Casaubon’s Book

Sharon March 26th, 2008

I worked my way through college (and saved for college in high school) by working in nursing homes and hospices.  It was good work, I liked it (although I often disliked the places I worked) and it gave me an education that came in very handy later, when Eric’s grandparents came to live with us.  I think it was helpful to me to learn early on something of what it was like to become vulnerable, dependent and fragile after a life of autonomy and independence.  One patient of mine once said to me, “You kids have no idea how hard it is to be old - you just see how hard it is to live with us.” 

So as I began to write this particular post, I’ve been thinking not only of how to handle the physical needs of the elderly and disabled, but more, how whenever possible, to make it easier to *be* them, not just to care for them.  I’m not sure that I have answers that I can pass on in this post - most of them have less to do with food storage than with relationships.  I think I will have to write more about this later. But for all of you who are now caring for an elderly family member, or may do so in the future, I think it is helpful, when you can, to remember that our goals should be balanced between making the very hard work of caretaking accessible and making the very hard work of being elderly less hard.

In a purely dietary sense, caring for the elderly or medically fragile could be just like feeding anyone else - or it could not be.  Many older people are restricted in their consumption of sodium, fats and other ingredients.  As we get older, the western diet tends to wear bodies down and people have to be more careful about what they eat.  Much of this is fairly specific - that is, your grandmother might require pureed, low sodium food, while my grandmother can eat anything she wants. 

 I’m going to assume here that the people we are talking about are either very elderly, towards the end of their lives, and suffering from debility of some sort, or have some kind of serious medical condition that requires them to be cared for.  Someone who is more capable and can do more of their own self-care should probably be consulted up front - approach them now and talk about what they might need - don’t assume.

So I’m going to focus on a few things that are fairly common across the board.  The first is the issue of dehydration. Many medically fragile people do not drink enough  (this applies also to young children when they get sick), and can rapidly become dangerously dehydrated.  This caused the death of a number of elderly people during Hurricane Katrina and causes deaths each year during heatwaves.  Dehydration can happen very quickly.  Everyone who cares for a child, elderly person or someone medically fragile should know how to recognize the signs of dehydration and also what fluids are best to rehydrate people with.  A study in The Lancet in 1978 observes  “The discovery that sodium transport and glucose transport are coupled in the small intestine so that glucose accelerates absorption of solute and water (is) potentially the most important medical advance this century.”

Someone suffering from dehydration due to heat, stomach illness or fever should not be given large quantities of cold water.  Instead, breastmilk (usually for children ;-), gruel (very thinned out cereals with a bit of sugar and salt added), green coconut liquid, carrot soup, dilute fruit juice or a rehydration liquid made with sugar (or better, molasses, which contains potassium) and salt should be given at room temperature.  There are more instructions here.  While this is especially important for those caring for the elderly, children and medically vulnerable, EVERYONE should familiarize themselves with this site and how to rehydrate someone suffering from dehydration.  Print the information out and store it somewhere too - it could save a life.  And store the elements of rehydration fluids somewhere readily available.  Slippery elm bark makes a gruel that can be eaten even by very nauseous people and stores for a good long time.

The other problem that plagues the elderly and those on lots of medications is often constipation.  This can be exacerbated in almost anyone by a sudden dietary shift, as is common when people start relying entirely on food storage. While such a diet is naturally high fiber, which is good, it is also unusual in the US.  The best cure for this is again, not to allow a major dietary shift - that is, to have elderly people adapt their diets now to food storage.  But if they are not already living with you, or object, this may not be possible.  So keeping a supply of stool softeners around and strongly encouraging people to drink a lot may make a huge difference.  In older people, if the option exists, try and transition them as gradually as possible.

Over time, lots of fiber and lots of liquids, lactobacilli (yogurt and other live fermented foods), exercise (even very frail people should get some movement every day, if necessary with you helping them move their limbs - this also helps with memory, overall sense of well being and a host of other problems) and high magnesium foods like leafy greens and seeds.  Sprouts might be especially important, since low magnesium levels are associated with chronic constipation.

Laxatives are a good thing to store for true emergencies but DO NOT overuse them - people become addicted to them physiologically very quickly - they become unable to move their bowels on their own. 

Generally speaking, food for the medically fragile or elderly, outside special diets, should be easy to chew (unless they are lucky to have good teeth and jaws), appetizing (that is, it should look and smell and taste good), come in small quantities - generally speaking, multiple small meals are better than three large ones, and be familiar whenever possible.  The best way to get these qualities are to become familiar right now with cooking out of your food storage in good ways.  Develop comfortable recipes, so that it doesn’t feel like a major transition when you shift.

My own feeling is that it is much more pleasant, appetizing and dignity enhancing for those who can’t chew well to get food that is soft in its natural form, ie, soups, stews, fruit sauces, compotes,  porridges, mashed vegetables, rather to puree up ham sandwiches or whatever (which, horribly enough, one of the nursing homes I worked at once did ;-P).  It should look and taste like food, be well seasoned and tasty.  I find that people are much more likely to eat that food, particularly if everyone else is eating that or something similar, than they are to eat mashed up foods.

Obviously, if you know of special diets, now is the time to think about adhering to them - learning to bake without sugar, storing milk replacements, or dealing with wheat intolerances early on is important.  On the subject of wheat, neither children nor the elderly should get too much of it - remember to keep your storage BALANCED - wheat is a common cause of digestive trouble.

But in the end, my own feeling is that food storage for the elderly, seriously disabled and fragile may be less about food than our attitudes towards them.  It can be hard to deal with someone who cannot do much work and has a lot of special needs - both psychologically and personally caretaking is difficult and can be exhausting and stressful.  But it is important to remember that this is all of our future - we are them.  The same needs will most likely come upon all of us - and what we do and learn here will shape us - and those who come behind us and will face the same dilemmas some day.

 Shalom,

 Sharon 

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