Eating Support for People with Alzheimer’s Disease: When “Not Eating” Is a Problem of Recognition

Written by: 増田 翼 (Registered Nurse)

We simply say “eating,” but there are several stages before food is actually eaten. We recognize the food, think about how to eat it, bring it to the mouth, chew it into a form that is easy to swallow, and send it to the throat. Then the final “gulp” that sends food from the throat onward is swallowing, known medically as deglutition.

In this column, I’ll talk about the importance of recognizing food and of getting “ready to eat”: knowing how to go about eating it.

As we age, we become more prone to illnesses such as dementia and stroke, and their symptoms or after-effects can cause problems at mealtimes. The symptoms vary: glancing around restlessly and being unable to focus on the meal, not knowing how to eat and being unable to use chopsticks well, or not feeling like eating in the first place.

Case: A, who left only the rice

A, a resident of a private, fee-based nursing home, gradually began eating less and losing weight, and as A’s strength declined, the falls became more frequent. A had been diagnosed with Alzheimer’s disease but loved shopping and looked forward to going to the nearby convenience store with a care worker.

The facility staff asked us, “Could there be a problem with A’s swallowing function?” so we were allowed to observe a meal.

A ate in the dining room with the other residents. The TV was on, but A did not seem distracted by it and was eating independently. A ate the side dishes but hardly touched the rice served in the rice bowl.

When we told A, “You still have some rice left,” A said, “Oh, really?”, picked up some rice with chopsticks, brought it to the mouth without any problem, chewed it well, and swallowed it smoothly without coughing. When we checked inside the mouth, A wore full dentures, but they did not slip out while A was talking or trap food, and they seemed comfortable.

When we asked the staff whether A always left the rice, they said, “When we served a yakitori rice bowl, A ate only the grilled chicken and left the rice. A did eat the parts covered in sauce.” When they showed us the bowl used that day, it was pure white porcelain, and the rice bowl A usually used was pure white as well.

So we asked the staff to serve the rice in a black bowl instead of the white one, and A began eating the rice too, without being prompted.

The problem was not swallowing but recognition

A had no problem with swallowing function. The problem lay in the stage before chewing and swallowing: recognizing the food.

After the switch to a black bowl, A began eating the rice as well and ate more than before, but this still was not enough to regain the lost weight. So we asked the doctor to prescribe a nutritional supplement, and A was able to get enough nutrition. With adequate nutrition, A has kept up their strength, still goes shopping at the nearby convenience store with a care worker, and enjoys their favorite rice crackers (senbei).

People with Alzheimer’s disease often lose some of their ability to recognize objects correctly. In A’s case, it seems A could not recognize white rice in a white bowl and mistook it for an empty dish that had already been finished, so the meal did not progress.

As this shows, when someone eats less, people tend to assume there is a problem with swallowing. In fact, it is common for swallowing to be fine while the person cannot correctly recognize the food.

Ideas for when chopsticks are hard to use or the person can’t focus on the meal

In A’s case, the symptom was being unable to recognize the meal, but there are other symptoms too, such as being unable to use chopsticks or a spoon well, or being unable to concentrate on eating. How should we deal with these?

When the person can’t use chopsticks or a spoon

Losing the ability to use eating utensils such as chopsticks and spoons is called apraxia. Even when chopsticks or a spoon are provided, the person may be unable to use them to bring food to the mouth, or may eat with their hands.

In that case, rice balls (onigiri) or sandwiches let the person eat with their hands and get other nutrients along with the rice or bread.

When the person can’t focus on the meal

Turning off the TV goes without saying, but other measures also help the person eat without being distracted: serve the food on a single plate instead of dividing it among small dishes, or serve fewer dishes at a time and bring out the next one when the first is finished.

Eating support that draws out what the person can still do

The number of people with dementia is expected to keep rising. To support eating, we will increasingly need to support not only the mouth and throat but also the eating environment. And although we speak of “dementia” as one condition, it is broadly divided into four types, each with different symptoms, so support must be tailored to the person.

If we think only in terms of getting nutrition in, it may be easier to feed the person ourselves. But to draw out what they can still do and help them enjoy their meals, I hope you will try a variety of ideas to adjust the eating environment.

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About the author: 増田 翼 (Registered Nurse)

This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.

This is an English translation of a column originally published in Japanese by Next Co., Ltd.

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