Under-Nutrition: The Dietary Dilemma Older Adults Have in Common

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Diane Hall, RD, LD, NHA

We all have in our care people who eat like birds and end up being put on our “weight monitor list.”

“25% of nursing home residents experienced weight loss when research staff conducted standardized weighing procedures over time.” – Journal of the American Geriatrics Society, 2009

Then there are the folks who want to eat only “junk” foods — those high in fats and added sugar. They’d be happiest on an all-desserts menu. Instead of being underweight, they often are overweight. But that extra weight is not supported by their diminished muscle mass, hence the term fat-frail. They also suffer from under-nutrition, because they’re not getting the vitamins and minerals that a healthy diet provides.

Contributing to the issue is that almost 80% of older adults have a chronic condition, and half of all older adults have two or more for which they take medications that may suppress appetite. This is especially true in nursing home communities where the percentage of people with medical conditions may run even higher and diet is usually dictated by diagnosis which leads to dietary restrictions that make it difficult for residents to work up an appetite.

Both of these examples of under-nutrition (malnutrition) may seem contradictory, but they are just birds of a slightly different feather. So, what can we do to ensure (pun intended) that both types of people consume a balanced, nutrient-dense diet while making certain that we honor choices?

The Centers for Medicare and Medicaid recommend a liberalized diet as the standard diet for most people in long-term care.1  People just don’t like being told what they can and can’t eat. They lose their appetites and their interest in food. Forget telling the sugar-lover that they can’t have sweets at each meal. And definitely don’t tell the picky eater they have to eat everything on their plate. Individualizing the diets of elders with chronic illnesses is one of the cornerstones of person-directed dining practices.

This excerpt from the manual, The Inside Scoop on Informed Choice, sums it up.

“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.”
— ADA Position Paper Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-Term Care 2005.

What is the answer? When educated about a particular diet or way of eating and given a broader range of foods to choose from, people will generally choose well and thrive. This approach can work for the picky eater as well as the junk food gobbler. Simply know what people want to eat and how they want to eat.

For more information on how you can get a clearer picture of a person’s eating preferences and habits, download a copy of the Dining Preferences form from The Inside Scoop of Informed Choice manual, to use in your own community. By creating an individualized dining plan for each elder, everyone will win.  Bon Appetite!

1 “Liberalized diets should be the norm, restricted diets should be the exception. Generally, weight stabilization and adequate nutrition are promoted by serving residents regular or minimally restricted diets.” — Centers for Medicaid and Medicare (CMS), Satellite Broadcast and Webcast Innovations in the Quality of Life — Pioneer Network

Diane Hall, RD, LD, NHA, is the author of “The Inside Scoop on Informed Choice: A Step-by-Step Guide for Individualizing Diets,” a manual that provides a process for obtaining informed consent about risky dietary decisions. She is president of Balanced Senior Nutrition, a full-service consulting firm with dietitians focusing on both quality of care and life, throughout the Southeast. For questions or comments, please write to: Diane@SeniorNutrition.net.