Peppers and temperature variations can make food more interesting, said Marcia Pelchat, a sensory psychologist at the Monell center in Philadelphia. "Older people complain that their food is never hot enough," she said. She's not sure why, but thinks hot food may produce more olfactory stimulation.
It also helps to tell older people what they're eating. Memory may fill in the missing sensory information. Giving them control over some garlic salt or a lemon wedge at the table can also help.
Louisa Miceli, a visiting nurse, cautions against loading plates with too much food. "They just can't tolerate a lot of food at once," she said. It's better to offer small portions of calorie-dense food.
Ronald DeVere, who included more than 50 pages of recipes in his book Navigating Smell and Taste Disorders, is a fan of something called Beer Salt from www.twang.com. (The Austin, Texas, neurologist says he has no financial interest in the company.)
Other herb mixtures also help. It's better for someone with impaired smell to put salsa on a baked potato, rather than bland condiments such as sour cream and chives, DeVere said. He also recommends "hyperconcentrating" flavors, such as adding strawberry extract to a strawberry dessert. Add sugar substitutes to unsweetened cereals, because they taste like "wallboard" to people with smell deficits, he said.
When food tastes flat, it often needs more acid, not more salt, said Caitlin Rogers, national director of dining and nutrition services for Sunrise Senior Living. She suggests adding a little vinegar or citrus juice.
Ella Goldstein, 79, one of Doty's patients, lost her sense of smell completely about a year ago. A self-described foodie, she still eats in fine restaurants and makes good meals for herself. She found herself oversalting just so she could taste "something," but stopped because of health concerns. She finds that sweet, sour, bitter, and hot flavors can now seem overpowering.
"I can enjoy certain things because of memory," she said. "I'm very sensitive to texture. That makes a very big difference to me."
Chris Loss, a professor at the Culinary Institute of America in Hyde Park, N.Y., said it's not easy to offset the loss of smell. Herbs, for example, can taste bitter if used in excess.
"All you can do is try lots of different things, as far as I can tell," he said. "There's not going to be a silver-bullet solution, 'Oh, just sprinkle this herb on top of everything.' "