & Schoonover, C.B. Patterns of parent care when adult daughters work and when they do not. The Gerontologist. 26:372-381. 1986. Sons generally provide care only in the absence of an available daughter. Sons are more likely to provide assistance with “male tasks,” such as home maintenance. Also, sons tend to help their fathers more than they help their mothers. Reference: Stoller, E.P. Males as helpers: The roles of sons, relatives and friends. The Gerontologist. 30:228-235. 1990.Family members provide approximately 80 percent of the necessary care for the elderly. References: Thompson, L., Long-term care: Support for family caregivers [Issue Brief]. Washington, DC: Georgetown University, 2004, and Long-Term Care Financing Project, Long-term Care Users Range in Age and Most Do Not Live in Nursing Homes. U.S. Agency for Healthcare Research and Quality, 2000. Usually there is one primary caregiver, and most often this is an adult daughter or spouse. The primary caregiver frequently must provide this care under complex circumstances. Often the caregiver must balance the concerns of the immediate family, work outside the home, and care for an older person. More than 50 percent of all informal caregivers are women. Many of these women, because they are married and having children later, frequently find themselves caring for their children and elders at the same time. Reference: Brody, E.M. & Schoonover, C.B. Patterns of parent care when adult daughters work and when they do not. The Gerontologist. 26:372-381. 1986. Sons generally provide care only in the absence of an available daughter. Sons are more likely to provide assistance with “male tasks,” such as home maintenance. Also, sons tend to help their fathers more than they help their mothers. Reference: Stoller, E.P. Males as helpers: The roles of sons, relatives and friends. The Gerontologist. 30:228-235. 1990.

15. Nearly three out of four people between ages of 50 and 54 have at least one living parent and one living child. One-fifth of middle-aged households include at least one elderly parent who cannot be left alone and needs help with activities of daily living. These are mostly multigenerational households that also include children and even grandchildren. In 29 percent of these households, adult children provide caregiving time, give money for needed care and assistance, and/or share living space with their disabled elderly parents. Reference: Federal Agency for Healthcare Research and Quality. Elderly/Long-term care. Middle-aged children often provide money, caregiving time, and shared living space to help their disabled elderly parents. http://www.ahrq.gov/research/feb00/0200ra18.htmNearly three out of four people between ages of 50 and 54 have at least one living parent and one living child. One-fifth of middle-aged households include at least one elderly parent who cannot be left alone and needs help with activities of daily living. These are mostly multigenerational households that also include children and even grandchildren. In 29 percent of these households, adult children provide caregiving time, give money for needed care and assistance, and/or share living space with their disabled elderly parents. Reference: Federal Agency for Healthcare Research and Quality. Elderly/Long-term care. Middle-aged children often provide money, caregiving time, and shared living space to help their disabled elderly parents. http://www.ahrq.gov/research/feb00/0200ra18.htm

16. The family members can be a good support system for the older relative. If an older relative is assessed to require more extensive care, a solution often is to move the person into one’s home. But such a move should be undertaken with careful consideration, because the picture is not always a “bunch of roses.”The family members can be a good support system for the older relative. If an older relative is assessed to require more extensive care, a solution often is to move the person into one’s home. But such a move should be undertaken with careful consideration, because the picture is not always a “bunch of roses.”

17. Ask the question: How many of you are caring for an older relative in your home? Wait for show of hands. Ask the question: Are you caring for more than one relative? Wait for show of hands. Remind the audience: If you are currently caring for an older relative in your home, chances are good that you will at some time during your lifetime.. Ask the question: How many are caring for an older relative and children at the same time in your home? Wait for show of hands.Ask the question: How many of you are caring for an older relative in your home? Wait for show of hands. Ask the question: Are you caring for more than one relative? Wait for show of hands. Remind the audience: If you are currently caring for an older relative in your home, chances are good that you will at some time during your lifetime.. Ask the question: How many are caring for an older relative and children at the same time in your home? Wait for show of hands.

18. Those of you who answered yes to that last question are part of the “Sandwich Generation.” That is a name for those people caught between the demands of raising children and caring for aging parents or other relatives. This group is rapidly increasing — currently about 25 percent of American families are involved in some way with older parent care. Eight in ten of these “sandwiched” individuals work full-time, and their added caretaking responsibilities cause some to reduce or shift their hours or to lose income. Also, four in ten of sandwiched workers incur extra expenses to care for their older relative, such as renting medical equipment or purchasing cell phones. The main point to remember is that caring for an elderly loved one will be challenging. You can expect that it will put a strain on your everyday life. While you’re helping your parents and relatives, try to get help and support from your whole family, as well as from professionals who specialize in elder care. Reference: Avoiding Caregiver Stress (2005) Home Instead Senior Care, Omaha, NE. http://caregiverstress.com/avoidcgs.html Those of you who answered yes to that last question are part of the “Sandwich Generation.” That is a name for those people caught between the demands of raising children and caring for aging parents or other relatives. This group is rapidly increasing — currently about 25 percent of American families are involved in some way with older parent care. Eight in ten of these “sandwiched” individuals work full-time, and their added caretaking responsibilities cause some to reduce or shift their hours or to lose income. Also, four in ten of sandwiched workers incur extra expenses to care for their older relative, such as renting medical equipment or purchasing cell phones. The main point to remember is that caring for an elderly loved one will be challenging. You can expect that it will put a strain on your everyday life. While you’re helping your parents and relatives, try to get help and support from your whole family, as well as from professionals who specialize in elder care. Reference: Avoiding Caregiver Stress (2005) Home Instead Senior Care, Omaha, NE. http://caregiverstress.com/avoidcgs.html

19. Being part of the “Sandwich Generation” can present challenges within the family and to the primary caregiver — who most often is the daughter or daughter-in-law. Eight in ten of these “sandwiched” individuals work full time, but they may find it necessary to discontinue or put on hold a career and stay at home to be a full-time caregiver. Alternatively, the added caregiving responsibilities cause some to reduce or shift their hours or to lose income. While young children and teenagers in the family can benefit from the older adult living in their home, they may feel resentful because of the decreased attention from their parents. Another challenge may be the additional expenses that may occur as a result of having to make major modifications to the home to accommodate the older adult. Some simple changes may be to 1) install grab bars in the bathroom, 2) replace faucets with levers so there is no knob to twist, or 3) put high-watt light bulbs in light fixtures to brighten the rooms. Some major home modifications may be to 1) convert a room on the first floor into a bedroom for an older adult who is unable to mange the stairs, 2) add railings and a ramp at the front entrance to the house, and 3) widen doors so a wheelchair or walker can pass through. Being part of the “Sandwich Generation” can present challenges within the family and to the primary caregiver — who most often is the daughter or daughter-in-law. Eight in ten of these “sandwiched” individuals work full time, but they may find it necessary to discontinue or put on hold a career and stay at home to be a full-time caregiver. Alternatively, the added caregiving responsibilities cause some to reduce or shift their hours or to lose income. While young children and teenagers in the family can benefit from the older adult living in their home, they may feel resentful because of the decreased attention from their parents. Another challenge may be the additional expenses that may occur as a result of having to make major modifications to the home to accommodate the older adult. Some simple changes may be to 1) install grab bars in the bathroom, 2) replace faucets with levers so there is no knob to twist, or 3) put high-watt light bulbs in light fixtures to brighten the rooms. Some major home modifications may be to 1) convert a room on the first floor into a bedroom for an older adult who is unable to mange the stairs, 2) add railings and a ramp at the front entrance to the house, and 3) widen doors so a wheelchair or walker can pass through.

20. The caregiver may not realize how overwhelming it can be to assume the responsibilities of full-time caregiving. Full-time caregiving can affect the physical, mental, and emotional health of the caregiver. The main points to remember are that caring for an older person will be challenging, and caregiving will put a strain on your everyday life. It is extremely important for the caregiver to take care of her or his own health. Once the older adult is living with the family, caregivers may find themselves unprepared for something as simple as meal preparation. Nutrition needs and preferences change with age, and the rest of this presentation will look at those changes and how to assure adequate nutrition for an older adult.The caregiver may not realize how overwhelming it can be to assume the responsibilities of full-time caregiving. Full-time caregiving can affect the physical, mental, and emotional health of the caregiver. The main points to remember are that caring for an older person will be challenging, and caregiving will put a strain on your everyday life. It is extremely important for the caregiver to take care of her or his own health. Once the older adult is living with the family, caregivers may find themselves unprepared for something as simple as meal preparation. Nutrition needs and preferences change with age, and the rest of this presentation will look at those changes and how to assure adequate nutrition for an older adult.

21. Nutrition for Older Adults Changes that affect nutrition as we age… Senses Body structure Specific nutrient needs Let’s talk specifically about how we can make sure our older adult relative get enough good, healthy food. As we age, many changes take place. Many of these changes can affect whether we get adequate nutrition. For example: • Sensory changes, such as loss of smell and loss of taste, can decrease the desire to eat. • Structural changes in the body, such as loss of teeth, can impair chewing; reduced muscle mass and a change in metabolic rate can lead to weight changes. • Also, older people have specific nutrient needs. For example, their thirst perception may be impaired, so they need to remember to drink enough water to prevent dehydration. They also may need more fiber to compensate for their slowed-down digestive system, and more calcium to prevent osteoporosis. Let’s talk specifically about how we can make sure our older adult relative get enough good, healthy food. As we age, many changes take place. Many of these changes can affect whether we get adequate nutrition. For example: • Sensory changes, such as loss of smell and loss of taste, can decrease the desire to eat. • Structural changes in the body, such as loss of teeth, can impair chewing; reduced muscle mass and a change in metabolic rate can lead to weight changes. • Also, older people have specific nutrient needs. For example, their thirst perception may be impaired, so they need to remember to drink enough water to prevent dehydration. They also may need more fiber to compensate for their slowed-down digestive system, and more calcium to prevent osteoporosis.

22. Sensory Changes Loss of smell Experiment with fresh herbs and unusual spices Focus on “eye appeal” The senses of taste, smell, sight, hearing, and touch diminish with age. As the sense of smell dwindles, it becomes difficult to identify and enjoy food. If food seems unappealing because of a reduced sense of smell, the following ideas may help to perk up meals. Flavor foods with strong seasonings, such as onion, garlic, oregano, or mint to enhance the senses. Focus on eye appeal. Older adults may be more likely to consume a meal that is colorful and that is presented attractively on the plate.The senses of taste, smell, sight, hearing, and touch diminish with age. As the sense of smell dwindles, it becomes difficult to identify and enjoy food. If food seems unappealing because of a reduced sense of smell, the following ideas may help to perk up meals. Flavor foods with strong seasonings, such as onion, garlic, oregano, or mint to enhance the senses. Focus on eye appeal. Older adults may be more likely to consume a meal that is colorful and that is presented attractively on the plate.

23. More Sensory Changes Loss of taste Altered by medications Can lead to loss of appetite Another sense that can be affected by aging is the sense of taste. A diminished sense of taste may make food less appealing, leading to a possible loss of appetite. Taste may also be altered by medications. If food seems unappealing because of a decrease in the body’s ability to taste, consider: • Flavoring foods with strong seasonings. • Using tart flavors such as pickles, vinegar, and lemon juice to enhance taste. • Marinating meats in fruit juices, Italian dressing, and sweet-and-sour sauce for extra zest. Another sense that can be affected by aging is the sense of taste. A diminished sense of taste may make food less appealing, leading to a possible loss of appetite. Taste may also be altered by medications. If food seems unappealing because of a decrease in the body’s ability to taste, consider: • Flavoring foods with strong seasonings. • Using tart flavors such as pickles, vinegar, and lemon juice to enhance taste. • Marinating meats in fruit juices, Italian dressing, and sweet-and-sour sauce for extra zest.

24. Structural Changes Reduced muscle mass and strength Reduced organ function Decrease in weight Structural changes that take place as the body ages include: • Reduced muscle mass. Progressive replacement of lean body mass by fat and connective tissue appears to be a consequence of aging. Studies suggest that exercise training may improve muscle function and reduce the risk of falls and fractures. • Reduced organ function. The kidneys, digestive system, and heart may all operate less efficiently. Kidney function can diminish 50 percent between the ages of 30 and 80. The muscles of the digestive tract become weaker, and additional fluids are needed to propel food through the body. Blood vessels become less elastic, leading to high blood pressure. Blood cholesterol levels rise with age. • Change in metabolic rate. Basal metabolic rate decreases by 20 percent between ages 30 and 90. Changes in metabolic rate (that’s the calories needed just to keep our bodies working) may reduce the number of calories needed each day and may contribute to weight changes. Weight generally trends downward after age 60.Structural changes that take place as the body ages include: • Reduced muscle mass. Progressive replacement of lean body mass by fat and connective tissue appears to be a consequence of aging. Studies suggest that exercise training may improve muscle function and reduce the risk of falls and fractures. • Reduced organ function. The kidneys, digestive system, and heart may all operate less efficiently. Kidney function can diminish 50 percent between the ages of 30 and 80. The muscles of the digestive tract become weaker, and additional fluids are needed to propel food through the body. Blood vessels become less elastic, leading to high blood pressure. Blood cholesterol levels rise with age. • Change in metabolic rate. Basal metabolic rate decreases by 20 percent between ages 30 and 90. Changes in metabolic rate (that’s the calories needed just to keep our bodies working) may reduce the number of calories needed each day and may contribute to weight changes. Weight generally trends downward after age 60.

25. More Structural Changes Loss of bone density Loss of teeth Other structural changes that take place as the body ages include: • The failure to absorb calcium efficiently. This can lead to bone loss, which may result in increased fractures and possibly osteoporosis. Your older adult relative may also notice a decrease in height! Older people should consume at least three cups a day of dairy products, such as milk, yogurt, or cheese. Also, encourage activity at least three times per week if the person is mobile. • Loss of teeth. People with dentures chew less efficiently than those with natural teeth, which may lead to decreased consumption of meats, fresh fruits, and vegetables. This can result in inadequate intake of iron, which can contribute to anemia. People who have difficulty chewing also might not get enough vitamins, particularly vitamin C, folate, and vitamin A. Dentures that don’t fit properly may also cause a person to unconsciously change eating patterns because of difficulty with chewing. Older adults should have a thorough dental checkup each year to assess permanent teeth or to adjust poorly fitting dentures. Until dental problems are corrected, consuming a soft diet may be necessary. Also, providing a wide variety of easy-to-chew foods will help to meet nutrient requirements. Some examples of easy-to-chew foods are:• Cottage cheese • Bananas • Milkshakes• Tuna • Custard • Chopped fruits and vegetablesOther structural changes that take place as the body ages include: • The failure to absorb calcium efficiently. This can lead to bone loss, which may result in increased fractures and possibly osteoporosis. Your older adult relative may also notice a decrease in height! Older people should consume at least three cups a day of dairy products, such as milk, yogurt, or cheese. Also, encourage activity at least three times per week if the person is mobile. • Loss of teeth. People with dentures chew less efficiently than those with natural teeth, which may lead to decreased consumption of meats, fresh fruits, and vegetables. This can result in inadequate intake of iron, which can contribute to anemia. People who have difficulty chewing also might not get enough vitamins, particularly vitamin C, folate, and vitamin A. Dentures that don’t fit properly may also cause a person to unconsciously change eating patterns because of difficulty with chewing. Older adults should have a thorough dental checkup each year to assess permanent teeth or to adjust poorly fitting dentures. Until dental problems are corrected, consuming a soft diet may be necessary. Also, providing a wide variety of easy-to-chew foods will help to meet nutrient requirements. Some examples of easy-to-chew foods are:• Cottage cheese • Bananas • Milkshakes• Tuna • Custard • Chopped fruits and vegetables

26. As a person gets older, the body needs fewer calories (energy from food). This is true because: • There is a decline in the metabolic rate, which is the number of calories needed for involuntary work such as breathing, heartbeat, and food digestion. • People tend to be less active as they age. Although older adults need to eat fewer calories to maintain the same body weight, they still need about the same amount of important nutrients (protein, vitamins, and minerals). As a person gets older, the body needs fewer calories (energy from food). This is true because: • There is a decline in the metabolic rate, which is the number of calories needed for involuntary work such as breathing, heartbeat, and food digestion. • People tend to be less active as they age. Although older adults need to eat fewer calories to maintain the same body weight, they still need about the same amount of important nutrients (protein, vitamins, and minerals).

27. Nutritional Needs Change with Age Daily requirements for most vitamins and minerals do not decrease with age Older adults need a nutrient-dense diet, which may be supplemented with a daily multivitamin. A healthy older individual can get all the vitamins and minerals he or she needs from foods. Sometimes, older people take a vitamin and mineral supplement to try to make up for poor eating habits. Even though most healthy older adults do not need supplements, some take a multivitamin with minerals for “insurance” to make sure they get the proper amounts each day. Anyone who plans to take a daily multivitamin should first check with their doctor. Other types of supplements are energy shakes that advertise themselves as meal replacements. They should be used to supplement meals, and only after consulting a doctor or registered dietitian.A healthy older individual can get all the vitamins and minerals he or she needs from foods. Sometimes, older people take a vitamin and mineral supplement to try to make up for poor eating habits. Even though most healthy older adults do not need supplements, some take a multivitamin with minerals for “insurance” to make sure they get the proper amounts each day. Anyone who plans to take a daily multivitamin should first check with their doctor. Other types of supplements are energy shakes that advertise themselves as meal replacements. They should be used to supplement meals, and only after consulting a doctor or registered dietitian.

28. The Energy Nutrients Carbohydrates Protein Fat The body needs fuel from food in order to survive. There are three key energy nutrients: Carbohydrates, protein, and fat. Carbohydrates provide energy. Most carbohydrates in our diet should come from complex carbohydrate foods, such as cereals, grains, corn, potatoes, and fruit. All adults should limit the amount of simple carbohydrates, or sugar-rich foods, such as soda, cakes, and cookies. Protein is needed to maintain healthy cells, help the body fight infections, heal wounds, and make enzymes and hormones. Protein needs may increase because of surgery, illness, or disease. Examples of protein-rich foods are meat, nuts, and beans. Fat is also important in the daily diet, but excessive fat consumption is a risk factor for heart disease, cancer, and obesity. Oils are fats, and the healthiest selections include olive oil and canola oil.The body needs fuel from food in order to survive. There are three key energy nutrients: Carbohydrates, protein, and fat. Carbohydrates provide energy. Most carbohydrates in our diet should come from complex carbohydrate foods, such as cereals, grains, corn, potatoes, and fruit. All adults should limit the amount of simple carbohydrates, or sugar-rich foods, such as soda, cakes, and cookies. Protein is needed to maintain healthy cells, help the body fight infections, heal wounds, and make enzymes and hormones. Protein needs may increase because of surgery, illness, or disease. Examples of protein-rich foods are meat, nuts, and beans. Fat is also important in the daily diet, but excessive fat consumption is a risk factor for heart disease, cancer, and obesity. Oils are fats, and the healthiest selections include olive oil and canola oil.

29. The Energy Nutrients Carbohydrates Grains are especially good for older adults Full of fiber (bulk) Provide energy, vitamins, and minerals When buying carbohydrates, look for “whole-grain” as the first ingredient Carbohydrates come in many forms. Grains are especially good for older people because grains are rich in fiber, B vitamins, and minerals, such as iron and magnesium. When buying carbohydrates, look for the term “whole-grain” as the first item in the ingredient list. Don’t be fooled into thinking a product is made from whole grains because it is brown. The color can come from molasses. The label must say “whole-grain” or “whole wheat,” not simply “wheat bread” or “wheat rolls.” If anyone in the audience asks about fiber, explain that it will be discussed later in more detail (in Slides 37 and 38). Carbohydrates come in many forms. Grains are especially good for older people because grains are rich in fiber, B vitamins, and minerals, such as iron and magnesium. When buying carbohydrates, look for the term “whole-grain” as the first item in the ingredient list. Don’t be fooled into thinking a product is made from whole grains because it is brown. The color can come from molasses. The label must say “whole-grain” or “whole wheat,” not simply “wheat bread” or “wheat rolls.” If anyone in the audience asks about fiber, explain that it will be discussed later in more detail (in Slides 37 and 38).

30. The Energy Nutrients Include a protein food source at each meal If chewing is difficult, chop meat well If tolerated, include dairy products As previously mentioned, protein is important for maintaining healthy cells, helping the body fight infections, and making enzymes and hormones. How can you ensure that an older adult gets enough daily protein? Be sure to include a protein source at each meal. Examples include meats, low-fat cottage cheese, and beans. If you’re on a budget, keep meat, poultry, and fish portions small. Consider other, less expensive protein sources, such as eggs, legumes, and peanut butter. If chewing is difficult, chop your meat or poultry well. Also remember to include dairy products, if tolerated. Milk, cheese, and yogurt and foods made with these ingredients also supply protein. Consult a registered dietitian for other ways to ensure enough protein in your food choices. As previously mentioned, protein is important for maintaining healthy cells, helping the body fight infections, and making enzymes and hormones. How can you ensure that an older adult gets enough daily protein? Be sure to include a protein source at each meal. Examples include meats, low-fat cottage cheese, and beans. If you’re on a budget, keep meat, poultry, and fish portions small. Consider other, less expensive protein sources, such as eggs, legumes, and peanut butter. If chewing is difficult, chop your meat or poultry well. Also remember to include dairy products, if tolerated. Milk, cheese, and yogurt and foods made with these ingredients also supply protein. Consult a registered dietitian for other ways to ensure enough protein in your food choices.

31. The Energy Nutrients Fat Solid fats vs. oils Eating less fat is often beneficial because it lowers the risk of chronic heart disease, cancer, and obesity All fats and oils are a mixture of saturated fatty acids and unsaturated fatty acids. Solid fats contain more “unhealthy fats” that increase cholesterol and, in turn, the risk for heart disease. Some examples include butter, margarine, shortening, lard, and mayonnaise, as well as fried foods. Oils contain “healthier fats,” which do not put a person at risk for heart disease, but are still high in calories. Some examples include olive oil, nuts, and fish. Most Americans consume enough fat without adding additional fats to the foods they eat. A lower fat intake is often necessary, especially in the older adult population, because of the risk of chronic heart disease, cancer and obesity. All fats and oils are a mixture of saturated fatty acids and unsaturated fatty acids. Solid fats contain more “unhealthy fats” that increase cholesterol and, in turn, the risk for heart disease. Some examples include butter, margarine, shortening, lard, and mayonnaise, as well as fried foods. Oils contain “healthier fats,” which do not put a person at risk for heart disease, but are still high in calories. Some examples include olive oil, nuts, and fish. Most Americans consume enough fat without adding additional fats to the foods they eat. A lower fat intake is often necessary, especially in the older adult population, because of the risk of chronic heart disease, cancer and obesity.

32. The Daily Diet Fluids Calcium Fiber Older adults have other nutrient requirements. Their daily diet must also include extra fluids, adequate calcium, and “bulk,” or fiber.Older adults have other nutrient requirements. Their daily diet must also include extra fluids, adequate calcium, and “bulk,” or fiber.

33. The Daily Diet Fluids Function: Reduce stress on kidneys Reduce constipation Ensure adequate blood volume Help carry medicine to proper places in the body Water is important, serving many essential functions in our bodies. Most older people do not consume all of the fluids their bodies need. The thirst signal that tells the body to drink may become weaker with age, so older people need to remind themselves to drink instead of waiting until they feel thirsty. Adults need at least six to eight cups, or 48 to 64 ounces, of fluids each day. In addition to water, fluids can also include juice, milk, soup, and decaffeinated tea. Adequate water intake reduces stress on kidney function, which tends to decline with age. Fluid intake also assists the digestive system and thus eases constipation. Fluids can ensure adequate blood volume as well as help the body distribute medication to proper places in the body. Water is important, serving many essential functions in our bodies. Most older people do not consume all of the fluids their bodies need. The thirst signal that tells the body to drink may become weaker with age, so older people need to remind themselves to drink instead of waiting until they feel thirsty. Adults need at least six to eight cups, or 48 to 64 ounces, of fluids each day. In addition to water, fluids can also include juice, milk, soup, and decaffeinated tea. Adequate water intake reduces stress on kidney function, which tends to decline with age. Fluid intake also assists the digestive system and thus eases constipation. Fluids can ensure adequate blood volume as well as help the body distribute medication to proper places in the body.

34. The Daily Diet Water Take regular breaks throughout the day to drink a glass of water Have fluids with your meal; try soups and juices Keep a water container available at all times Drinking fluids is important. People who make drinking lots of water part of their daily routine don’t have to worry about depriving their body of one of its most important nutrients. Water is especially important when the weather is very hot or very cold to guard against dehydration. Some tips to assist with increased fluid consumption include: • Take breaks throughout the day to concentrate on consuming water. • Consume fluids with meals. Fluids are not just water; soups, fruit juices, and milk also count. • If an older adult is bed-ridden or uses a wheelchair, it may be difficult for them to reach fluids. Keep fluids nearby in a container or glass to encourage fluid intake. If a person is very weak or frail, using a small glass or a straw may make drinking easier. Drinking fluids is important. People who make drinking lots of water part of their daily routine don’t have to worry about depriving their body of one of its most important nutrients. Water is especially important when the weather is very hot or very cold to guard against dehydration. Some tips to assist with increased fluid consumption include: • Take breaks throughout the day to concentrate on consuming water. • Consume fluids with meals. Fluids are not just water; soups, fruit juices, and milk also count. • If an older adult is bed-ridden or uses a wheelchair, it may be difficult for them to reach fluids. Keep fluids nearby in a container or glass to encourage fluid intake. If a person is very weak or frail, using a small glass or a straw may make drinking easier.

35. The Daily Diet Calcium Calcium is the most abundant mineral in the body Strengthens bones and teeth Reduces risk of fractures from falls Calcium gets a lot of attention because it is critical to bone health, especially in women. Calcium is the most abundant mineral in the body. It makes up about 1.5 to 2 percent of the body weight and 39 percent of total body minerals. Most of the body’s calcium is used for strengthening bones and teeth. Stronger bones reduce the risk of fractures from falls. Inadequate dietary calcium during growth and building periods has been linked to increased incidence of fractures. Adult bone loss begins during the 50th year of life in both sexes. Low bone mass is a principal risk factor for hip fractures in the older adult population. Calcium gets a lot of attention because it is critical to bone health, especially in women. Calcium is the most abundant mineral in the body. It makes up about 1.5 to 2 percent of the body weight and 39 percent of total body minerals. Most of the body’s calcium is used for strengthening bones and teeth. Stronger bones reduce the risk of fractures from falls. Inadequate dietary calcium during growth and building periods has been linked to increased incidence of fractures. Adult bone loss begins during the 50th year of life in both sexes. Low bone mass is a principal risk factor for hip fractures in the older adult population.

36. Specific Nutrient Needs Show me the calcium Make dairy choices at every meal Dairy products are the best source of calcium. In fact, about 70 percent of calcium in the American diet comes from milk and milk products. Make dairy choices at every meal. Low-fat and fat-free dairy products are just as rich in calcium as full-fat versions, and they are better choices if you are watching fat in your diet. Also, consider calcium-fortified products such as orange juice, cereal, rice, and bread, especially if you are preparing meals for a person who is lactose intolerant.Dairy products are the best source of calcium. In fact, about 70 percent of calcium in the American diet comes from milk and milk products. Make dairy choices at every meal. Low-fat and fat-free dairy products are just as rich in calcium as full-fat versions, and they are better choices if you are watching fat in your diet. Also, consider calcium-fortified products such as orange juice, cereal, rice, and bread, especially if you are preparing meals for a person who is lactose intolerant.

37. Specific Nutrient Needs Fiber The part of the plant that cannot be digested Lowers blood cholesterol Reduces constipation Fiber is a complex carbohydrate and is generally defined as the part of a plant that cannot be digested. Thus, it adds virtually no calories to the diet. One function of fiber is that it lowers blood cholesterol. The quantity of fiber needed to produce this effect varies by food source. Some examples of high-fiber, cholesterol-lowering foods include oatmeal, apples, pears, and prunes. Another function of fiber is that combined with proper water intake, it helps to speed up the passage of food through the body. This is especially important for older people because the muscles that move food through the digestive tract become weaker, thus slowing the passage of food through the intestines, causing constipation. Fiber is a complex carbohydrate and is generally defined as the part of a plant that cannot be digested. Thus, it adds virtually no calories to the diet. One function of fiber is that it lowers blood cholesterol. The quantity of fiber needed to produce this effect varies by food source. Some examples of high-fiber, cholesterol-lowering foods include oatmeal, apples, pears, and prunes. Another function of fiber is that combined with proper water intake, it helps to speed up the passage of food through the body. This is especially important for older people because the muscles that move food through the digestive tract become weaker, thus slowing the passage of food through the intestines, causing constipation.

38. Specific Nutrient Needs Fiber boosters Whole grain bread and flour Brown rice Fruits and vegetables Legumes and peanut butter High-fiber cereal * Add additional fiber to food by sprinkling on some bran Dietary fiber is beneficial for many health conditions, such as constipation, diarrhea, diverticulitis, cardiovascular disease, colon cancer, and diabetes. Fiber-rich foods are the best way to improve intestinal health. The American Cancer Institute recommends 20 to 30 grams of dietary fiber each day. Fiber-boosting foods include fruits; vegetables; whole grain breads and cereals; dried peas, beans, nuts, and seeds; and high-fiber cereal. Check the food label on each product to determine the amount of fiber it provides. Also, consider adding a spoonful of bran to foods to add additional fiber. Dietary fiber is beneficial for many health conditions, such as constipation, diarrhea, diverticulitis, cardiovascular disease, colon cancer, and diabetes. Fiber-rich foods are the best way to improve intestinal health. The American Cancer Institute recommends 20 to 30 grams of dietary fiber each day. Fiber-boosting foods include fruits; vegetables; whole grain breads and cereals; dried peas, beans, nuts, and seeds; and high-fiber cereal. Check the food label on each product to determine the amount of fiber it provides. Also, consider adding a spoonful of bran to foods to add additional fiber.

39. Variety: Spice Up Life More than 40 nutrients required daily The diets of seniors often lack variety. When this is the case, they may become bored with eating the same foods every day. As a result, they eat less or miss out on the more than 40 nutrients they need each day. It is important to make mealtimes appetizing and something to look forward to. This will help to increase the intake of nutrient-dense meals and meet daily caloric needs. Consider setting the table with cloth napkins and a tablecloth to increase the eye-appeal of the meal, or try to adding color to the plate with a variety of fruits and vegetables. The diets of seniors often lack variety. When this is the case, they may become bored with eating the same foods every day. As a result, they eat less or miss out on the more than 40 nutrients they need each day. It is important to make mealtimes appetizing and something to look forward to. This will help to increase the intake of nutrient-dense meals and meet daily caloric needs. Consider setting the table with cloth napkins and a tablecloth to increase the eye-appeal of the meal, or try to adding color to the plate with a variety of fruits and vegetables.

40. Opportunities to Include a Variety of Foods Provide breakfast foods for lunch or dinner Include a snack between meals Encourage small, frequent meals There are many opportunities to include a variety of foods at mealtimes. For example: 1. Consider providing breakfast foods for lunch or dinner. In some cases, breakfast is the favorite meal of the day. 2. Include snacks between meals if mealtime intake appears poor. 3. Some older adults are intimidated by large portions. Consider encouraging small, more frequent meals. This may help the older person consume the proper amount of calories and nutrients. 4. It is important to provide a variety of fruits and vegetables throughout the day. Fruits and vegetables are packed with vitamins and minerals and help individuals live longer, healthier lives. Make fresh fruits and vegetables that are “in season” available at all times. Frozen and canned varieties are another option. Ask audience to name other types of fruits and vegetables other than what is pictured above. Remember, the key is variety! Have you tried an alternative soup? Examples: • Carrot and ginger soup • Beef and lentil soup • Butternut squash soup There are many opportunities to include a variety of foods at mealtimes. For example: 1. Consider providing breakfast foods for lunch or dinner. In some cases, breakfast is the favorite meal of the day. 2. Include snacks between meals if mealtime intake appears poor. 3. Some older adults are intimidated by large portions. Consider encouraging small, more frequent meals. This may help the older person consume the proper amount of calories and nutrients. 4. It is important to provide a variety of fruits and vegetables throughout the day. Fruits and vegetables are packed with vitamins and minerals and help individuals live longer, healthier lives. Make fresh fruits and vegetables that are “in season” available at all times. Frozen and canned varieties are another option. Ask audience to name other types of fruits and vegetables other than what is pictured above. Remember, the key is variety! Have you tried an alternative soup? Examples: • Carrot and ginger soup • Beef and lentil soup • Butternut squash soup

41. Additional Tips for Increasing Food Consumption Taste and smell Texture and consistency Social dining Here are some tips to encourage eating by people who may have lost interest in food. To increase taste and smell: Use herbs, spices, and lemon juice to increase the flavor of foods. Serve foods at body temperature. Flavors are not as easy to detect in cold or hot foods. Consider texture when preparing a meal: Serve food with a variety of colors, temperatures, and textures. Use fresh and canned foods. Older people enjoy a variety of textures (crunchy, smooth) during their meals. Encourage social dining: Encourage older relatives to dine with the family. Invite guests at mealtimes. Eat out occasionally. Set a nice table with colorful placemats or trays and a centerpiece.Here are some tips to encourage eating by people who may have lost interest in food. To increase taste and smell: Use herbs, spices, and lemon juice to increase the flavor of foods. Serve foods at body temperature. Flavors are not as easy to detect in cold or hot foods. Consider texture when preparing a meal: Serve food with a variety of colors, temperatures, and textures. Use fresh and canned foods. Older people enjoy a variety of textures (crunchy, smooth) during their meals. Encourage social dining: Encourage older relatives to dine with the family. Invite guests at mealtimes. Eat out occasionally. Set a nice table with colorful placemats or trays and a centerpiece.

42. Factors to Consider when Preparing Meals for Older Adults Does your family member have difficultywith chewing? Is your family member on a restricted diet? What is the activity level of your adult relative? Do they take medications? Many factors must be considered when preparing meals for an older person. Does your family member have difficulty with chewing? As discussed earlier, losing teeth can make eating and chewing foods difficult. Consider a soft diet if chewing difficulties exist, and visit a dentist to adjust dentures that fit poorly. Is your family member on a restricted diet? Ask a health care specialist to explain any health conditions that may affect diet, and adjust the diet accordingly. Speak with a registered dietitian if a more detailed diet explanation is necessary. What is the activity level of your older adult relative? If they are mobile, they may have an increased appetite or willingness to go out of the house for a meal. Weight-bearing exercises can help protect against osteoporosis. Does your older adult relative take medications that may interfere with some foods? Speak with a doctor, registered dietitian, or pharmacist to help avoid any food-medication interactions. An older adult’s declining strength and energy may make choosing from a variety of foods and preparing meals difficult. Keep a reserve of easy-to-prepare foods on hand for sick days or when the weather is bad. Some examples include canned tuna, dried beans, ready-to-eat cereals, and dry soup mixes. Many factors must be considered when preparing meals for an older person. Does your family member have difficulty with chewing? As discussed earlier, losing teeth can make eating and chewing foods difficult. Consider a soft diet if chewing difficulties exist, and visit a dentist to adjust dentures that fit poorly. Is your family member on a restricted diet? Ask a health care specialist to explain any health conditions that may affect diet, and adjust the diet accordingly. Speak with a registered dietitian if a more detailed diet explanation is necessary. What is the activity level of your older adult relative? If they are mobile, they may have an increased appetite or willingness to go out of the house for a meal. Weight-bearing exercises can help protect against osteoporosis. Does your older adult relative take medications that may interfere with some foods? Speak with a doctor, registered dietitian, or pharmacist to help avoid any food-medication interactions. An older adult’s declining strength and energy may make choosing from a variety of foods and preparing meals difficult. Keep a reserve of easy-to-prepare foods on hand for sick days or when the weather is bad. Some examples include canned tuna, dried beans, ready-to-eat cereals, and dry soup mixes.

44. Assessing the Daily Diet of an Older Adult Was Today a Good Nutrition Day? Refer to the Was Today a Good Nutrition Day handout in the packet of materials. Have the audience assess one recent day’s worth of meals for their older adult relative as a take-home activity. Take a moment to think about the daily meals of your older adult relative. Review the five food groups and the amount consumed by your older adult relative on a daily basis. Take home the handout and use it as a guide when planning meals for them. Refer to the Was Today a Good Nutrition Day handout in the packet of materials. Have the audience assess one recent day’s worth of meals for their older adult relative as a take-home activity. Take a moment to think about the daily meals of your older adult relative. Review the five food groups and the amount consumed by your older adult relative on a daily basis. Take home the handout and use it as a guide when planning meals for them.