The role of rehabilitation in older adults who have eating disabilities.

A KEY indicator for unintentional weight loss among older adults is reduced functional ability. it is therefore important to institute appropriate strategies that promote their independence, maintain a practical level of functioning, and sustain their ability to self-feed.

In addition to the physical tasks of eating, the social aspects of dining may be significant to the older adult. We need to maximise eating independence and provide a suitable framework for which other interventions may be added to promote independence in eating and make the elderly more comfortable during mealtimes.

Conditions and disorders affecting the eating abilities include:

Finger foods are indicated for older adults who are unable or will not use a fork or spoon to feed themselves.

Dysphagia

Dysphagia is impairment in any or all stages of swallowing, resulting in reduced ability to obtain adequate nutrition by mouth and/or affect safety during oral feeding. The signs and symptoms of dysphagia include:

?Excessive mouth movement during chewing and swallowing.

?The need to swallow two to three times with each bolus of food.

?Food remaining on the tongue after swallowing.

?Coughing and choking before, during, or after swallowing foods, liquids or medication.

?Nasal regurgitation, excessive drooling.

?Wet vocal quality, hoarse, breathy voice, or gargly breathing.

?Frequent throat clearing.

?Feeling of something caught in the throat.

?Pocketing of food in the mouth.

?Weight loss, dehydration and fever.

Dementia

Those with dementia may forget whether or not they have eaten, how to feed themselves, or how to chew and swallow. they may also have impaired spatial perception. Eating abilities are also affected by acute neurologic changes. Movement may be impaired, resulting in difficulty bringing food from the plate to the mouth.

Older adults also require more light than a younger person. they may have difficulty focusing between distant and near objects. Such poor acuity or low vision problems are due to cataract, glaucoma, macular degeneration or diabetic retinopathy, which affects their eating.

Coping strategies include:

?Consider the color contrast of the table setting when providing meals, which may be visually helpful.

?Adjust the proper height for the chair to the table.

?Make sure the trunk of the client is stable and the head is tilted slightly forward.

Dining atmosphere and experience

A calm dining atmosphere and appropriate setting is crucial for the eating-disabled older adult. This helps to prevent the client from becoming discouraged when they eat. The dining atmosphere should be free from distractions, i.e. loud conversations, blaring television.

The area should have adequate ventilation and lighting (with no glare). The absence of odours would be helpful. it is good to have dining room chairs with armrests with a sturdy base to allow correct positioning.

Personal considerations

It is important to consider basic needs before providing meals for the eating-disabled older adult. This provides comfort and basic infection control measures.

?Wash their hands and face before the meal.

?Personal assistive devices such as proper dentures, eyeglasses and hearing aids should be in place.

?Incontinence care and toileting are provided before meals.

?Properly positioned in chairs and wheelchairs.

?Positioned at the appropriate distance from the table.

Appropriate foods

Finger food is indicated for older adults who are unable, or will not use a fork or spoon to feed themselves. The food should be of a consistency that can be easily eaten. Foods allowed are any bread or rolls, cereals without milk, cakes or cookies, scrambled eggs or omelettes cut up into small pieces. Others include bite-sized cut fruits, minced meat cutlets, pieces of crackers, fish or chicken nuggets, soups served in a mug, or raw cut vegetables.

Also consider nutrient dense food for the elderly who are having problems with nutrition. These include:

?Small chicken or meat buns, chicken or red bean buns.

?Cream of mushroom or pumpkin soup.

?Finely cut meehoon and vegetable soup.

?Slices of bread with cheese, kaya, margarine, or peanut butter, cut into finger-sized portions.

?Muffins, cakes, jelly, soy bean curds and other desserts made with milk and soy.

?Small pieces of cookies or biscuits.

?Yogurts, ice cream, milk shakes and milk-based juices.

?Chicken pies, tuna sandwiches, and cheese on toast.

Quality of life improves when nutritious meals that meet individual food preferences are served in a pleasant, friendly atmosphere that promotes socialisation. With older adults, these approaches may be more beneficial than restricted therapeutic diets.

Appropriate mealtime positioning promotes independence in eating. Monitoring for problems at mealtimes and providing interventions can maximise the rehabilitation of eating-disabled elderly.

Mary Easaw-John is senior manager, dietetics & food services, Institut Jantung Negara. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr low Wah Yun, psychologist; Datuk Dr nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader?s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.