Meals on wheels for the more well-heeled

By Marrissa-Catherine Carrarini for The Times

Joan Mills lives in a retirement block of flats in Trowbridge, near Bath. She's in her seventies, independent and sociable, but she decided recently to stop making her own meals. “I can cook for myself, but the problem is the shopping,” she says. “I have an arthritic hip and I can get bad back ache. It gets so heavy that I can't carry it all home.”

Instead, she has signed up with Wiltshire Farm Foods, one of a growing number of private meal delivery companies that cater to those who, because they are elderly, disabled or just disinclined, don't want to shop and cook for themselves.

Joan Mills can choose her weekly menu from its website (www.wiltshirefarmfoods.com ) or by filling out a form, and Wiltshire delivers frozen dishes such as duck breast in brandy sauce (£4.50) or salmon fillet in a seafood sauce (£3.70) with perhaps a side order of dauphinois potatoes (£1.50). She heats the dish up in the oven and tucks in. “It has worked out really well,” she says.

The services provided by companies such as Wiltshire are not new. The concept of meals on wheels has been around since the end of the Second World War, when local authorities and volunteers began providing hot food daily to elderly people displaced by the war.

Today, local council meals-on-wheels schemes deliver 40million meals every year to 200,000 people in the UK. But private companies such as Wiltshire may well be the future of home-delivered food.

The pressure on public services is growing as the population ages and the Local Government Association last month announced that it would be making cuts in meals-on-wheels services to pay for more bus passes for the oversixties. Private companies are expected to pick up the slack, although some councils, for example Somerset, already find it more convenient to outsource all their home-food deliveries to private companies.

The service gives relatives peace of mind

“Most of the people who use our service are elderly or disabled, but they haven't really got to the meals-on-wheels stage yet,” says Jason Coles, a delivery man for Wiltshire Farm Foods. “Most can still use a microwave or oven to heat the meals up, but without our service they couldn't cope. Often it's the relatives of our customers who persuade them to use the meals because it is a big weight off their mind that their parent or whomever is eating well.”

Robin Peters has his grandfather's meals delivered to his office every week because he doesn't want his grandfather to be disturbed at home. He takes the frozen dishes round when he visits and his grandfather heats them up in the microwave. “My grandad lives on his own and this makes sure that he gets a nutritious, well-balanced meal once a day. My nan died and after that he wasn't able to cook for himself. This gives me peace of mind and he's happier,” Peters says.

Frozen-meal delivery services are especially valuable to elderly men. “Those who use our service are really reliant on it. It's their generation; they can't cook,” says Coles.

But it isn't just an inability to cook that can make meal times difficult for the elderly. Facing life on their own, perhaps for the first time if they went from a big family straight into married life, means that many people give up preparing food altogether. “I find it so hard shopping for one,” says Joan Mills. “Nowadays if I want cabbage, I have to have cabbage for the whole week. The same with salad. Otherwise it just ends up going off in the fridge. It is so much better having my meals delivered.”

The rise of the out-of-town supermarket and closure of local shops has also made life for the elderly difficult. Joe and Matilda Carr, who are in their eighties, live in the small village of Eddington, near Trowbridge. There is no longer a village shop, only a pub. “Having some of our meals delivered is a real convenience. It is difficult living far from a shop and this way it also saves on the washing-up,” says Matilda Carr with a smile, as she unpacks the couple's dinners.

Services such as Wiltshire Farm Foods may be a blessing for many, but with a single course costing up to £5, they may be out of the price range for others. Meals on wheels, by comparison, costs between £2 to £3 for a hot dish, including a dessert. On the other hand, the quality of private companies food is probably superior: Wiltshire, for example, offers slow-cooked lamb shank, with caramelised onions, mashed potatoes and redcurrant sauce (£4.75) or coq au vin, with pomme de terre Anna (£4.07). You don't usually get that from your local authority.

Wiltshire colour-codes every meal to specific dietary requirements and provides nutrition information leaflets with all its food. This is useful for carers and/or family members as dietary requirements change with age. Elderly people may need to eat less (as they lead more sedentary lives) but they will often need more nutrients, especially vitamin D, calcium and fibre (see box, below).

“About 70 per cent of older people living in the community are at risk of malnutrition, so it is vital that there is a service that provides a nutritionally balanced meal,” says Derek Johnson of the National Association of Care Catering (www.thenacc.co.uk).

Daily choice of ethnic meals

Council-provided food is improving, however. In Southwark, an ethnically diverse South London borough, the Afro-Caribbean range is cooked every day and delivered from a local restaurant. Jacquie Hibbs, the welfare catering commissioning manger for Southwark Council, says that other choices inlude kosher, halal and Asian vegetarian. Both meals on wheels from local councils and Wiltshire Farm Foods offer low-fat, low-salt, gluten-free and diabetic meals.

However, it might be argued that the quality and nutritional value of the food is secondary to having a familiar face at the door once a week or every day. “The visit is as important as the actual food,” says Coles, who often finds himself opening jars and changing light bulbs for his customers.

Yet despite his helpfulness, for many people a weekly visit is not enough. Derek Johnson believes it is a “worrying trend” that frozen food is delivered once a week rather than a daily hot meal.

“Delivering every day allows for an important social interaction. It is often a lifeline for many because detection of deteriorating health,illness and other welfare concerns are always reported by the delivery person to the relevant agencies.”

Times Nutritionist Amanda Ursell's guide to the mature palate

The physiological changes that take place as we grow older affect how much we eat and what we want to eat. For example, we tend to produce less saliva over the years, which makes it harder to chew and swallow certain foods. Problems with gums, missing teeth or poorly-fitting false teeth are also common, as are difficulties in swallowing, and it is important when you are planning meals for elderly people to take these into account.

Appetite changes with age

Loneliness and depression can have a profound effect on what and how much we want to eat at any age. The acuity of our taste buds also declines, which makes food seem less tasty. Making sure that food is moist and extra flavoursome can make all the difference between a meal being eaten or refused. When elderly people miss meals, the effects are more serious. They tend to need fewer calories to get them through the day, but their requirement for vitamins and minerals remains much the same as for young people. So, if they eat less, they can struggle to get a sufficient amount of nutrients. One of the best ways to make sure that they get enough nutritional benefit from their food is to provide plenty of variety in their diets. This minimises the risk of deficiencies and keeps alive an interest in eating.

Daily intake

As a rough guide, elderly people should have one main meal a day, plus two “meal snacks”, such as a sandwich or bowl of soup. They should also be encouraged to have between half a pint and a pint of milk a day, either as a drink or in puddings or yoghurt. It is good to aim for one serving of meat, fish, offal, poultry, cheese, pulses (including peas) or eggs at two of the meals; and one serving of bread, pasta, pitta, rice, potato or banana at each meal or meal snack. They should eat two to three portions of vegetables a day, and leafy vegetables such as cabbage or spinach three times a week. Ideally, elderly people should also try to have one to two fruits a day, which can include a glass of fruit juice, and at least eight cups of fluids, which can include teas and coffees, soups and juices.

Supplements

There is no harm in giving older people a multivitamin supplement each day. It should contain no more than 100 per cent of the daily recommended intake. Multibionta or Sanatogen multivitamins are all good options.

Treats

While it's not good for elderly people to survive on biscuits all day, this is not the stage of life to get overzealous with healthy eating advice. So if someone in their eighties enjoys tea with sugar, the let them. Equally, trying to move them from butter to margarine could reduce enjoyment of meals and any damage that foods rich in saturated fats will have done will already have occurred.

Make meals even healthier

Some quick ideas for turning inexpensive foods into nutritious meals are worth bearing in mind. For example, adding milk powder to soups increases the protein levels and turns it into a good “meal snack” when eaten with bread. Milk powder added to custard, porridge and white sauces also ups their protein value. Meanwhile, peanut butter is great as a protein-rich “meal snack” when spread quite thickly on toast with slices of tomato. Added calcium is gained by sprinkling grated cheese into mashed potato or on to beans on toast. Canned sardines or mackerel in a sandwich are excellent for protein, calcium and vitamin D, the latter two nutrients being crucial for bone health.

How old is he or she?

The effects of ageing vary widely from person to person and the same changes do not always occur, or do not occur, at the same age. What is right for one person may not be so for another.