Position of the American Dietetic Association: Liberalization of the diet prescription improves quality of life for older adults in long-term care

Western Home Communities, Cedar Falls, IA, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 01/2006; 105(12):1955-65. DOI: 10.1016/j.jada.2005.10.004
Source: PubMed

ABSTRACT It is the position of the American Dietetic Association (ADA) that the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by liberalization of the diet prescription. The Association advocates the use of qualified dietetics professionals to assess and evaluate the need for medical nutrition therapy according to each person's individual medical condition, needs, desires, and rights. In 2003, ADA designated aging as its second "emerging" area. Nutrition care in long-term settings must meet two goals: maintenance of health and promotion of quality of life. The Nutrition Care Process includes assessment of nutritional status through development of an individualized nutrition intervention plan. Medical nutrition therapy must balance medical needs and individual desires and maintain quality of life. The recent paradigm shift from restrictive institutions to vibrant communities for older adults requires dietetics professionals to be open-minded when assessing risks vs benefits of therapeutic diets, especially for frail older adults. Food is an essential component of quality of life; an unacceptable or unpalatable diet can lead to poor food and fluid intake, resulting in weight loss and undernutrition and a spiral of negative health effects. Facilities are adopting new attitudes toward providing care. "Person-centered" or "resident-centered care" involves residents in decisions about schedules, menus, and dining locations. Allowing residents to participate in diet-related decisions can provide nutrient needs, allow alterations contingent on medical conditions, and simultaneously increase the desire to eat and enjoyment of food, thus decreasing the risks of weight loss, undernutrition, and other potential negative effects of poor nutrition and hydration.

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    • "As regards assessment of nutrition, considerable number of studies have examined the nutritional status of institutionalized elderly people and reported prevalence figures for malnutrition and nutritional problems [21]. According to the American Dietetic Association (ADA), the nutrient requirements of elderly peopleare not fully understood, although it is known that the physiological and functional changes that occur with agingcan result in changes in nutrient needs [22]. "
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    ABSTRACT: Background. This work was constructed in order to assess the nutritional and functional status in hospitalized elderly and to study the associations between them and sociodemographic variables. Methods. 200 elderly patients (>65 years old) admitted to Internal Medicine and Neurology Departments in nonemergency conditions were included. Comprehensive geriatric assessments, including nutritional and functional assessments, were done according to nutritional checklist and Barthel index, respectively. Information was gathered from the patients, from the ward nurse responsible for the patient, and from family members who were reviewed. Results. According to the nutritional checklist, 56% of participants were at high risk, 18% were at moderate risk of malnutrition, and 26% had good nutrition. There was a high nutritional risk in patients with low income and good nutrition in patients with moderate income. Also, there was a high nutritional risk in rural residents (61.9%) in comparison with urban residents (25%). Barthel index score was significantly lower in those at high risk of malnutrition compared to those at moderate risk and those with good nutrition. Conclusions. Hospitalized elderly are exposed to malnutrition, and malnourished hospitalized patients are candidates for functional impairment. Significant associations are noticed between both nutritional and functional status and specific sociodemographic variables.
    Journal of aging research 10/2013; 2013:101725. DOI:10.1155/2013/101725
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    • "In fact, up to 85% of residents suffer from malnutrition (Crogan and Pasvogel, 2003; Suominen et al., 2005), implying that many residents have inadequate food intake. Malnutrition can result in a compromised quality of life (Crogan and Pasvogel, 2003; American Dietetic Association, 2005), and can lead to chronic disability, functional decline, increased health care utilization, increased health care costs and death (Reed et al., 2005; Woo et al., 2005). The causes of malnutrition are multidimensional, including dental caries, impaired chewing capacity, impaired ability to eat certain foods and even environmental factors such as poor food quality or lack of assistance while eating (Isaksson et al., 2003; Carrier et al., 2007). "
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    ABSTRACT: The purpose of this article is to describe nutritional problems that may be predictive of poor resident outcomes in nursing homes. In a recent study, seven resident-focused problems or categories that may affect malnutrition and/or food intake were identified (Crogan and Alvine, 2006; Crogan et al., 2007). Regression analysis found that three of seven resident-focused problems were predictive of low serum prealbumin levels, impaired functional status and improved quality of life.
    European journal of clinical nutrition 02/2009; 63(7):913-5. DOI:10.1038/ejcn.2008.73 · 2.71 Impact Factor
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    • "Communitydwelling centenarians may not have access to the wholesome foods that they need. Contributory factors , which could be further explored in the centenarians and their caregivers, include physical or mental problems that contribute to problems with biting, chewing, and swallowing, impaired ability to shop or cook, and a lack of knowledge about the food and nutritional needs of older adults (Kuczmarski and Weddle 2005; Niedert 2005). Caregivers in both the community and in skilled nursing facilities must be prepared to address a variety of food-and nutritionrelated concerns of these elders, including the need for foods from all of the recommended food groups, interventions for declining food intake and body weight, and the appropriate use of consistencymodified foods and oral liquid supplements. "
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    ABSTRACT: The purpose of this study was to examine the dietary habits among centenarians residing in community settings (n=105) and in skilled nursing facilities (n=139). The sample was a population-based multi-ethnic sample of adults aged 98 years and older (N=244) from northern Georgia in the US. Compared to centenarians in skilled nursing facilities, those residing in the community were more than twice as likely to be able to eat without help and to receive most of their nourishment from typical foods, but they had a lower frequency of intake of all of the food groups examined, including dairy, meat, poultry and fish, eggs, green vegetables, orange/yellow vegetables, citrus fruit or juice, non-citrus fruit or juice, and oral liquid supplements. A food summary score was created (the sum of the meeting recommendations for five food groups). In multiple regression analyses, the food summary scores were positively associated with residing in a nursing facility and negatively associated with eating without help and receiving most nourishment from typical foods. These data suggest that centenarians residing in communities may have limited access to foods that are known to provide nutrients essential to health and well-being. Also, centenarians who are able to eat without help and/or who eat mainly typical foods may have inadequate intakes of recommended food groups. Given the essential role of foods and nutrition to health and well-being throughout life, these findings require further exploration through the detailed dietary analyses of centenarians living in various settings.
    Journal of the American Aging Association 12/2006; 28(4):333-41. DOI:10.1007/s11357-006-9021-9 · 3.39 Impact Factor
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