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The primary purpose of eating is to provide our bodies with nutrition and calories for energy and growth. Also, eating is often a social occasion when family and friends spend time together. However, within this framework it should be remembered that eating, and to an even greater extent, feeding oneself, requires energy to be expended (i.e., calories are both being acquired and being used by the same activity). For that reason, we should always be aware of the level of effort that is being put into eating so that the activity does not burn too many calories and thus reduce the benefit of the total calories consumed. If someone is using a lot of energy eating, their ability to sustain the effort will no doubt cause them to fatigue. This article will provide a brief overview of factors that contribute to fatigue at mealtimes and how the fatigue might be reduced.
Many people feel sleepy after a meal but there is a big difference between being sleepy and being fatigued. For people who fatigue easily during a meal there is normally an underlying medical condition that causes the fatigue. The average person eats without exerting enough effort for them to be aware that they are expending any energy. As we learn to feed ourselves as infants, we develop the muscle strength and coordination to make eating easy and, for the most part, automatic.
The most obvious reason that someone fatigues quickly at mealtimes is that they are frail. Both the elderly and individuals with degenerative conditions exhibit rapid fatigue. It is recommended that for these individuals, mealtimes be abbreviated and meals supplemented with nutritious snacks. Therefore, that person will be provided three small meals that can be consumed in fifteen minutes or less, and the meals will then be supplemented with three of four snacks, depending upon the number of calories that are needed to sustain the particular individual. Furthermore, within this scenario, the eating/feeding practices can be modified to conserve energy. Half-way through the meal the caregiver can provide more assistance either by helping load the utensil or by offering to feed the individual. Also, food preparation can contribute to reducing the level of effort that is required to feed oneself. If meat is cut into very small pieces then it can be picked up easily with either a spoon or fork and will require less chewing before it is ready to be swallowed, thus, less energy is expended by the person eating.
For many people, the physical exertion required to go through the steps needed for self-feeding are extremely demanding and will cause rapid fatigue. If muscle control and coordination is difficult, executing the complex task of picking up food and bringing it to the mouth can be exhausting. For those who fatigue rapidly due to the demands of muscle control, various approaches can be offered. As mentioned previously, one approach is to shorten mealtimes. Instead of three meals a day, five smaller meals can be provided. The provision of small meals provided more frequently, reduces the demands on muscles for extended times. (However, the logistics of doing this is difficult for some people, particularly children in school or those who reside in an institutional setting where scheduling food for times other than set mealtimes is difficult.)
Another approach to reducing fatigue due to muscle coordination demands is to reduce the number of movements that are required for each bite of food. For example, supporting the individual’s elbows and forearms stabilizes the arms and makes moving food from a bowl to the mouth easier.
Also, in some cases, if the individual only eats what food they can until they start to fatigue, it helps the mealtime to be enjoyable and stress free. At that time a supplemental drink can be offered to provide the additional calories needed. It requires much less effort (i.e., energy) to drink than to eat. Mealtimes should be enjoyable and relaxing and if someone is “pushed” to continue eating once they are tired, the mealtime pleasure is quickly removed.
Fatigue occurs more rapidly if someone is unwell. For example they have a cold. Also, if effort has been expended on an activity prior to the meal, the individual will become tired sooner.
All of these factors should be considered to make appropriate mealtime accommodations for those who fatigue easily due to self-feeding or eating. For those who fatigue very rapidly due to the effort of self-feeding, assistive technology should be considered to reduce the effort expended during meals. Equipment like the Mealtime Partner Dining System can enable people to continue feeding themselves even if they easily fatigue when feeding themselves in the traditional manner.
|The Mealtime Partner can be positioned to meet the specific needs of each user. The user does not have to adjust their position to eat using the device because the Partner’s flexible mounting systems permit positioning to fit the user's needs, making mealtimes a comfortable, relaxed experience, with the user positioned safely for eating. For more information about the Mealtime Partner Dining System, you can visit Mealtime Partners website, or view our 4 minute video. There is no other assistive dining system that meets the positioning needs of the users, like the Mealtime Partner.|
|Safety in Eating: For more on safety, please refer to previous Newsletter topics: Promoting a Chin Tuck for Safer Eating, and Positioning for Eating.|
|MtP Tip of the Month: Use a vinyl tablecloth under the seat of someone who is messy during meals. Clean-up is much easier. Simply pick up the tablecloth, folding the spilled material inward, and shake it outside to remove excess food. Once it has been shaken it can be wiped just as if it had been used on a table.|
Aspiration of thin food or fluid can have serious health consequences. For that reason, thickened foods and liquids are often prescribed when someone has been identified as at risk of aspiration. Both food and liquids can be thickened to lessen the risk of choking or aspiration. Foods or liquids can be slightly thickened or can be made very thick. Common descriptions of thickened consistencies are: “nectar-like”, “honey-like”, and “pudding-like”. These terms describe the consistency of the food or liquid when compared with common table foods with which we all are familiar and are used by manufacturers when providing instructions of how much thickening product should be added to specific volumes of liquids to provide the desired viscosity (thickness).
This article is intended to provide information about the variety of products available to thicken foods or liquids and is intended to provide professionals and caregivers insight into the food/liquid thickening products that are available to them so that they can better evaluate which product is most appropriate for the person for whom they are providing care. (However the best method of judging any of these products is through your own experimentation.) The reason it is being included as a Mealtime Partners Newsletter topic is that on many occasions individuals with whom we interact that require a thickened diet, complain about the “taste” of the products being used. In many cases, even though the manufacturers say their products are tasteless, recipients find that the products have both an undesirable taste and texture.
As mentioned in last month’s topic on Food Flavor, some people do not consume an adequate amount of nutrition because they aren’t interested in the food they are served. By adding flavor to the food they eat, they potentially will be more motivated to eat, and are less likely to be under nourished (or malnourished). On the other hand, degrading the flavor of the food using a thickening product may make food they ordinarily would eat, now undesirable, leading to the same outcome.
In a study reported in 2005, Jane Mertz Garcia, et al.1 compared the viscosity of five different liquids thickened to nectar or honey-like consistencies with a variety of thickening products. Their findings indicated that variations in preparation procedures and the liquids being thickened, may produce differing results from day to day and depending upon the chemical makeup of what is being thickened (e.g., the acid in orange juice) different results may be acquired. Additionally, it was reported that “there is no assurance that ‘nectar’ or ‘honey’ products from one manufacturer are similar across its product line or to the viscosity of a competitor’s product”.
There are the five brands of thickening products commonly available in the United States. The following descriptions are provided by the manufacturing companies:
THICKENUP® made by Nestle Healthcare Nutrition Products (http://www.nestlenutritionstore.com) is recommended by the manufacturer for hot or cold foods. It is a powder that thickens foods or liquids instantly without lumping. It uses 100% modified cornstarch to thicken and maintains its consistency over time.
Thick-it, and Thick-it 2 Extra Strength Instant Food Thickener, are thickening powders made by Milani (http://www.thickitretail.com). Thick-it 2 is recommended for individuals with diabetes as it requires half the amount to thicken food or liquid than regular Thick-it and therefore fewer carbohydrates are used to achieve the same thickening result. Introduced in 1987, Thick-it was the first instant food thickener on the market in the U.S. Even though the manufacturer describes it as instant, they recommend that food or liquid is let stand for 30 – 60 seconds to achieve correct consistency.
SimplyThick®, and SimplyThick The Thickening Gel You Can’t Taste®, are all produced by SimplyThick, LLC (http://www.simplythick.com). SimplyThick is a gel rather than a powder and the manufacture claims that it mixes more easily and consistently than powder. For thickening clear liquids the gel dissolves without graininess or after-taste. Thick and Easy® products, manufactured by Hormel Health Labs, provide a line of instant food thickener as well a line of products that address nutrition with foods that taste better but still address the texture necessary for safe eating and drinking.
Hydra-AideTM is produced by Links Medical Products (http://www.linksmed.com). It is a gel formula that thickens hot or cold liquids. It is available in either individual packs or bulk form. When mixing single servings the manufacturer recommends that the gel and fluid be mixed for 30 seconds with a fork. For larger volumes whisking the liquid for 3 minutes is recommended, after which the liquid should be allowed to stand for two minutes to reach its correct viscosity.
Some products continue thickening for a while after they have been mixed, so check the consistency after a minute or two and then again after ten minutes to see that the food being thickened is at the desired thickness. Also, you might find that some products work better with certain foods or liquids because of how the chemistry of the item being thickened and the product interact and that to use more than one product is most successful for the individual for whom you are providing care. Remember, if the food or drink tastes unpleasant, less will be consumed, which can result in under nutrition or dehydration.
There are too many combinations of foods and thickening products to provide insight into exactly which products do best with which foods (or drinks). Also, individual tastes vary considerably. The most important recommendation that we can make is that prior to giving someone any of these products, you taste them yourself after the thickening product has been added to the food or liquid you are offering. You will find that some foods and drinks mask the taste of the product, while the flavor of others is considerably degraded by its use. An example of this is coffee. Plain coffee that is thickened is poorly received by most people. However, coffee that is sweetened and has creamer in it, will often mask the taste of the thickening product adequately to provide an enjoyable beverage for the consumer.
Learning to eat independently can be messy. Rather than being upset by the spills during meals, just use a clothing protector like the Mealtime Partner Cover-up. Cleanup is simple. Just wipe the Cover-Up with a damp cloth and it is ready to be used for the next meal. The cover-up is waterproof so food and liquids do not soak through and stain clothing. Using a Cover-Up is a great time-saver. Laundering will no longer be needed after every meal. Click here to see our complete line of Cover-Ups.
1. Mertz Garcia, J., Chambers, E., Matta, Z., & Clark, M. Viscosity Measurements of Nectar- and Honey-thick Liquids: Product, Liquid, and Time Comparisons. Dysphagia. 2005 Fall:20(4): 336-8.
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