While respecting the need to follow established dietary guidelines for specific medical conditions, the authors suggest that restrictions should be loosened if a patient’s oral intake is poor.
Care providers should examine the trade-off between the consequences of malnutrition and unintended weight loss (UWL) versus specific disease-related health risks. They should also involve patients in food choices, the authors propose.
The views are part of a position paper recently published in The Journal of the Academy of Nutrition and Dietetics.
“Registered Dietician Nutritionists (RDNs) should evaluate each individual and assess the risks vs the benefits of a restrictive diet,” wrote first author Becky Corner, Fellow of the Academy of Nutrition and Dietetics and leading expert in elderly nutrition.
“Maximising food intake can help prevent undernutrition/malnutrition and unintentional weight loss (UWL), which can lead to additional health complications. Individualising to the least restrictive diet can enhance nutritional status and improve quality of life, particularly for older adults in PAC settings.
“Including older individuals in decisions about food can increase the desire to eat and improve quality of life,” Corner added.
“For most older adults in long-term care, the benefits of less restrictive diets outweigh the risks. When considering a therapeutic diet prescription, the health care practitioner should ask: is a restrictive therapeutic diet necessary? Will it offer enough benefits to justify its use?”
Stating the position of the Academy of Nutrition and Dietetics (AND), the authors recommend that as part of the inter-professional care team, RDNs should develop appropriate nutrition interventions tailored to a patient’s medical condition and preferred health care choices.
Avoiding malnutrition a priority
Avoiding malnutrition and UWL is essential in geriatric nutrition, particularly in frail individuals, the authors emphasise. Although therapeutic diets are designed to improve health, the flavour and variety of food may be unsuitable.
“Older adults may find restrictive diets unpalatable, resulting in reduced pleasure in eating, decreased food intake, UWL, and malnutrition,” wrote Corner.
“In contrast, more liberal diets are associated with increased food and beverage intake.”
Decreased appetite and food intake leading to malnutrition in the elderly is commonplace among older adults and is a recognised predictor of morbidity and mortality, explained the authors.
“Consequences of malnutrition include loss of strength and function, increased risk of falls, depression, lethargy, immune dysfunction, increased risk of infection, delayed recovery from illness, pressure injuries, poor wound healing, increased chance of hospital admission and readmission, increased treatment costs, and increased mortality.”
The Academy of Nutrition and Dietetics is the United States' largest organisation of food and nutrition professionals, whose mission is to advance public health and nutrition. The group uses its research journal to help influence public and legislative discussion about health, food safety and nutrition.
Source: The Journal of the Academy of Nutrition and Dietetics
Volume 118, Issue 4, Pages 724–735 doi: 10.1016/j.jand.2018.01.022
“Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings”
Authors: Becky Dorner, Elizabeth K Friedrich