【高齢者】食事以外で栄養を摂る事はできますか?
母親の食事量がどんどん落ちてきています。
年を重ねると、「食が細くなる」なんて言葉を聞いたことはありませんか？
食事は生きていく上で欠かす事のできない大事な生命活動の一つといえます。
ではその大切な食事摂取量が減ると、どのような事がおきるのでしょうか。
高齢になると食べたくても食べれない事や、食べる意欲がわかなくなったりすることが多くあります。
それでも生きていくには栄養のある食事が欠かせません。
では食べること以外で栄養を摂取する方法はあるのでしょうか。
今回は高齢者にとっての「食事」や「栄養」について説明していきたいと思います。
目次
高齢者はなぜ食が細くなるのか
食が細くなる理由は、加齢による、体の機能の変化が考えられます。
① 胃の機能が低下する
年を重ねると胃の弾力性が徐々に低下していきます。
食べ物が入ってきても胃が十分に広がらず、たくさんの量をためておくことができないため、依然と同じように食べる事が出来なくなってしまいます。
消化にも時間がかかったり、胃から小腸へ送る蠕動運動（ぜんどううんどう）も低下するため、胃に食べ物がのこったままになり、お腹も空かなくなります。
胃酸も多く分泌されてしまい、胃に負担がかかってしまいます。
また、油を多く含むものは分解されにくいため、胃もたれのような不快感があります。
② 食道の機能が低下する
胃だけではなく、食道の機能も低下します。
胃へ食べ物を送る蠕動運動が弱くなったり、括約筋（かつやくきん）の衰えによって、胃との通路が閉じにくくなります。
そのため胃酸が食道へ逆流してしまい、「逆流性食道炎」という病気になってしまい、それによって胸やけやむかつきを感じてしまいます。
③口腔機能（こうくうきのう）の変化
・唾液の減少
唾液が減ると口の中が乾いてしまい、菌が増えてしまい口内炎や歯周病のもとになってしまいます。それに伴う痛みや不快感によって、食欲が減退してしまいます。
・咀嚼力（そしゃくりょく）の低下
咀嚼力とはかむ力の事です。噛んだり飲み込んだりする力が衰え、むせる事が増えます。
また、虫歯や歯周病などで歯がなくなり、固い物を嚙まなくなることで、筋力が衰えてしまいます。
・舌の機能が低下
年を重ねると舌の感覚も衰え、味を感じにくくなります。高齢者の食事が濃くなるのはこのためです。味覚が感じにくくなると今まで食べていたものもおいしく感じられなくなるため、食欲の低下につながります。
一部を紹介しましたが、上記以外にも活動量の低下で空腹を感じにくいことや、吸収能力の低下、食事環境や精神的な影響など、様々な原因があります。
食が細くなってきている方への効果的なアプローチ
高齢者の食欲をアップさせる一番の方法は「好きな物を献立に取り入れる」ことです。
かといって、毎日・毎食となると偏ってしまいますので、今回は食事の内容ではなく食欲をアップさせるきっかけを紹介したいと思います。
①一人で食べないようにする
一人で食べる事が多くなると、食事を抜く事や食べ物を残すことに抵抗感がなくなってしまいます。まずは誰かと食事をし、「食事の時間」が楽しいと思うようになれば、食欲が上がるかもしれません。
②適度な運動をする
軽く運動を行うだけでも食欲は大いに刺激する事ができます。人の体はカロリーを消費すると食物からさらにエネルギーを取り入れようとする性質があります。
③盛り付けを工夫する
たくさんの量を盛りつけず、少量を小分けにする事で、見た目の圧迫感を減らし、食べようとする気持ちを起こしやすくすることができます。また、大きなお皿に少量を盛りつけて食べると、脳が「少量しか食べていない」と錯覚し、食事量を上げる事ができます。
④五感で食欲を刺激する
料理を作る時の音や、匂いなどを感じてもらいましょう。例えばまな板のトントンといった音や、何かを炒める音、グツグツと煮込む音など。匂いならハーブや香辛料など、本人が好む匂いを感じてもらう事も効果的です。
高齢者に多い「低栄養状態」
「低栄養」とは、エネルギーとタンパク質が欠乏し、健康を維持するために必要な栄養素が足りない状態を言います。
特に高齢になると体内の筋肉や水分が減り、様々な症状が現れてきます。
・認知機能の低下
・気力がなくなる
・皮膚の炎症や乾燥
・骨量の減少に伴う骨折の危険
・免疫力や体力の低下し、病気にかかりやすい
等々。
低栄養はなかなか自覚症状がないことも多く、本人も周囲も気づきにくいことが特徴です。
そこで血液検査など、健康診断を定期的に受けておくことをお勧めします。
その結果、以下の点に注意する事で栄養状態を評価する目安になります。
・体重の変化
・BMI（体格指数）
・血清（けっせい）アルブミン値
食事以外で栄養を摂る方法は？
食事以外での栄養摂取の方法はあります。
介護を受けておられる方であれば、まったく食事が出来ない方なども居られます。
ここでは食事が難しくなってきた方への栄養摂取の方法を紹介します。
①経腸栄養剤(けいちょうえいようざい)を飲む
経腸栄養剤とは、栄養素がバランスよく配合された高エネルギーの栄養剤です。消化管を使って簡単に消化・吸収をすることができます。普通の食事では栄養素を十分に消化・吸収ができない場合や、大きな手術後で、腸を安静にさせたい場合などにも使われます。
②血管に直接栄養剤を注入する。
点滴を使用し、直接体内に栄養剤を注入する方法で、大きく分けて2種類あります。
・「抹消（まっしょう）静脈栄養」
一般的に行われる点滴をイメージしてもらえればわかりやすいと思います。腕や手の甲などの細い血管に針を刺し、製剤を注入する方法です。あまり高濃度のカロリーを投与すると血管に炎症が起きてしまうため、投与には上限があります。そのため、短期的にエネルギーを補助する方法です。
・「中心静脈栄養」
こちらは首や鎖骨の下、脚の付け根などを走る太い静脈にカテーテルを挿入し、心臓付近まで進め、必要な製剤を注入する方法です。太い血管を使うため、一日に必要なカロリーを全て投与する事ができるため、長い期間、エネルギーを確保する事ができます。
③胃瘻(いろう）
胃に穴を開けて、直接栄養を注入する方法です。今は胃カメラ（内視鏡）を使って造設する事が多く、全身麻酔などは不要になりました。寝たきりになった人が使用するイメージ化もしれませんが、口から食事ができなくなった人にとっては、大切な命綱であり、現代医療においては、なくてはならない、栄養療法の一つといえます。
また、一時的に胃ろうで栄養管理をし、後に閉鎖することもできます。
まとめ
食事の量が減ったり、食事ができなくなっても、健康を維持し、栄養を確保する方法はたくさんあります。
しかし口から食事を摂取することはとても大切な事です。
栄養摂取ももちろん重要ですが、「食べ物を認識し、手を使って口まで運び、歯で噛み、飲み込む」この一連の動作は何となく行動しているようでも実際は脳の指令を受けて様々な情報伝達、指令系統を働かせています。つまり脳が活性化するのです。
噛むことで唾液が分泌され、口の中を清潔に保つことができ、飲み込むことで嚥下（えんげ）状態も保持でき、誤嚥性肺炎のリスクを回避することができます。
まずは、「食事は楽しい」と思えるよう、家族や友人、周囲の方たちとの会話を楽しみながら食事をし、充実感を得る事ができれば、食欲も上がり、生活の質も向上させることができるのではないでしょうか。
他の観点からまとめてます。こちらも参考にしてみてください。
「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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