Eating well when you are very ill

I lost my dear uncle last month. He died at his home at the age of 80 from complications of emphysema after 50-plus years of smoking.

He had it his way, though. No assisted living, no nursing home. Independent until the end, he lived alone in a Chicago motel room for the last 12 years of his life.

His lung disease took away his mobility and reduced his 6-foot 2-inch frame to 130 pounds. With no microwave oven or stove, and only a small refrigerator for food storage, meals became whatever could be gotten from a package or opened with a hand-held can opener from the comfort of his chair.

Despite the malnutrition that accompanied his disease, my uncle took steps to prolong his life. Three years ago, he stopped smoking. And he got some long-distance coaching from his two dietitian nieces.

Like lung disease, cancer and other chronic illnesses often leave people with no appetite and little strength for fixing meals. Eating well in these cases poses a challenge. When weight loss is a threat, a good diet can help preserve a healthy weight and maintain strength.

My uncle applied every trick in the textbook. Among the most helpful:

• Eat small, frequent meals or snacks. They take less time and effort to prepare and eat, and smaller quantities of food in the stomach can cause less pressure and feel more comfortable for some people.
• Drink your nourishment. Fluids are easier to get down and can be concentrated in calories and nutrients. My uncle drank Ensure Plus, which delivers 350 calories in an eight-ounce can. That's as many calories as in a peanut butter sandwich. Similar brands of meal replacement drinks are available in grocery stores and pharmacies. Carnation Instant Breakfast is another, cheaper option.
• Go with no-effort meals. It may sound grim to eat a diet of boiled potatoes, kidney beans, baked beans and pickled beets from cans and jars. But ready-to-eat foods are simple and quick, and canned fruits and vegetables are nutritious. Jars of applesauce, fresh bananas and cups of yogurt are also easy.
• Know how much you are eating. My uncle kept a daily log of the foods he ate or drank and their calorie counts. If the total for a day came in at less than 1,500 calories, he'd drink a can of Ensure.

My uncle had bags of groceries delivered to his room by his neighborhood supermarket, where he could also order the occasional deli salad or sandwich. He indulged the family sweet tooth with cookies and bite-sized candy bars. ("When I need an energy boost," he'd say.) Desserts add calories but little in the way of nutrition. He'd sometimes pop a multivitamin and mineral supplement. Not ideal, but it probably didn't hurt.

What else works?

• Gifts that support health. At holiday times and for special occasions, my uncle received fresh fruit (Harry and David mail-order pears), nuts and dried fruit.
• Meals in the company of others. Many people who are sick feel more like eating when they're with others. When family visited and he was still able to get around, my uncle enjoyed trips to the Full Moon restaurant for a hearty, hot meal.
• Make enough for later. For anyone well enough to cook meals, prepare enough to freeze leftovers in small batches for reheating later.

My uncle preferred his privacy, but group meal programs, Meals on Wheels and other meal delivery programs are available in many areas. Health care providers and social workers can often make a referral.

With a bit of know-how, older adults facing a chronic illness can design for themselves a low-effort diet to support their health.

My Uncle Vic did it, and he was in our lives a little longer as a result.