My parent lives alone. Are they eating enough?

If your parent lives alone, it is worth checking how they eat, because Thai surveys find that older people who live alone tend to eat fewer fruit and vegetables and a less varied diet than those who live with family. In a 2018 national household survey of 2,048 people aged 60 and over, only 31.9% ate at least 400 g of fruit and vegetables a day, and those who lived alone were the least likely to. You cannot see their plate every day, but you can ask how many meals they eat and what was on them, look at their fridge and shopping when you visit, and watch for clothes getting looser. If their weight is going down without trying, take them to a doctor.

Do older Thai people who live alone eat less well?

In some ways. Two large Thai surveys found that older people who live alone tend to eat fewer fruit and vegetables and a less varied diet, but not every kind of food follows that pattern.

What Thai studies found

What these numbers can and cannot tell you

Most of these surveys asked people to recall what they ate, which is easy to over- or under-estimate. They were taken at one point in time, so they show that living alone and eating less well go together, not that one causes the other. In the 2018 survey, 6.3% of the older people lived alone, and living alone was not the only factor: sex, where people lived, education, work and income all made a difference too.

Why might a parent who lives alone eat less well?

The US National Institute on Aging (NIA) lists common roadblocks that make it harder for older adults to eat well. Several of them weigh more heavily on someone who eats alone.

Cooking for one

The NIA notes that some older adults get tired of planning and cooking meals every night. With no one to cook for, it is easy to fall back on instant noodles or the same simple dish, which fits the 2021 Thai survey finding that older people living alone were the most likely to eat instant food. The same survey found the opposite for high-fat food, fast food and snacks, which were much more common in homes shared with working-age adults and children, so living with family is not automatically healthier.

Money and shopping

A fixed or limited income can limit what someone buys. The NIA suggests deciding on a food budget, planning meals around what is on sale, and buying reasonably priced fruit and vegetables such as bananas, apples, oranges and carrots.

Apart from cost, getting to a market may also be harder for someone who no longer drives or walks far.

Chewing, taste and appetite

The NIA says people who have problems with their teeth or dentures often avoid meat, fruit and vegetables. It also notes that the senses of taste and smell can change with age, dental problems or medicines, that some people feel full sooner than when they were younger, and that some medicines reduce appetite. For eating with few teeth, see Older parents with few teeth: how can they get protein?

Mood

Being unhappy can cause a loss of appetite, according to the NIA. Feeling down now and then is normal, but if it lasts a few weeks or months, the NIA advises talking with a doctor.

What should an older parent eat in a day?

The aim is the same as for any adult: food from all the main groups, every day, in amounts they can manage.

Use the food groups as a checklist

England's NHS Eatwell Guide groups food into fruit and vegetables; starchy foods such as rice, bread and potatoes; beans, pulses, fish, eggs, meat and other protein; and dairy or alternatives such as soya drinks. It suggests drinking 6 to 8 cups or glasses of fluids a day. The balance does not need to be met at every meal, but over a day or even a week.

The 2:1:1 plate for each meal

The 2:1:1 formula recommended by the Thai Health Promotion Foundation (ThaiHealth), as explained in Ramathibodi Hospital's @Rama magazine, divides a 9-inch plate into 4 equal parts:

For more on eating alone and covering the food groups, see Living alone with patchy meals: how can I cover food groups? It is written for working adults, but the shopping tips work at any age.

I live far away. How can I check whether my parent is eating enough?

You will not see every meal, so look for patterns rather than single days.

Ask about yesterday, meal by meal

"Did you eat?" usually gets a "yes". Instead, ask what they had for breakfast, lunch and dinner yesterday, and what was on the plate. Listen for missed meals and for missing groups, such as no vegetables, fruit or milk for days, or rice with only a little sauce. The Thai HART study found lunch was the meal skipped most often among people aged 45 and over.

Look in the fridge and kitchen when you visit

• Is there fresh food, or mostly instant noodles and snacks?
• Is cooked food being kept for days? The CDC advises refrigerating cooked leftovers within 2 hours, or within 1 hour when it is hotter than 32°C (90°F), and keeping the fridge at 4°C (40°F) or below.
• Is food that was bought on your last visit still unopened?

Watch for changes in the body

England's NHS lists signs that someone may not be getting enough from their diet:

• weight going down without trying, or clothes, belts and jewellery becoming looser over time
• less appetite, or a lack of interest in food and drink
• feeling tired all the time or weaker than before

A photo now and then, or a quick check of how a familiar shirt fits, can show changes that are hard to notice over the phone.

How can I help my parent eat better from a distance?

Make food easy to get

The NIA mentions food delivery services as one option for older adults who are tired of cooking. You can help set up delivery or a regular order with a nearby shop, and stock foods that keep and are easy to eat, such as canned fish, UHT milk or unsweetened UHT soy milk, bananas and oranges, plus boiled eggs made ahead and kept in the fridge.

Make meals social again

The NIA suggests potluck meals, cooking with a friend and having some meals at a nearby community centre or religious facility, which also means company while eating. In the 2018 Thai survey, older people who lived with others were more likely to eat enough fruit and vegetables than those who lived alone. When you visit, cook together and leave portions in the fridge. Between visits, a video call at mealtime lets you eat "together".

Keep in touch with neighbours and relatives nearby

A neighbour, a relative in the same village or the local community health volunteer can notice when your parent stops going to the market or looks thinner. Agree with your parent who you can ask.

For a wider look at your parents' daily routine, including drinking, moving and medicines, see our guide to older parents' daily routine

When should we take a parent who lives alone to see a doctor?

Take your parent to a doctor if:

• they have lost a lot of weight without trying over the past few months; the NHS lists losing 5 to 10% of body weight within 3 to 6 months as one of the main signs
• their appetite has dropped since starting a medicine (the NIA advises talking to the doctor about side effects)
• food seems to get stuck or is hard to swallow
• they have felt down for a few weeks or longer

If chewing is the problem, the NIA advises seeing a dentist, and having the fit of dentures checked. The NHS also says that if a family member has lost a lot of weight, talk to them about your concerns and encourage them to get help.