“Food nourishes the spirit as well as the body.” That might sound like something you’d hear from your favorite, and not quite diet-friendly, restaurant, but it’s actually part of a paired Practice Paper/Position Paper from the American Dietetic Association (Dorner et al 2010b). While the ADA is perhaps more commonly thought of as the agency who tells us things we don’t want to hear about our favorite foods, the newly-released companion papers emphasize the importance of providing older adults with food options that fit their desires, tastes, and rights.
The papers present this new emphasis on enjoyable foods in a culture change/person-centered care framework. (See our recent articles on the topic.) The position paper states that “[c]are for individuals who reside in health care communities must meet two goals: maintain health and preserve quality of life,” and that while these two goals can conflict, food must also “enhance quality of life” (Dorner et al 2010a). Person-centered care, the paper argues, has reminded us that individual dignity, autonomy and choice should guide caregiving.
Such reminders, however, often sound like obvious platitudes without any clear means of implementation. Fortunately, the position paper also presents more specific arguments for tasty food. It reminds us that, due to changes in health and sensory ability, food can be less appetizing as we age. For individuals in care facility, the very desire to eat is often a victory. As most of us have experienced, diet foods restrict our range of food choices and our food pleasure. Citing a literature review on the high rate of malnutrition and undernutrition in older adults, the paper stresses weight maintenance as a pragmatic measure of adequate nutrition, and states that restrictive diets tend to lower food intake, while “more liberal diets are associated with increased food and beverage intake.”
The position paper also offers general nutritional guidelines for diabetes, cardiovascular disease, kidney disease, obesity, Alzheimer’s, and palliative care. Finally, the paper reminds readers that “[p]roviding a therapeutic diet against a resident’s wishes is a violation of resident rights,” noting the simultaneous obligation to ensure that the resident understands the risks of not following such a diet. (2010a).
The practice paper more specifically addresses actions that should be taken by facilities and professionals. It offers general guidelines about the need for dietitians to be flexible, and for them to take a more prominent role in choices about dining services and in broader policy and education. The paper specifically states that almost all older adults in care settings should have individualized nutritional plans that consider the individual’s preference and rights as well as the advice of dietary/nutrition professionals.
The practice paper also addresses considerations at the level of the institutions, discussing how these individual “liberalized” diets relate to regulations on Home and Community-Based Services, Assisted Living Facilities, and CCRCs. The paper also suggests culture change-friendly terminology to use, and offers suggestions for changes in dining services such as buffet dining, restaurant-style menu/service, the use of spices, and the involvement of residents and other older adults on decision-making. Also included for practitioners are overviews, case studies and suggested interventions relating to specific medical situations
Finally, the paper includes suggestions for educators and researchers. The ADA would like to see dieticians have a greater involvement in policy and general public awareness of individualized nutrition for older adults. The paper also encourages specific research agendae such as a study of the outcomes of individualized nutrition interventions, appropriate caloric and protein intake for older adults, and the role of culture and ethnicity on food values.
What can we make of this paper? While the ADA must of course consider the interest of its member dieticians, the paper does bring up some excellent facts that, presented in the context of food choice, should make a lot of food-lovers happy as well. These policy and practice ideas presented by the ADA seem grounded in the reality of how people make food choices, a pragmatic approach that seems potentially useful. I would have been interested to see alcohol and/or caffeine use addressed, but perhaps this relates more to my own interests as a researcher rather than to the needs of policy-makers and practitioners.
What do readers think? We’d love to hear dieticians, health care consumers, families, and other experts weigh in (no pun intended) on this one, either by email or in our comments.
Dorner, B., Friedrick, E.K., Posthauer M.E. (2010a). “Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities.” Journal of the American Dietetic Association 110(10): 1549-1553
Dorner, B., Friedrick, E.K., Posthauer M.E. (2010b). “Practice Paper of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities.” Journal of the American Dietetic Association 110(10): 1554-1563
Press release: http://www.eatright.org/Media/content.aspx?id=6442458877
Position paper abstract: http://www.eatright.org/About/Content.aspx?id=8373
ADA Nutrition Care Process: http://www.eatright.org/HealthProfessionals/content.aspx?id=7077
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