Take Eating Concerns to a Registered Dietitian: How to Use Home-Visit Nutrition Counseling in Japan

Written by: 稲山 未来 (Registered Dietitian)

Did you know that there are registered dietitians who visit older people living at home to advise them on meals and nutrition? It is, in effect, nutrition counseling that comes to your door. Japan’s long-term care insurance includes services like this provided by registered dietitians.

In this column, based on questions families often ask, I’ll explain how registered dietitians help solve the eating concerns of older people living at home.

Question 1: “I don’t know whether the meals they eat are enough”

They’ve been eating a little less with age. Cooking has become a chore, so meals have fewer dishes than before. They eat more bread and noodles, which are easy to eat without cooking, and their diet may have become unbalanced. Do you have worries like these?

You may have a vague sense that the diet is unbalanced, yet not know what is lacking, by how much, or how to eat differently.

The registered dietitian first visits the home and asks about everyday eating habits. Then they explain whether the current diet provides enough nutrition and, specifically, what is lacking.

Nutrients that older people tend to lack include protein, vitamins and dietary fiber.

Protein shortfall

Some people find hard foods such as meat difficult to chew, and grilled fish and the like can feel dry and hard to swallow for people who produce less saliva.

But protein is the building block of muscle and skin, so a continued shortfall can weaken the muscles of the legs and lower back and leave the skin dry and easily damaged.

When meat and fish are hard to eat, cheese, yogurt and similar foods are easy sources of protein. Using ground meat to make meatballs, or pouring a sauce thickened with potato starch over fish, gives food a smooth, slippery texture that makes it easier to eat.

Vitamin and fiber shortfall

Shortfalls in vitamins and fiber occur when people eat fewer vegetables.

Vitamins mainly help keep the body in good working order, so a shortfall weakens immunity, making people more prone to colds and fatigue.

Dietary fiber mainly gives bulk to stools, so a shortfall makes constipation more likely. Older people are prone to constipation anyway because their intestines become sluggish, so care is needed.

People eat fewer vegetables partly because vegetables are fibrous and hard to chew, but some also hold back from buying fresh vegetables because they cook only small amounts at a time and worry they won’t use them up. For older couples living on their own, or people who live alone, the worry of “not being able to use it all up” is hard to avoid.

That’s where frozen vegetables come in handy. The range of frozen vegetables has grown recently, and you can now buy spinach, okra, eggplant and more. They are in the frozen section of convenience stores and supermarkets, so do take a look.

Frozen vegetables keep for a long time, with no worry about them going bad. Just adding a few frozen vegetables to your usual miso soup boosts vitamins and fiber. Please give it a try.

Question 2: “Chewing and swallowing have become difficult, and I don’t know how to make food easier to eat”

As explained above, when chewing strength weakens, hard and fibrous foods become hard to eat. But avoiding them because they are hard to eat leads to an unbalanced diet, so it is best to adapt cooking methods as much as possible and keep eating a balanced diet.

In the home-visit service, the registered dietitian comes to the home and demonstrates cooking methods using the household’s own cooking equipment.

For example, for someone who has started to find meat a little hard to chew, food needs to be prepared so that it doesn’t leave bits in the mouth or become sticky. A common approach is to use a care-food gelling agent (a kind of special gelatin that makes food easy to swallow) to set the food to a suitable firmness.

Even people who have cooked for many years are rarely used to making care food. Registered dietitians also give support on how to cook and process food so that it can be eaten safely and enjoyed.

How to get support from a registered dietitian

Having read this far, some of you may be thinking, “I’d really like to consult a registered dietitian.”

This is a long-term care insurance service called “in-home medical management guidance” (kyotaku ryōyō kanri shidō), provided on the instructions of the attending physician. Start by talking to your care manager.

If you are told that there are no registered dietitians nearby who can make home visits, one option is to contact the dietetic association in your prefecture. Dietetic associations are organizations involved in a wide range of services provided by registered dietitians.

You can easily find the dietetic association for your area online. Contact them and ask whether there is a registered dietitian who can visit your home. Even if there isn’t one nearby, they will look for a registered dietitian who can support you.

Summary

Registered dietitians may not be a familiar profession, but they specialize in food and nutrition. Above all, they work with you to remove worries about meals and to think about how you can enjoy eating. When meals are causing you concern, please remember that registered dietitians are there to help.

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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