For families
Strength, independence, and the practical side of helping.
For anyone helping an older adult stay strong and stay themselves. What to notice, what helps day to day, how to prepare for a conversation with the care team, and how to support their choices once there is a plan.
What to notice
Strength shows up in ordinary things first.
Changes in strength, mobility, recovery and eating are easy to explain away one at a time. Written down together, with roughly when they started, they are what a dietitian or physician needs to hear, and the sooner the better. Clinicians check strength first, because it predicts poor outcomes better than muscle size does.
Strength
- Pushing up on the armrests to stand, or needing two attempts.
- Jar lids, bottle caps and faucets that have become a struggle.
- Shopping bags carried one at a time, or left for someone else.
Worth mentioning as soon as you notice it. There is no need to wait for it to get worse, and nothing here is too small to raise.
Mobility
- Stairs taken one step at a time, with a hand on the rail.
- A slower walk to the store, or stopping to rest on the way.
- Holding furniture to cross a room; a fall or a near fall.
Worth mentioning straight away, and any fall or near fall should be reported even without an injury.
Recovery
- A cold or a stomach bug that takes weeks to get over.
- Coming home from the hospital weaker than they went in.
- Days in bed or in the chair that are not followed by a bounce back.
Worth mentioning as soon as recovery seems slow. Do not wait to see whether strength comes back on its own.
Eating
- Smaller portions, skipped meals, the protein left on the plate.
- Clothes, rings or a watch strap that have become loose.
- Meals that are mostly toast, crackers or soup because they are easy.
Worth mentioning at the first sign. Do not wait for weight loss to show before raising it.
If something worries you now, don’t wait for the appointment. Contact their doctor promptly if they are losing weight without trying, or are having trouble swallowing. If they are choking, cannot breathe, or suddenly seem very unwell, call 911.
Morning
Getting out of bed and up from the chair
Is it slower, or two attempts?
Midday
The main meal
Is there protein on the plate, and is most of it eaten?
Afternoon
A walk, the stairs, the shopping
Shorter, slower, or avoided?
Evening
How the day has worn
Tired earlier? Slow to shake off a cold?
A day has four ordinary moments where these changes show. Noticing them over a week or two, and writing down what you see, gives the care team something concrete to work with.
Evidence and sources
Sources: 1
What helps day to day
Enough protein. Movement within the plan. Company at the table.
Expert groups recommend enough protein, regular activity and attention to how someone eats for older adults. What that means for one person is set by their care team, and none of these ideas replaces an assessment.
Protein-rich food ideas across a day
Breakfast
Cooked eggs, yogurt, milk.
Lunch
Beans, lentils, canned fish, cheese.
Dinner
Fish, meat, tofu, dairy.
Add protein to what they already eat
Adding is often easier than changing: a familiar meal with something extra in it is usually easier to accept than a new food.
For example: a fully cooked egg alongside soup or rice; milk instead of water in oatmeal; grated cheese on vegetables; yogurt with fruit instead of a cookie; beans or lentils folded into a stew. Check new ideas against any diet plan they already have, for kidney disease or diabetes for instance.
Keep the body doing what it does
Muscle keeps what it uses, and everyday activity is part of the signal to rebuild. The right activity is the one in their care team's plan, with whatever support they need to do it safely.
For example: keeping up the walks, stairs and carrying that are already part of their day, with a hand or a rail where needed, and asking the care team which program they recommend before adding anything new.
Make meals easier, not smaller
Eating less can have a practical cause, and easing it can help more than encouragement.
For example: smaller plates filled more often; a dental check if meat is being avoided; food that can be eaten with one hand if a grip is weak; and if chewing or swallowing is difficult, asking the care team which textures are right before changing what is served.
Eat together when you can
Many people eat more when they are not eating alone, and a shared meal is also where changes are noticed.
For example: one shared meal a day; a regular lunch with a neighbor; a phone call at mealtime when you cannot be there.
Prepare for a conversation
Choose what concerns you. Take the right questions.
Tick the things you have noticed, and the list of questions narrows to the ones that fit; print them and take them with you. The caregiver guide has pages for mealtime and strength notes, a log and the appointment questions. Nothing you tick is stored or sent anywhere; it only changes what is shown on this page.
Questions to take
With nothing ticked, five general questions to start with. Tick a concern to narrow the list.Showing the questions that fit what you ticked, plus the one to end on.
- Has their strength or weight changed over the last few months, and should we track it?
- Could any of their medicines be affecting appetite, taste or thirst?
- Are chewing, swallowing or dental problems making meals harder?
- Would a referral to a dietitian help, and how do we arrange one?
- What changes at home would you like us to notice and report back?
- Is it safe for them to keep doing the stairs and the shopping, and is there a strength or balance program you would recommend?
- Would an assessment by a physical therapist or an occupational therapist help, and how do we arrange one?
- How much protein should they aim for each day, and is there any reason, such as kidney disease, to limit it?
- Is there a reason to check for an underlying cause of eating less?
- Should we weigh them regularly at home, how often, and what change would you want to know about?
- What does recovery usually look like after this illness, and when should we worry that it is too slow?
- Is a short period of extra nutrition support worth considering during recovery?
- Could a dental or a swallowing assessment help, and which foods and textures are safe meanwhile?
- Could any medicine be changed, timed differently or taken with food to help appetite?
- Could low mood be part of this, and who could help with it?
- Are there meal delivery services, community meal programs or visiting services you would recommend locally?
Worth bringing
- A list of their medicines, including anything bought over the counter.
- Recent weights if you have them, with dates.
- What you have noticed and roughly when it started, in a few lines.
- What they enjoy eating, and what has dropped away.
Following the plan
Their choices, the care team's plan, and your part in both.
Once there is an assessment there is usually a plan: foods to aim for, a weight to keep an eye on, exercises from a physical therapist, sometimes a medical food used under a physician’s supervision. The plan works when the person owns it and the family makes it easy.
Keep the choice theirs
- Ask what they feel like, not what they should have. Offer, do not insist.
- Keep the foods they love in the plan; add to them rather than replace them.
- Let them set the pace at the table and on the stairs.
- Decisions about their care are theirs and the clinician's; your job is to make the plan livable.
Follow the plan as given
- If weighing was asked for, do it the same way each time and write it down.
- If a medical food is part of the plan, use it exactly as the physician or dietitian directed, and tell them what worked and what did not.
- Keep exercises to what the physical therapist set; add nothing without asking.
- Report changes early rather than waiting for the next appointment.
Two guides
Patient and caregiver resources.
Patient handout
What sarcopenia means, how protein and activity fit in, when to talk with a clinician and what to ask, with the sources listed. Written for the older adult and for you.
Use it before the appointment, or leave it with them to read in their own time.
Caregiver guide
Printable notes for the person helping, titled Mealtime and strength notes: what they enjoy, in their words; changes you have noticed and since when; a week of meals; questions to choose from; and when to call sooner.
Print it, keep it in the kitchen, and bring it to appointments.
Where CORUS fits
Nutrition added to the food they already eat.
For some older adults, everyday food alone no longer covers their needs. The first CORUS product is an unflavored powder in a sachet, a medical food made to add nutrition to familiar food, for use under physician supervision, launching soon. Whether it suits a particular person is their clinician's decision.
Launching soon.
The first CORUS product is preparing for launch. Product details, clinical information and how to get it will be published here when it launches.