Identify specialty diet options appropriate for long-term care facilities Demonstrate understanding of how to integrate specialty diets in a manner that is both cost-effective and suitable for the population served, while considering staff and equipment constraints Understand techniques to enhance flavor and presentation
It is the position of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) that the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by a liberalized diet.
A regular or mechanical soft diet is recommended for nearly ALL longterm care residents for satisfaction and to prevent malnutrition (OR) The least restrictive diet order possible is recommended for those in longterm care
Energy needs decrease approximately 5% per decade Protein needs do not decrease with age 50-60% of calories should come from carbohydrates Older people are at risk for dehydration
Maintain health & preserve quality of life Long-term care is different from acute care in that chronic diseases and overall quality of life become the focus Prevent malnutrition and further decline that is associated with poor nutrition, such as increased mortality, loss of lean muscle mass, depression, pressure ulcers and increased hospital admissions
Is the therapeutic diet necessary? Do the benefits outweigh the risks of under nutrition due to poor intake?
Diabetes Cardiovascular Disease Chronic Kidney Disease Obesity Alzheimer s/dementia
The position of AND (Academy of Nutrition and Dietetics) is that diets such as no concentrated sweets or no sugar added are no longer considered appropriate The American Diabetes Association recommends that residents should receive a consistent amount of carbohydrates throughout the day in conjunction with appropriate medication Note: Education should be provided any time nutrition modifications are encouraged
The American Heart Association recommends treatment for hypercholesterolemia & hypertension in all persons regardless of age It is their position that benefits of treatment outweigh risks Typically, for palatability, a 2-3 gram sodium diet is recommended in this population DASH Diet is often encouraged Note: A written order is needed for a salt substitute
Poor nutrition status is often difficult to identify in this population because weight changes are often related to fluid shifts Residents who are on dialysis need increased protein and calories Residents, who have CKD who are not on dialysis, may need a more individualized nutrition care plan
Often just 5% of weight loss can increase quality of life by reducing the amount of medication taken for chronic diseases Encouraging weight loss in older populations has the potential to cause loss of lean body mass, which can lead to more significant health problems
A physician,as well as a nutrition care professional, should complete an assessment & risk benefit analysis prior to recommending a weight loss plan Note: In this population we often use usual body weight or weight prior to decline instead of ideal body weight
Meal plans for this group should include nutrient-dense foods with resident preferences always under consideration Prompting or feeding assistance may be necessary Note: Because tastes change obtaining food preferences frequently may be beneficial
Things to consider when modifying diets Common specialty diets Liberalized geriatric diet Additional modification options Snacks
Nutrition requirements Choose nutrient-dense options Cook s skill set Kitchen equipment and setup Cost Food preferences Should keep up-to-date food preferences on all residents
No added sugar No concentrated sweets No salt added No fried food/limit eggs
2 gram sodium 1500 calorie diet for diabetes Carbohydrate allowances 30g.-45g.-45g. 2000 calorie diet for diabetes Carbohydrate allowances 45g.-60g.-45g.
Consistent amounts of carbohydrates (approximately 45-60 g per meal) Low in saturated fats 2 grams sodium or DASH diet DASH-Dietary Approach to Stop Hypertension Rich in calcium, potassium, magnesium, noted to lower blood pressure in 2 weeks Obtain food preferences
Mechanical Soft As with therapeutic diets the least restrictive texture modification should be chosen Renal Note- May need to consult a SLP Light Supper Allergy/intolerance Increase in fiber
Snacks should be made available between meals to encourage intake Likewise, nutritional supplements should be served between meals The snacks provided should be appropriate for most of the residents Note: Educating residents on their diet can promote autonomy and independence
No food is nutritious until it is eaten Anon.
Cinnamon: fruits, pork, sweet potatoes Dill: chicken, vegetables, potatoes, pasta Garlic: meats, soups, salads, vegetables, pasta Nutmeg: potatoes, chicken, cauliflower, broccoli, cabbage Onion: meats, stews, vegetables, salads, soups, beans Paprika: chicken, soups, salads, sauces, beans Rosemary: meats, sauces, stuffing, potatoes, peas Thyme: meats, sauces, soups, peas, tomato dishes
Hot garnishes Cold garnishes
If a meal is colorful sometimes a garnish is not needed Garnish options Tomato wedges Orange or lemon wedges or slices Fresh herbs Chopped pimento Parsley
Most cold plates (salads, fruits, sandwiches) should be garnished Place desserts a on doily; for puddings or jello, place on a lettuce leaf or in a fluted cup. Add a swirl of whipped cream for an added effect Note: A doily should not be placed under a food item that may become soggy
Salads- mixing colorful lettuce with cheaper iceberg lettuce increases appeal while mildly affecting cost Add shaved carrots for contrast Fruits- Canned fruits should be drained and placed in cups Fruit cups can be substituted for dessert
Utilize smaller portions to not overwhelm residents Variety of color increases appeal Avoid one color meals Cooking foods properly can retain bright color
Place items on the tray or table so that they are easily accessed Condiments should be in one place, a small bowl or cup works well Color coordinate plates, linens, and silverware Educate employees on consistency Place photos of completed meals in the plating area Note: Make sure to discuss these potential changes with employees prior to changes being made
Notice portion size, plating and garnish
What do you notice?
What do you notice?
Before After
Quality of life and nutritional status of long-term care residents may be improved by a liberalized diet Modifications to your regular menu may reduce the need for specialized diets Seasoning and presentation are key in increasing intake and thus preventing malnutrition
Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities." Journal of the American Dietetic Association 110.10 (2010): 1549-553. Print. "Nutrition for the Older Adult." Oklahoma Nutrition Manual. 12th ed. N.p.: n.p., 2006. E1-E9. Print. American Dietetic Association. The Sodium Story. Chicago: American Dietetic Association, 2002. Print. Miller, Don, R.D., C.E.C., and Nancy Yezzi, R.D., L.D. Basic Destination 10 Garnishing Program for Patient Trays. N.p.: Destination 10, 2001. Print.
Jensen, Danielle, MS, R.D.L.D. Fruit Plate with Dip. 2005. Photograph. Jackson County Memorial Hospital, Food and Nutrition, Altus. Jensen, Danielle, MS, R.D.L.D. Fruit with Cottage Cheese. 2004. Photograph. Jackson County Memorial Hospital, Food and Nutrition, Altus. Jensen, Danielle, MS, R.D.L.D. Fruit Plate. 2004. Photograph. Jackson County Memorial Hospital, Food and Nutrition, Altus. Jensen, Danielle, MS, R.D.L.D. Shake & Bake Chicken and Broccoli Before. 2005. Photograph. Jackson County Memorial Hospital, Food and Nutrition, Altus. Jensen, Danielle, MS, R.D.L.D. Shake & Bake Chicken and Broccoli After. 2005. Photograph. Jackson County Memorial Hospital, Food and Nutrition, Altus.