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

ArticleinJournal of the American Dietetic Association 105(12):1955-65 · January 2006with99 Reads
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.
    • "In addition, as recently reviewed by Darmon et al. [144], restrictive diets such as low sugar, low salt, or low cholesterol diets for persons with diabetes mellitus, hypertension or hypercholesterolemia , respectively, seem to be less effective with increasing age, albeit data on their effects in older persons in general are rare and are also lacking for persons with dementia. In a position statement, the American Dietetic Association concludes that liberalization of diet prescriptions for older adults in long-term care may enhance nutritional status and quality of life [109]. In individual cases, e.g. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. Objective: It is the purpose of these guidelines to cover these issues with evidence-based recommendations. Methods: The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. Results: 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. Conclusion: Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
    Article · Sep 2015
    • "Historically, nutritional management of residents with diabetes in institutions has been a prescribed therapeutic or 'diabetic' diet generally comprising of the following restrictions ; no concentrated sweets and restricted calories and/or fat, sometimes known as a 'No concentrated sweets diet [7] or ''ADA diet'' [8]. Although with literature reporting that as many as 50% institutionalized older adults are malnourished [9] and limited data to demonstrate effectiveness of restrictive diets [6] in achieving optimal glycaemia (HbA1c < 8%, 64 mmol/mol), the therapeutic 'diabetic' diet is no longer recommended by the ADA and a move to liberalize diet prescriptions for older adults in aged care has occurred [10] albeit inconsistently, with many facilities still offering a version of a diabetic therapeutic menu. There are limited studies that inform current menu standards and facilities may now opt for a generic liberalized menu incorporating less restriction on calories, fat and carbohydrate from refined sugar, which is offered to all residents, loosely based on the ADA [4] and IDF guidelines [5], some with particular emphasis on high energy foods to reduce risk of malnutrition and a consensus from existing literature that such a diet will not impact on diabetes management [2,11]. "
    [Show abstract] [Hide abstract] ABSTRACT: A systematic review of the literature was conducted to review and evaluate the evidence supporting a liberalized diet for the management of diabetes mellitus in aged care homes and examine the effect of this on glycaemia, nutritional status and diabetes comorbidity risk factors. A 3 step search of eight databases followed by independent data extraction and quality assessment by two authors was undertaken. Studies which compared therapeutic diets to a liberalized diet or observation studies reviewing the effects of therapeutic diets on glycaemia and nutritional status were included. Of the 546 studies identified, six met the inclusion criteria. Methodological quality of the studies was rated poor and the majority concluded no statistically significant change in diabetes management outcomes with a liberalized diet, but modest increases in glycaemia were observed. Inadequate data was available to determine effects of diet change on nutritional status or diabetes risk factors. Overall studies were in support of a liberalized diet but due to the low quality of the evidence and a lack of significant findings it may not be appropriate to extrapolate these conclusions to inform dietetic practice.
    Full-text · Article · Jan 2015
    • "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]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Oct 2013
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