Page 37 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
refused to comply with the ordered restriction after appropriate risk benefit education. Clearly, our residents can benefit from clarification and communication of best practice in a timely manner.
The American Dietetic Association (ADA) Position Papers are a statement of ADA’s stance on an issue, which is derived from pertinent facts, data and the research literature. They are not a comprehensive literature review of the topic, but rather present current facts, data and research. Current Position Papers on Ethical and Legal Issues in Nutrition, Hydration and Feeding, Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-Term Care and Nutrition Across the Spectrum of Aging all provide relevant guidance to long-term care professionals, but are often not widely recognized or adopted by the medical community.
The ADA Evidence Analysis Library is a synthesis of the best, most relevant nutritional research on important dietetic practice questions, available free to ADA members and by subscription to non-members. These evidence-based nutrition practice guidelines are developed to help health professionals and consumers make decisions about health care choices. The recently introduced guideline, Unintended Weight Loss in Older Adults, concludes there is scientific evidence that medical nutrition therapy increases the effectiveness of efforts to address unintended weight loss through consideration of MNT, caloric needs, diet liberalization, modified texture diets, medical food supplements, enteral nutrition, dining environment and feeding assistance. While directly relevant (and generally supportive of the practices of resident-centered care and culture change), it is not yet widely disseminated or adopted. For example, selected recommendations include:
“Diet Liberalization: For older adults, the Registered Dietitian should recommend liberalization of diets with the exception of texture modification. Increased food and beverage intake is associated with liberalized diets. Research has not demonstrated benefits of restricting sodium, cholesterol, fat and carbohydrate in older adults.”
“Dining with Others: The Registered Dietitian should collaborate with other health care professionals and administrators to encourage all older adults to dine with others rather than dining alone. Research reports improved food intake and nutritional status in older adults eating in a socially stimulating common dining area.”
“Improvement of Dining Ambience: The Registered Dietitian should collaborate with other health care professions and administrators to promote improvement of dining ambience. Research indicates that improvements in physical environment and atmosphere of the dining room, food service and meals, and organization of the nursing staff assistance may result in weight gain in older adults.”
“Creative Dining Programs: The Registered Dietitian should encourage creative dining programs for older adults. Research indicates that dining programs, such as buffet-style dining and decentralization of food service, demonstrate improvements in food intake and/or quality of life.”
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