【栄養と食事拒否】親が食事を食べません。どうしたらいいですか!?
認知症を持つ高齢家族を介護するみなさん、家族が食事を食べなくなってしまったとお悩みではありませんか。「食事を拒否している」と言うだけでなく、他にも理由が存在するかもしれません。ここでは食事拒否と高齢者の栄養についてまとめています。
目次
どうして食事を拒否するのでしょうか…
まず最初に私たちが食べ物を食べる際には、どのような動きをしているか考えてみます。
お腹が空く、食べ物が出されれば食べ物を認識する、食事を口に運ぶものを認識し、箸などを持ち手をつかう、口へ食べ物を運ぶ、口の中で噛んで飲み込む。
このように多くの動作が成り立ち食べ物を摂取しています。
認知症を持つ高齢の方に食事拒否が見られるのは、どのようなことが原因なのでしょうか。
それにはいろいろな視点があります。
特に以下のようなことが原因となることが少なくありません。
・ 食べ物を認識することができない
・ 食べ物を口に運び、噛んで飲み込むという、一連の動作がわからない
・ 体調が悪く、食欲がない。特に、風邪や便秘などが原因となることが多い
・ 気分が落ち込んでしまっている
・ 飲み込む（嚥下）の力が弱ってしまい、食事が進まない
・ 薬の副作用によって、食事に気が向かない
これらのことに思い当たる可能性はありませんか？
本人意外の方が食事を食べない場面に居合わせると、「食事拒否」としか見えないことがあります。しかし改めて拒否をする本人の立場になって考えると単に「拒否」しているだけではなく、食べられない理由があるのかもしれません。
本人が食事拒否をする場面を再度考え、その原因を探ってみましょう。
原因別に食事拒否の対処を考えてみましょう
では先に挙げた食事拒否の原因から、症状別にその対処法をご紹介していきます。
①失認・失行（目の前にあるものの意味がわからない、当たり前のようにしていた行動ができなくなる)
食事を食べ物として認識できなくなることや、食べ物を口に入れ、噛んで飲み込むといった一連の動作を忘れてしまうと言った症状があります。 このような失認・失行と言った症状がみられる認知症の方場合の食事拒否の解消へ繋げるには、食事の介助をする方が一緒に目の前で食べるようにしましょう。認知症の方の場合、食べる動作を真似して食べてくれることがあります。 他には、食事の前に、目の前にあるものがどんな食べ物であるか説明するようにしましょう。声掛けをしながら一緒に食事をすることで食事に対しイメージがわき、スムーズに食事が進む場合があります。
②体調不良
体調不良の際にも食事拒否が起こりやすいと言われています。
認知症の方で体調不良をうまく訴えられることができない場合があります。
そのため、介護している側もその異変に気づくことができることが大切です。
日々接する上で、「暑くはないですか？」「眠れていますか」などと「はい」か「いいえ」で答えられる簡単な質問を心がけます。
毎日体調を確認するようにしましょう。
体調が悪い場合、受け答えがいつもと異なっていたり、顔色や表情・態度などの変化が見られる可能性があります。
その場合体調戻ることで、食欲が戻ってくることがあります。
例えば便秘の場合、排便が見られると食欲がでる場合もあります。大切なのは、認知症の方の体調不良に介護者が気づいて対処するということです。
③気分が落ち込んでいる
認知症が原因となり、気分が落ち込みやうつ傾向に陥ることがあります。その結果、食事を美味しいと感じられなくなってしまうことがあります。うつ状態の場合には、行動に移るまでに時間がかかってしまうことがあります。最初の一口を食べられる場合には、そのまま食べ続けることができる場合もあります。「おいしいおかずができました、味見をお願いできませんか？」などと声をかけ、一口から食べてもらうのもよいでしょう。 他にも、食事の時間は誰かが一緒にいるという環境を作ることを心がけるようにします。一人きりより、誰かと食べると言う食事の環境を作ることで、気分の落ち込みがの改善が見られる場合もあります。
④飲み込む力(嚥下機能)が低下している
飲み込む力が低下すると、食べ物や唾が気管に入ってしまい肺炎等の原因になります。そのため、誤嚥しないよう、食べ物の固さや大きさを食べやすい大きさにするなど、工夫してみるのが良いでしょう。 それでも認知症の方が食べにくそうな様子が見られる場合、とろみ剤を使用する方法もあります。とろみ剤を使用するととろみがつき、気管に入るリスクが減る場合があります。気管にこれはとろみを食事につけるもので、 片栗粉で作ったとろみとは異なります。片栗粉で代用できるものではありません。必ず市販されているとろみ剤を使用するようにしましょう。
⑤薬の副作用によるもの
薬によって、眠気を催すものや喉の渇きが強くなると言った副作用（場合によっては副効果）が存在する場合があります。この作用が食事を摂取する時間に出現したらどのようになるでしょうか。食事に対し集中できなくなったり、飲み物は摂取してもおかずは食べないなどの行動に繋がることが考えられます。現在内服している薬があれば、かかりつけ医や薬剤師に状況を伝え、薬の種類を再検討してもらうことや飲み合わせなどを相談しましょう。初診の医療機関に行く場合にもお薬手帳を持参するよう習慣をつけることも大切です。
栄養が心配です…
それでも栄養面やカロリーといった点で心配される方もいることでしょう。
具体的にどのくらいのカロリー量を摂取することが必要なのでしょうか。
ここでは75歳以上の方の1日における必要カロリーとたんぱく質についてご紹介させていただきます。
参考：知っておきたい高齢者の食と栄養 社会保険福祉協会 中村育子
男性
女性
上記のグラフで活動レベルは、普段どのくらいの活動を行っているかという基準です。
寝た切りで介護をしている方はⅠほぼ、自立の方はⅡと考えてください。
これだけのカロリーは生きていくために必要なものとなります。
食事の好みは人によります。
一見少ない量しか食べていなくても、もともと少食である場合も考えられます。甘いものが好きな方、洋食より和食が好きな方など、認知症をお持ちの方が好きな食事内容を工夫していきます。
また栄養補助食品等も一つの手です。参考URL(明治メイバランスシリーズ)
ゼリーから飲み物など様々な種類があります。カロリーをしっかり摂取する必要がある方や栄養が偏りやすい方などにおススメです。
このような製品は薬局、ドラックストア、スーパー、通信販売で購入が可能です。
栄養摂取には様々な方法があります。かかりつけ医や介護の専門企業等に相談してみましょう。
まとめ
認知症をもつ高齢者の方が食事に対して拒否をされる場合には、様々な理由があります。
介護者である家族は、本人の日々の様子をみながら、長い目で食事摂取の介護を行う必要があります。また、栄養摂取がサポートできる食品も販売しているので毎日の取り入れてみるの手です。
ご家族の一番良いのは、介護の専門家のサポートをうけることです。
これまでの介護経験より、認知症をもつご家族に合った対応をアドバイスしてもらうことができるでしょう。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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