What If Meals Take Two Hours? Why Eating Should Be Quick, and How to Make Up for Missing Nutrition

Written by: 稲山 未来 (Registered Dietitian)

I am a home-visit registered dietitian working with a home-visit dental practice. In my work, I often hear from people who are struggling with eating and swallowing.

In this column, I’ll share how to deal with a concern I hear often, based on a real case.

“Eating takes so long. But I still want them to get enough nutrition!” Many of you may share this worry. My advice in such cases is: “Eating should be a short, focused effort! Make up for missing nutrition efficiently.” Let me explain what that means in practice.

What is home-visit nutrition guidance?

Have you heard of home-visit nutrition and dietary guidance? In Japan, it is a service in which a registered dietitian visits the homes of older people who cannot get to a hospital, or people with physical disabilities, to provide nutritional guidance.

Case: “Meals take two hours”

One day, our clinic received this request:

“Their ability to eat seems to have declined, and each meal takes two hours. As soon as one meal ends, the next one begins; it’s as if they’re eating all day. We’d like you to examine their eating function and teach us rehabilitation exercises so they can eat properly.”

Because the concern was about eating, a registered dietitian visited along with the dentist.

Should they finish the meal, however long it takes?

While the dentist examines swallowing and mouth function, the dietitian asks the family what the person eats and how.

This person was eating the same meals as the rest of the family, cut into bite-sized pieces. They spent a long time chewing, and eating about as much as before took them two hours.

The first question to consider here is: “Do they have to eat as much as before, even if it takes two hours?”

Some may say, “It’s sad to see them eating for two whole hours,” while others may say, “But if they don’t eat, they’ll lose even more weight. They need to keep trying.”

The harm of taking a long time

When we eat, we put food in the mouth, chew it, then swallow. Chewing uses the muscles of the jaw and cheeks, and swallowing uses the muscles of the throat.

So the longer a meal goes on, the more tired older people become, since they have less stamina to begin with. It’s exactly like doing squats over and over: we get tired, our movements become less smooth, and we can no longer bend our knees deeply enough.

The longer eating takes, the more both chewing and swallowing strength decline. As a result, the person can’t make full use of their ability to eat and swallow, and the risk rises of aspiration, where food goes into the windpipe by mistake, and of choking, where food blocks the entrance to the windpipe so the person can’t breathe. Picture doing so many squats that you finally fall over.

That is why the first important point is: precisely because older people have less strength and stamina, eating should be a short, focused effort!

A reasonable mealtime is about 30 minutes. If meals take more than an hour, review what is being eaten.

How to make up for missing nutrition

Eating in a short, focused time doesn’t mean cramming food into the mouth. Inevitably, the person will eat less and get less nutrition. In that case, nutrition needs to come from sources other than the meal itself. Here are the main ways.

Ask the attending physician to prescribe a nutritional supplement

If weight loss is significant, or if the person was already undernourished, talk to their attending physician about prescribing a nutritional supplement. If malnutrition is diagnosed, a nutritional formula to be taken as medicine may be prescribed.

Use over-the-counter nutritional drinks

More and more drugstores now sell nutritional supplement drinks. Take a look at the care food section, where you’ll find high-nutrition drinks; trying them is one option.

Raise the calories of the meal itself

If the person can’t drink any more, or doesn’t like sweet things and dislikes the taste of supplements, find ways to raise the calories without changing the content of the meal.

The easiest and simplest way is to use oil. Oil is a very efficient source of energy. You can raise calories by adding stir-fried dishes to the menu, lightly frying ingredients before simmering them instead of just simmering, or drizzling a little olive oil over dressed vegetable dishes.

Have snacks between meals

If the person can’t eat much at once, they can get nutrition from small, frequent meals. Try giving energy little by little at intervals: for example, after breakfast and a short rest, fruit at 10 a.m., and a sweet at snack time.

Our advice in this case

With all this in mind, we gave the following advice to this person, whose meals were taking two hours:

• Reduce the amount of food to what can be eaten within one hour

• Make up for the missing energy with nutritional drinks sold at drugstores and elsewhere

• If chewing is tiring, prepare soft foods as much as possible until strength recovers

Summary

In older people whose strength has declined, the longer a meal lasts, the more fatigue reduces their ability to chew and swallow. Keep meals to under an hour. And if they eat less as a result, find ways to provide nutrition from sources other than meals.

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About the author: 稲山 未来 (Registered Dietitian)

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.

About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us