The quality of life and nutritional status of older adults residing in long-term care, post-acute care, and other settings can be enhanced by individualized nutrition approaches, according to the Academy of Nutrition and Dietetics. This includes using the least restrictive diet and providing autonomy for older adults. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, working as a team, should be actively involved in developing facility policies and procedures and educating staff, residents and family members on the current research and benefits of an eating plan based on each individual's needs and with the least amount of restrictions.
For example, the nutrition and dietetics practitioner may need to explain that although therapeutic diets are intended to improve health, they can negatively affect the variety and flavor of foods offered to older adults. Providing less restrictive diets can help maximize meal intake and prevent undernutrition and unintended weight loss, which can lead to additional health complications. In these circumstances, the risks versus the benefits of any dietary restrictions need to be evaluated.
Implementing liberalized diets can also help a long-term care facility meet compliance with federal long-term care regulations. The State Operations Manual of the Centers for Medicare and Medicaid Services-Appendix PP-Guidance to Surveyors for Long-Term Care Facilities emphasizes the importance of protecting and promoting the rights of residents. Therefore, the provision of a therapeutic diet against a resident's wishes would not be in support of their personal preferences and may have negative implications on the resident's health or quality of life. Informing staff that providing a more liberal diet as a means to maintain or improve a resident's nutritional status may also serve as an incentive for change within the facility, especially if it results in a decreased reliance on supplements.
When considering a therapeutic diet prescription, a practitioner should ask: "Is a restrictive therapeutic diet necessary?" and "Will it offer enough benefits to justify its use?" RDNs should then utilize the Nutrition Care Process and develop an individualized care plan that is consistent with needs based on nutritional status, medical condition and personal preferences, rather than diagnosis alone. Care should be taken not to reduce the patient's quality of life.
Also, the RDN should encourage creative dining programs for older adults. Research suggests dining programs that provide choices, such as buffet-style dining and decentralization of food service, demonstrate improvements in food intake and quality of life.
- Dorner B, Dunedin FL, 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.
- Pioneer Network Food and Dining Clinical Standards Task Force. New Dining Practice Standards. Published August 2011. Accessed June 4, 2020.