Page 35 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
MEETING THE CHALLENGE OF PROFESSIONAL STANDARDS OF QUALITY FOR NUTRITIONAL CARE OF THE ELDERLY
As with the issues of self-determination, resources related to clinical nutrition best practice abound, but translating them into practice in long-term care is a challenge to all and an impossible task for most. We need a best-practice document specific to long-term care which could be incorporated into regulatory overview, interpretive guidance, protocol and investigative guidelines in areas of clinical concern. This document, by defining professional standards of quality for nutritional care of the elderly, could eliminate the potential for less-than-optimal approaches for many of our elders, and confusion among health professionals regarding outcomes and regulatory compliance. It is hoped that a national workgroup with representatives from all stakeholders and peer organizations can carry out the sacred work of developing best- practice guidelines for professional standards of quality for the nutritional care of the elderly.
Clinical and professional literature on the issues of nutrition and aging is prevalent, but unfortunately, not centrally indexed for practitioner access and not always clear and consistent in recommendations. Single studies are published consistently in selected professional journals, but often they are easily accessible only to members of a select profession and not widely read or even acknowledged by other professions. For example:
The Journal of the American Dietetic Association, September 2007, included two such articles:
Benefits of Snacking in Older Americans validated the importance of making elders’ favorite foods accessible 24/7. “Snacking is an important dietary behavior among older adults...(and) may ensure older adults consume diets adequate in energy,” it concludes. (Zizza et al, 2007)
Changes in Type of Foodservice and Dining Room Environment Preferentially Benefit Institutionalized Seniors with Low Body Mass Indexes confirms the impact of elders’ surrounding on their nutritional intake, stating, “Bulk foodservice and a home-like environment optimize energy intake in individuals at high risk for malnutrition, particularly those with low BMIs and cognitive impairment.” (Desai et al, 2007)
The Journal of the American Geriatric Society, Volume 56, 2008, published:
Prevention of Unintentional Weight Loss in Nursing Home Residents: A Controlled Trial of Feeding Assistance. The authors concluded, “Two feeding assistance interventions are efficacious in promoting food and fluid intake and weight gain in residents at risk for weight loss. Both interventions require more staff time than usual NH care. The delivery of snacks between meals requires less time than meal time assistance and thus may be more practical to implement in daily NH care practice.” (Simmons et al, 2008)
The American Medical Directors Association consistently publishes relevant, clinically respected studies and articles on nutrition in long-term care, but unfortunately, these
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