Nutritional Guidance for Post-Surgery Care of Elderly Patients

Postoperative Care for the Elderly

Hello: My grandmother is currently one hundred years old and underwent surgery for peritonitis in mid-December.
She was discharged in January for recovery.
At the time of discharge, the doctor did not provide specific dietary guidelines, only advising her to start with congee and to eat small, frequent meals.
My grandmother is lactose intolerant and experiences diarrhea when consuming commercial nutritional supplements.
The elders believe that commercial chicken essence is too greasy and rich in nutrients, making it unsuitable for her.
However, it seems that only consuming plain congee is not providing enough nutrition, and her strength is gradually declining.
We are unsure how to adjust her diet.
Since she is elderly and post-operative, everyone is being very cautious, but the elders have differing opinions.
We urgently need professional advice and guidance.

1.
Can she consume vegetable puree and root vegetable puree mixed into her congee?
2.
Is it possible to make congee with a variety of grains instead of just plain rice congee every day?
3.
Are there any specific ingredients that should be avoided, such as ginger, scallions, taro, or pumpkin?
4.
Could certain ingredients potentially cause an increase in body temperature? She has had slightly elevated body temperature in the past two days, and the caregivers mentioned it might be due to consuming ginger and overly rich foods.
Is this possible?
5.
How often can she consume products like chicken essence?
6.
Is it permissible for her to have fresh fruit juice or fruit puree?

Li Shufen, 30~39 year old female. Ask Date: 2016/02/01

Dr. Shi Guimei reply Nutrition

Dear Shufen,
Hello! It is acceptable to cook porridge using vegetable puree and root vegetable puree (including taro or pumpkin) mixed with white rice.
However, if only these ingredients are consumed, it may lead to insufficient protein intake.
It is important to also include soft-textured protein-rich foods such as tofu or soy milk, eggs (which can be made into steamed eggs or egg drop soup), deboned fish (boiled, steamed, or occasionally pan-fried with a small amount of oil), and lean ground meat (such as braised lean meat or lean meat porridge).
Dishes can also be enhanced with garlic, scallions, or a little ginger to stimulate appetite.
If there is not excessive ginger consumption, then the fever should not be related to ginger; please check if there has been improper use of warming items.
If a fever has developed, medical attention should be sought.
You may supplement with fresh juice or fruit puree twice daily.
There is no need to supplement with chicken essence, but if you wish to consume it occasionally, that is fine.

Wishing you health and happiness!
Sincerely,
Dietitian Shih Kuei-Mei
Director of Nutrition Department, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2016/02/01

More Info

Post-surgery nutritional care for elderly patients, especially those who have undergone significant procedures like your grandmother, is crucial for recovery and overall health. Given her age and recent surgery for peritonitis, it’s essential to ensure she receives adequate nutrition while considering her specific dietary restrictions, such as lactose intolerance.

1. Dietary Adjustments: Since your grandmother is lactose intolerant and experiences diarrhea from commercial nutritional supplements, it’s advisable to avoid these products. Instead, you can incorporate easily digestible foods that provide essential nutrients. Using vegetable purees and root vegetable purees mixed into her porridge is an excellent idea. These purees can add vitamins, minerals, and fiber without overwhelming her digestive system.
2. Variety in Grains: Instead of serving plain white porridge daily, consider using a mix of grains to enhance nutritional value. Quinoa, millet, and brown rice can be cooked into porridge, providing more protein, fiber, and essential nutrients than white rice. This variety can help maintain her interest in food and ensure she receives a broader spectrum of nutrients.

3. Foods to Avoid: Certain foods may be harder for her to digest or could potentially cause discomfort. Ginger, scallions, taro, and pumpkin can be stimulating for the digestive system and may lead to increased body temperature or discomfort in some individuals. If her caregivers have noticed a rise in her body temperature after consuming these foods, it might be wise to limit or avoid them for now. Instead, focus on bland, soothing foods that are easier on her stomach.

4. Temperature Regulation: While certain foods can influence body temperature, it’s essential to monitor her overall health. If her temperature remains elevated, it could be due to infection or other underlying issues rather than solely from her diet. Always consult with her healthcare provider if you notice persistent changes in her health status.

5. Chicken Essence and Similar Products: Products like chicken essence can be beneficial due to their protein content, but they should be introduced cautiously. Start with small amounts and observe how she reacts. If she tolerates it well, you can offer it a few times a week rather than daily to avoid overwhelming her system.

6. Fresh Juices and Purees: Fresh fruit juices or fruit purees can be a good source of vitamins, especially vitamin C, which is vital for healing. However, ensure that they are not too acidic, as this can irritate the stomach. Diluting juices with water can help make them easier to digest.
7. Frequent Small Meals: As you mentioned, small, frequent meals are ideal for elderly patients recovering from surgery. This approach helps prevent overwhelming her digestive system and allows for better nutrient absorption.
8. Hydration: Ensure she stays hydrated, as fluids are crucial for recovery. If she struggles with plain water, consider herbal teas or diluted juices to encourage fluid intake.

9. Consultation with Professionals: Given the complexity of her dietary needs and restrictions, it may be beneficial to consult with a registered dietitian or a healthcare provider specializing in geriatric nutrition. They can provide tailored advice based on her specific health status and recovery needs.

In summary, focus on providing a balanced diet that includes a variety of easily digestible foods, avoid known irritants, and ensure she remains hydrated. Monitoring her response to new foods and maintaining open communication with her healthcare team will be key to her recovery.

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