Increasing years are associated with diminishing activity and a lessening demand for energy. Less nourishment must therefore be taken in proportion as age advances, or the individual will suffer. If a man of sixty continue to take the same abundant breakfast, substantial lunch, and heavy dinner, which he indulged in at the age of thirty or forty, it will lead to serious trouble. He may accumulate fat which will still further diminish his general activity, and will lead to serious heart mischief. Or he will develop various symptoms of gout or rheumatism, which will be in turn associated with evidences of kidney weakness and marked liability to apoplexy. We must bear in mind that the tissues in later life have less power to eliminate, and that the excretory activity of organs like the kidneys diminishes with increasing years. The amount of food therefore consumed in old age must be proportionate to the lessened demand of the tissue, and to the diminished powers of elimination. The total intake of food must be reduced. For the same reasons a man of seventy requires less food than a man of sixty years of age, and an octogenarian less than a man of seventy. It is often difficult to get the relatives of an old man to believe that it is inadvisable to "support" the weight of years by liberal feeding. The attempts to strengthen the old man by giving extra nourishment in the form of strong beef-teas, egg flips, and the like, cannot be too Strongly deprecated. Such liberal feeding merely goes to overcharge the blood with impurities, and to accelerate the decay of the tissues. Given a fair constitution, the use of a physiological diet in old age promotes a comfortable life, and is attended by a freedom from serious trouble which is of the greatest advantage both to the individual and to his relatives. It will be convenient to give the guiding rules for the dietetic management of a person of seventy years of age. Care has to be taken in the following directions: i. To restrict the total amount of food, ii. To make the diet simple and nutritious, avoiding excess of animal food, iii. To pay special attention to the form of administration of carbohydrates; old people are specially prone to flatulence.

Diet

The food should be given at short intervals, say five to six times in twenty-four hours; the diet should be simple; by this it is to be understood that not only is the quantity of food taken to be gradually diminished in proportion to decreased activity of body and mind, but that not more than two or three different forms of food should be served at any one meal. There is no objection to variety in the choice of foods. All food must be in a form admitting of easy mastication.

Any system of diet must be varied according to the circumstances and personal idiosyncrasies of the individual, but the following arrangement of meals can be recommended. If the patient is markedly obese, the diet must be restricted and modified along the lines laid down for Obesity on p. 500.

6 A.m . - Cup of tea freshly made; nothing to be eaten with it.

Breakfast: 8.30 A.m . - A small cup of tea or coffee; breadstuff should not be hot rolls, or indigestible new bread; eggs or fish cooked in various well-known ways.

Lunch: I Or 1.30 P.M . - Fish and a farinaceous pudding; or, fish and biscuits and cheese. It is, in most cases, better to reserve the meat or fowl to the evening meal.

4 P.M . - A cup of freshly made tea.

Dinner: 7 P.M . - Should generally commence with a little soup, a vegetable puree, or a good fish soup (vide infra). Fowl or game, red meat only occasionally, and one dish of vegetable. Pudding of a light, farinaceous variety, or stewed fruit.

10 P.M . - A cup of good consomme, or beef-tea or chicken tea, with a thin slice of toasted bread, is a very good thing tor an old person just as they get into bed.

Milk And Cream

Cream is a capital substitute for other forms of fatty food, and should be taken with tea and pudding.

Milk, if it can be digested, should always form a part of the dietary of the aged; the tendency should be to increase the amount of milk used as the vegetables and fruits are diminished. Milk is, of course, used in the cooking of gruels and farinaceous foods. As a beverage, milk can be taken with cocoa or coffee, or warmed and taken with a little saline or effervescing water.

Bread

White or brown bread should always be toasted, and some forms of bread are found to be more digestible than others, e.g. a "pan loaf." The toast should be thoroughly toasted through, and quite brittle; two to three slices crisply toasted should be sufficient. Dry biscuits and rusks have also special value in the diet of the aged (see also p. 93).

Butter

Fresh butter is the most wholesome of all fat foods; 1 ounce being taken in some form in the twenty-four hours.

Soups

The light forms of consomme, vegetable purees, and fish soup are all appreciated when taken in small quantity. Rich animal purees, hare soup, kidney soup, ox-tail and turtle, all throw too much strain on the digestive glands, and should be avoided. (See also Soups for the Gouty, p. 448).

Chicken, veal, and beef-teas may all be used for the light supper meal at night. A few additional recipes may be given for useful soups. These are supplementary to those recommended under the section on Convalescent Diet (p. 302), which have also special value in the dietary of the aged.

Brunoise Soup

I carrot, young.

1/2 turnip, young.

2 leaves celery.

Flower of small cauliflower.

1 onion.

1 ounce butter.

1 pint water.

I pint milk.

1 teaspoonful salt.

Pepper.

2 ounces of stale bread, toasted.

Stew the ingredients, except the toast, together for one hour, then break the toast in pieces, add it to the rest, and stew all together for another hour. Pass all through the sieve, and return to the stewpan to yet hot.