Liberalizing Diets in Long-Term Care

Therapeutic diets are often ordered for residents of long-term care facilities. A therapeutic diet is defined as a diet intended to treat a disease or help manage a medical condition. Some examples include a 2 gm sodium, diabetic, and renal diets. However, many of these diets may not be appropriate for nursing home residents. Focus for the long-term care resident is on quality of life, quality of care, as well as residents’ rights. As a part of the The New Dining Practice Standards, The Academy of Nutrition and Dietetics reports that protein-energy malnutrition effects 23% to 85% of long-term care residents and most of these were on restricted diets that might discourage intake. Therefore, the Academy recommends that long-term care facilities individualize residents’ diets to maximize meal intake of those who are at nutritional risk. In many cases, a regular diet improves meal intake, minimizes struggles over dietary compliance, and improves residents’ quality of life. With assessment and monitoring by a registered dietitian, a regular diet (with texture modifications) can be appropriate for many long-term care residents, even those with a diagnosis of diabetes or hypertension.

Liberalized diets are defined by efforts to relax dietary prescriptions established to help manage or treat a disease like diabetes, high blood pressure, congestive heart failure, or renal disease. More than just supporting improved quality of life, a move toward liberalized diets has been shown to result in improved intake and a decrease in the malnutrition and unintended weight loss that often occurs when residents are served food they don’t want—and consequently won’t eat. As diets are liberalized, there is opportunity for experienced dietitians, dietary managers, chefs, and nurses to educate long- and short-term residents on making wise nutritional choices, and helping them understand how their decisions, good or bad, may affect their overall health.

You may ask: will we need to increase medication for all our diabetics? The answer is probably not. According to Nutrition411, “in many frail elderly patients, it is not realistic to manage medical conditions or change medication in an attempt to reduce blood sugar levels.” Glycemic goals for the elderly may include an HbA1c of <8.0 rather than the 7.0 guidelines set for other adults by the American Medical Directors Association. Also, support for the use of regular diets for nursing home residents with type 2 diabetes is provided by a study in which 14 nursing home residents received the regular diet and 14 received a no-concentrated sweets diet. At 6 months, there was no change among the subjects’ HbA1c in either group. The American Diabetes Association recommends the use of regular diets with consistent amounts of carbohydrate at meals and snacks. Calories should meet estimated nutritional needs. Regular menus in long-term care facilities are generally consistent in calories, served at consistent times, and portions are controlled. If desserts are served, the portions are typically small. A fat restriction is not indicated for the majority of this population due to a potential risk of malnutrition. Menus usually contain few fried items if any, gravies are broth-based, not made from meat drippings, and little salt is used in preparation of foods.

Most experts agree that a benefit exists to preventing and treating heart disease even in elderly patients (defined as 65 and older). However, there is evidence that the importance of serum cholesterol levels as a risk factor for coronary heart disease decreases, virtually disappears after age 65. One should consider the functional age of a client, quantity versus quality of life, presence of other risk factors such as dementia, terminal illness, and the resident’s wishes (advanced directives). Even in this case, a regular diet is appropriate to enhance the dining experience and allow choices.

Put yourself in the shoes of these residents. Would you want to finish out your days eating bland food, no dessert, low sodium bread and cheese, or would you rather have a slice of pizza and ice cream? We need to consider residents’ rights and give them choices because they have so few choices left. Mealtime is a way for the resident to take a very active part in their own healthcare. Let’s help them do just that.

 

This article was written by Lisa Stewart and can be found here.