If Eating Feels Difficult, Adjust the Eating Environment: Notes from the Front Lines of Eating Support (5)

Written by: 五島 朋幸 (Dentist)

Eating by mouth requires two main elements: the “function” of eating by mouth, and the “environment” surrounding it.

As long as eating function, such as chewing and the throat movements used in swallowing, is sufficient, you don’t need to think much about the environment. But once eating function declines, adjusting the surrounding environment can sometimes help a person keep eating.

Does that surprise you? What is the environment for eating? And did you know that there are professionals who specialize in the environment? In this column, I’ll talk about the eating environment.

Eating environment and function

Are you able to chew and eat properly? Probably few of you struggle much, though some of you may find eating hard because of a cavity.

Try drinking water at a stand-up curry counter

Counter-style curry shops and similar restaurants often have very tall stools. They have a footrest partway down, and you usually rest your feet on it while eating, but what happens if you deliberately let your feet dangle while drinking water? Please try it next time.

You can drink the water, but it takes surprisingly more effort. Also, try tilting your head all the way back and swallowing your saliva. It is very hard, and you may even hear a loud gulp.

Have you ever sat down at a restaurant and felt that the table was oddly high? Your arms are raised, and it becomes a little harder to pick up food. You may have noticed afterward that you had made more of a mess on the table than usual.

There are even simpler examples. What if you moved your chair 20 cm (8 in) farther back than usual from the table where you always eat? Or what if the only chopsticks provided were long cooking chopsticks? It would be very hard to eat, wouldn’t it? All of these are part of the “environment.”

Posture, body position and utensils are very important, and when they aren’t right, some people become unable to eat. When supporting someone who has difficulty eating by mouth, be sure to look at the environment.

Look at mealtime posture

When someone needs eating support, first check how they are eating. Some eat at their usual table and chair, some in a wheelchair, and some even in bed.

I’ll leave the details of each case to professionals in each field, but here are three checkpoints.

1. Foot position

As in the curry counter example, dangling feet make for a posture in which swallowing is difficult. Whether the person is in a chair or in bed, check that the soles of their feet rest firmly and stably on the floor or a footrest.

2. Neck angle

Swallowing saliva while looking up was hard, wasn’t it? When the chin is raised, swallowing is not only harder but also more likely to lead to aspiration (food, drink, saliva or anything else that should go into the esophagus entering the windpipe) or choking.

3. Position relative to the food

Even when trying to eat with chopsticks or a spoon, a person may be unable to reach the food or even see it. A common example: when a petite older woman eats at a regular table while sitting in a wheelchair, the food ends up close to eye level, so she can’t see it well and can’t reach it herself.

The meal itself as part of the environment

Did you know that for people whose ability to eat by mouth has declined, there are options such as care food, soft food, minced food and blended (pureed) food? Thickening is another method.

These are designed so that people with reduced eating function can still eat. None is better or worse than the others; they are types of meals chosen according to the person’s abilities. For example, soft food for someone whose chewing has weakened so that hard foods are difficult, and thickening for someone whose swallowing has declined.

So how can you tell whether the current meals are appropriate? Of course a professional assessment is needed, but remember this as a first checkpoint: if a meal starts taking more than 30 minutes, assume that the current food texture has become hard for the person to eat.

Other aspects of the environment

There are other aspects of the environment to consider, too. For example, some people with dementia can’t concentrate on their meal if the TV is on or other people are nearby.

And of course, being unable to eat because dentures aren’t working well is also a problem of the mouth’s “environment.” Environmental problems really do vary from case to case. If someone seems to be having trouble eating, observe them carefully.

Consult the professionals of the eating environment

So whom should you consult about these environmental problems? It depends on the case, but the main options are as follows.

Physical therapists

Physical therapists are the professionals of posture. They will help you think about mealtime posture, too.

Welfare equipment specialist advisors

Welfare equipment specialist advisors are professionals in the care environment. They have extensive knowledge not only of tables and chairs but also of wheelchairs and care beds.

Occupational therapists

If there are problems with the movements involved in eating, occupational therapists can help. They will suggest the information and tools the person needs for their situation.

Speech-language-hearing therapists and registered dietitians

For food texture, registered dietitians can help, as well as dentists and speech-language-hearing therapists. Dentists and speech-language-hearing therapists assess eating function, and registered dietitians plan meals to match it.

Finally

As you can see, eating by mouth requires adjusting not only the person’s own function but also the environment. And there are many professionals you can rely on for this.

There is no rule that a particular problem must be taken to a particular person. In many communities, networks of professionals who provide eating support have been established. If you run into any difficulty, just speak up. You will surely be connected with the right person.

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About the author: 五島 朋幸 (Dentist)

Born in Hiroshima in 1965. Graduated from the School of Dentistry at The Nippon Dental University in 1991 and began providing home-visit dental care in 1997. Head of Fureai Shika Goto (Fureai Dental Clinic Goto) since 2003. PhD in dentistry. His roles have included clinical associate professor in the Department of Oral Rehabilitation at The Nippon Dental University Hospital, lecturer in the Department of Dental Hygiene at The Nippon Dental University College at Tokyo, and part-time lecturer at Tokyo Medical and Dental University. Representative of the Shinjuku Eating Support Study Group. Since 2003, he has hosted the radio program “Doctor Goto’s Passionate Home-Visit Clinic.” His books (in Japanese) include Oral Care: Dos and Don’ts (Chuohoki Publishing) and Home-Visit Dentist Doctor Goto 1: The Dentist Comes to Your Home! (Osumi Shoten). (Profile as of the time of writing.)

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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