Position of the American Dietetic Association: Liberalized diets for older adults in long-term care

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 a liberalized diet. 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. One of the major determinants among the predictive factors of successful aging is nutrition. Long-term care includes a continuum of health services ranging from rehabilitation to supportive care. Nutrition care for older adults in long-term settings must meet two goals: maintenance of health through medical care and maintenance of quality of life. However, these goals often seem to compete, resulting in the need for a unique approach to medical nutrition therapy (MNT). Typically, MNT includes assessment of nutritional status and development of an individualized nutrition intervention plan that frequently features a theraperutic diet appropriate for managing a disease or condition. MNT must always address medical needs and individual desires, yet for older adults in long-term care this balance is especially critical because of the focus on maintaining quality of life. Dietetics professionals must help residents and health care team members assess the risks versus the benefits of therapeutic diets. For frail older adults, overall health goals may not warrant the use of a therapeutic diet because of its possible negative effect on quality of life. A diet that is not palatable or acceptable to the individual can lead to poor food and fluid intake, which results in weight loss and undernutrition, followed by a spiral of negative health effects. Often, a more liberalized nutrition intervention that allows an older adult to participate in his or her diet-related decisions can provide for the person's nutrient needs and allow alterations contingent on medical conditions while simultaneously increasing the desire to eat and enjoyment of food. This ultimately decreases the risks of weight loss, undernutrition, and other potential negative effects of poor nutrition and hydration.