So how does one help an older person who has difficulties in eating? The first step is to correctly identify all problems that may contribute to the eating problem. One has to bear in mind that in an older patient, multiple problems contribute to multiple mechanisms of eating impairment.
A comprehensive geriatric assessment is important to reveal diseases that affect eating. Included in the assessment is a detailed medication review to rule out drug-related problems. A thorough physical and neurological examination will identify pertinent diseases. Memory evaluation may be needed in selected situations, especially if forgetfulness is prominent. Swallowing evaluation through endoscopy is recommended especially if a patient has frequent choking episodes or has repeated hospitalizations for pneumonia.
Management of eating problems should address all identified contributing factors and this involves multiple strategies:
· Ensure that dentures are always properly fitted and regularly assessed. Any oral ulcers should be treated.
· Discontinue any unnecessary medications.
· Adjust the dosage of medications to minimize side effects on eating.
· Optimally treat all conditions, whether physical, neurological, or psychological.
· Relax dietary restrictions to allow enjoyment of food without compromising their health.
· Find taste alternatives to make food palatable in case of restrictions.
· Maintain caloric intake with small frequent feedings.
· Provide an environment that promotes a better appetite, like eating in groups and without distractions.
· Implement timed feeding for those who are cognitively impaired.
· Modify the consistency of food for those who cannot adequately swallow or handle solid food.
· Know a patient’s food preferences and modify the menu based on this. Even patients who are cognitively impaired may eat better if they see food that they like.
In severe situations where nothing seems to work and the older patient continues to lose weight because of inadequate food intake, there may be no other option for long term feeding than tube feeding either by a tube inserted through the nose (nasogastric tube or NGT) or one inserted through the abdomen into the stomach (gastrostomy tube).
The decision to use these strategies should take into account the patient’s advance directives, prognosis, resources, and family support.