Liberalizing Diets:

Nourishing Tenants with

Dignity and Individuality

Denice Nycz, RD,CD, CSG, EP-C

Have you ever wanted to be a

SUPER HERO!

Oivind Hovland/Getty Images; Healthy Mind

by Verywell; Kendra Cherry; May 2016.

Super Heroes . . .

Healthy Mind; VeryWell; Kendra Cherry; May 2016.

retrieved from

• Are competent and confident

• Are concerned with the well-being of

others

• See things from the perspective of others.

Super Heroes of Healthcare

• Lifelong heroes are

caregivers who care for

and comfort the sick,

depressed and dying.

• Their acts of heroism come

in the form of empathy,

nurturance and value for

human dignity.

Our tenants rely on their

Super Heroes.

• So they can reach

their full potential

with. . .

– Dignity

– Independence

– Individuality

Some Tenants’ Health and

Individuality is in Jeopardy.

Restrictive diets could

rob some tenants of

their independence,

health and happiness.

Affects of Heavily

Restricted Diets

• Loss of independence

• Dissatisfaction and anxiety

• Poor intakes

• Weight loss

• Muscle breakdown

• Malnutrition

• Pressure wounds

• Lethargy

• Immune disfunction

• Delay in recovery from illness

• Overall decline of quality of life

Effects of Aging on Diet and

Appetitie

• Sensory losses

• Decline in oral health

• Changes in gastrointestinal

physiology

• Body composition changes

• Age related injuries (falls)

• Medications

‘Nothing wrong with aging, everyone is doing it!’TM

The Power of Good Nutrition

• Impacts the quality of life

• Delays or prevents chronic disease

• Can add additional years of life

• Increases functionality

Position of the Academy of

Nutrition and Dietetics

• . . . “the quality of life and nutritional

status of older adults residing in health

care communities can be enhanced by

individualization to less-restrictive

diets.” J AmDiet Assoc. 2010.

Risks vs. Benefits of Least

Restrictive Diets

• “For many older adults residing in health

care communities, the benefits of less

restrictive diets outweigh the risks . . .” • J Am Diet Assoc. 2010.

CMS Recognizes

Liberalized Diets

• “. . . It is often beneficial to

minimize restrictions consistent

with a resident’s condition,

prognosis and choices.”

• State Operations Manual: Appendix PP-

Guidance to surveyors for long term care

facilities.

Considering a

Liberalized Diet

• Is the tenant being deprived of familiar, well-

liked foods for reasons that are vaguely

defined?

• Has the diet approach emphasized tenant

choice and dignity?

• Does the tenant’s diet contribute to overall

health and quality of life?

Specific Disease Conditions to

Consider when Liberalizing Diets

• Diabetes Mellitus

• Cardiovascular Disease

• Chronic Kidney Disease

• Obesity/weight loss

• Alzheimer’s

Disease/dementia

• Palliative Care

Specific Disease Conditions to

Consider when Liberalizing Diets

• Diabetes Mellitus

• Cardiovascular Disease

• Chronic Kidney Disease

• Obesity/weight loss

• Alzheimer’s

Disease/dementia

• Palliative Care

Common Modified Diets in

Health Care Communities

“There is no evidence to

support prescribing diets such

as no concentrated sweets or

no sugar added for older adults

living in health care

communities, and these

restricted diets are no longer

considered appropriate.

J Am Diet Assoc. 2010.

• General

• No Added Salt

• Consistent Carbohydrate

• Renal (resident specific)

• Consistency

Modifications;

– General Texture

– Mechanical Soft

– Puree

The Role of the Care Team

“Individualized plan of care

should be developed

consistent with needs based on

nutritional status, medical

condition and personal

preferences.” J Am Diet Assoc. 2010.

• Collaboration among

the tenant, family and

care team.

• Recommended that a

Registered Dietitian

assess for nutrition

intervention.

• Physician approval for

change in diet order.

AMDA Clinical Practice Guideline for Alteration in Nutritional Status.2010, 20.

ADA Position Paper Individualized Nutrition Approaches for Older Adults in

Health Care Communities.2010.

ADA Position Paper Liberalization of Diet Prescription Improves Quality of Life

for Older Adults in Long Term Care.2005.

CD-HCF Dining Skills: Practical Interventions for the Caregivers of Older Adults

with Eating Problems. American Dietetic Association.2001.

Chernoff, R. 2006.Geriatric Nutrition. Jones and Bartell. Boston, Ma.

New Dining Practices Pioneer Network Food and Dining Clinical Standards Task

Force. 2011.

Niedert, K. and Becky Dorner.2004 Nutrition Care of the Older Adult.American

Dietetic Association.

Mahan, K. and S. Escott-Stump.2008. Krause’s Food and Nutrition Therapy.

Saunders. St. Louis, Mo.

Oivind Hovland/Getty Images; Healthy Mind

by Verywell; Kendra Cherry; May 2016.