A graze that would close in a week on a grandchild can stay open for a month on a grandparent. Families often notice this and assume nothing can be done about it, because that is what happens with age. Some of it is age. A good deal of it comes from things that can be changed, and food is one of the biggest.
This matters because older people are also the ones most likely to have wounds that need healing: bedsores after an illness, skin tears from a small knock, leg ulcers, surgical wounds after a fracture, diabetic foot wounds.
Why do wounds heal more slowly with age?
Several changes add up. The skin becomes thinner and drier, with less collagen and fewer small blood vessels, so it tears more easily and has less supply for repair. Cells divide more slowly, so each stage of healing takes longer. Immune responses weaken, which raises the risk of infection. Many older people also have conditions that slow healing on their own, such as diabetes, heart disease, vein problems and kidney disease, and take medicines that affect skin or appetite.
Then there is movement. Someone who sits or lies for long hours puts steady pressure on the same patches of skin, and pressure cuts off blood flow. That is how bedsores start, and why a bedsore cannot heal while the pressure continues.
Why do older people eat less?
Appetite falls with age for several ordinary reasons, and they often stack up:
- taste and smell fade, so food seems bland
- thirst fades, so they drink less and feel full sooner
- loose dentures, missing teeth or a sore mouth make chewing hard
- medicines can dull appetite, cause nausea or leave a bitter taste
- constipation, which is very common, leaves the stomach uncomfortable
- living or eating alone takes the pleasure out of meals
- low mood, grief or memory problems mean meals get skipped
- moving less means feeling less hungry
The result is common and easy to miss: an older person slowly losing weight and muscle. Losing muscle weakens them, raises the risk of falls, and leaves the body with less protein to draw on for healing.
How much protein do older adults need?
More than many people assume. Nutrition experts generally recommend that healthy older adults eat about 1.0 to 1.2 grams of protein per kilogram of body weight a day, which is more than the amount usually quoted for younger adults. With a wound, the target rises to around 1.2 to 1.5 grams per kilogram.
For a 55 kg grandmother with a healing wound, that is roughly 65 to 80 grams of protein a day. If she currently eats a little dal, a roti and some rice, she may be getting half that.
The exception is kidney disease, which is common in older people. If they have it, ask the doctor for a protein target before raising protein.
Practical ways to feed an elder who eats very little
Offer small meals often. Five or six small portions a day are easier to face than three plates, and usually add up to more food.
Put protein first. Serve the dal, egg, paneer or curd before the rice or roti, while appetite is strongest.
Fortify foods they already accept. Two tablespoons of milk powder in a glass of milk or a bowl of dalia adds about 5 grams of protein. An egg or some grated paneer can be stirred into khichdi. Besan can go into kadhi or chilla.
Make it soft. Moong dal khichdi, curd rice, dalia, idli with sambar, soft paneer bhurji and scrambled eggs are easy to chew and swallow.
Use drinks. Many older people will drink when they will not eat. Milk with a banana and milk powder, lassi, sattu drink or thin dal can carry real protein.
Eat together. People eat more in company. Even sitting with them while they eat helps.
Check the mouth. A dentist visit for loose dentures or a sore gum can change how much someone eats more than any recipe.
Fluids need a schedule
Thirst fades with age, so older people often drink far too little without noticing. Many also cut drinks deliberately to avoid getting up at night. Offer drinks at fixed times through the day, give more in the morning and afternoon and a little less after about 6 pm, and keep a light cup with a spout or straw within reach. Pale straw-coloured urine usually means they are drinking enough. Sudden confusion in an older person can be a sign of dehydration, among other things, and needs medical attention.
Nutrients worth asking the doctor about
Some older people run low on nutrients that affect strength and healing. Vitamin B12 deficiency is common, especially in lifelong vegetarians, and can cause tiredness, numbness and memory changes. Vitamin D is often low in people who rarely go outdoors. Anaemia from low iron is also common. A doctor can check these with simple blood tests and treat any shortfall. Avoid starting high-dose supplements without asking, since older people often take several medicines that can interact.
Caring for someone with memory problems
People with dementia may forget to eat, forget they have eaten, or not recognise food on the plate. A few changes help. Serve one or two items at a time instead of a full thali. Use a plate that contrasts with the food, such as a coloured plate for white rice. Offer finger foods like small parathas, idli, cut fruit or paneer cubes that can be eaten without cutlery. Give gentle prompts, and allow plenty of time.
Protecting fragile skin from new wounds
Preventing a new wound is easier than healing one:
- change position at least every two hours for someone in bed, and more often if the skin is reddening
- check heels, hips, the lower back and elbows daily for red patches that do not fade
- keep skin clean and dry, and moisturise dry skin
- lift instead of dragging when moving someone in bed, to avoid skin tears
- pad bed rails and furniture edges
- keep nails short and use soft clothing
When should you see a doctor?
Get medical advice if an older person:
- is losing weight without trying, or eating less than half of meals for more than a week
- has a wound that is not clearly improving after two weeks
- has spreading redness, swelling, pus or a bad smell around a wound
- has a red or dark patch of skin that does not fade after pressure is removed
- becomes suddenly confused, drowsy or unwell
- coughs or chokes when eating or drinking
The bottom line
Older skin heals more slowly, but a large part of the slowdown comes from things a family can help with: eating too little protein, drinking too little, sitting on the same spot for too long, and mouth or medicine problems that get in the way of meals. Small, protein-rich meals, drinks on a schedule and regular changes of position give ageing skin its best chance.
For more on feeding a reluctant eater, see what to do when someone will not eat. For pressure sores, see what to feed someone with a bedsore, and for fluids, how much to drink while a wound heals.