Older Adults

Individualized Nutrition Approaches for Older Adults

May 10, 2018   /

 

Long-term Care and Post-Acute Care 

 

Reviewed and Updated by Mary Ellen Posthauer, RDN, CD, LD, FAND

 

Rationale

“It is the position of The Academy of Nutrition and Dietetics that the quality of life and nutritional status of older adults in long-term care, post acute care, and other settings can be enhanced by individualized nutrition approaches. The Academy advocates that as a member of the interprofessional team, the registered dietitian nutritionists (RDNs) assess, evaluate, and recommend appropriate nutrition interventions according to each individual’s medical condition, desire, and rights to make health care choices.”

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Facilities should consider the risk and benefits of restrictive diets, and should individualize residents' diets to maximize meal intake, improve quality of life, and respect residents' rights. In many cases, a regular or liberalized diet order increases meal intake, reduces the risk of weight loss, and malnutrition, and improves resident satisfaction with dining. The registered dietitian nutritionist may recommend a regular diet, which is appropriate for many residents, even those with disease specific conditions such as diabetes or chronic kidney disease

 

Policy

It is the policy of this facility that a regular or individualized diet, with texture modifications as appropriate, is ordered based on the nutrition assessment, including for residents with disease specific conditions, such as diabetes, hypertension etc. All residents admitted to this facility are assessed by the facility’s registered dietitian nutritionist.

Date effective:   _____________________

Approved by: _______________________

 

Procedure

  1. Residents are admitted on the diet ordered on the discharge summary.  
  2. A dietary communication slip with the resident’s diet order is sent to the kitchen.
  3. The facility’s registered dietitian nutritionist completes a nutrition assessment for the resident per facility policy. The dietetic technician registered and/ or the certified dietary manager may collect information for the assessment.
    1. Information about the resident’s history of therapeutic diets is obtained through resident/family /caregiver interviews and the medical record.
    2. Food preferences, including religious, ethnic and cultural needs are obtained through patient/family interviews.
    3. Meal intake is observed and assistance is offered as needed.  
  4. The registered dietitian nutritionist recommends the appropriate diet
    1. Many older adults with diabetes benefit from a regular diet or individualized diet.
    2. Blood glucose levels, such as HgbA1C, are generally higher for older adults than younger individuals. Fluctuations in blood sugars can be managed by adjusting medications. Education about appropriate food choices for managing diabetes on a regular diet should be part of the plan of care.
    3. Residents with renal failure and/or congestive heart failure may benefit from regular diets catered to meet their specific condition. The focus is on maintaining appropriate lipid and/or blood pressure levels while preserving the resident’s quality of life.
  5. Texture modified diets should also be evaluated and when possible advanced to the least restrictive diet based on the nutrition assessment and the resident’s rights.
  6. At each quarterly review, the nutrition teams determine if the diet order remains appropriate for each resident. The plan of care is adjusted if necessary.
  7. When residents on therapeutic diets experience weight loss or poor intake individualizing and liberalizing the diet in an attempt to improve meal intake is an accepted and recommended intervention.
  8. Annual continuing education is provided to update new staff on this policy.

 

Reference and recommended reading

  1. Dorner, B, Friedrich EK, Position of the Academy of Nutrition and Dietetics: Individualized nutrition approaches for older adults: long-term care, post-acute care, and other settings. J Acad Nutr Diet. 2018;118:724-735.
  2. New Dining Practice Stanards. Pioneer Network Dining Practice Standards: https://www.pioneernetwork.net/wp-content/uploads/2016/10/The-New-Dining-Practice-Standards.pdf Accessed April 19, 2018.

 

Current review date: 4/30/18

Previous review date: 11/10