3 ways food keeps residents engaged in long-term care

It is projected that by 2030 in America, people over the age of 65 may make up as much as 20 percent of the overall population. As many as 80 percent of the people in this age group have at least one chronic illness, and about 12 million Americans (2015) reside in long-term care facilities.

As we age, we may experience a decreased ability to think clearly, move easily, and decline in overall bodily functions that can inhibit the ability to perform daily living tasks. Many of these declines can also have a direct affect on our food intake and nutrient use. In fact, unintentional weight loss is one of the biggest concerns for our aging population. Here are some ideas + tips to keep residents engaged with food in your facility.

The liberalized diet

Many long-term care facilities offer specialized therapeutic diets when needed. For example, a person with diabetes or hypertension may be given a specific diet that omits excess sugar, salt, etc.

However, many facilities are adopting a new approach to diet prescriptions that are based on a dietetic professional and/or physician’s assessment of the patient’s dietary and medical needs, rights, and personal food preferences. This term is referred to as liberalized diet/meal plan.

Taking the time and effort to construct a liberalized meal plan may be all it takes to improve the quality of life, and decrease unintended weight loss for the aging person/long-term care resident. One study in 2009 found that after four months of a liberalized diet, long-term care residents showed improved cognition, motor skills, and a decreased risk of malnutrition.

In other words, food really is THAT important. At times, this can be difficult for the registered dietitian to enforce because of some physicians and nurses coming from the school of thought that heavily modified diets are a way to combat disease. Fortunately, many long-term care facilities and medical staff are now adapting the liberalized diet approach with their residents.

New dining standards

As dietitians, we often focus on providing the best nutrition for our older residents, but we also need to take into consideration the aspects of their overall dining experience.

For countless elderly, mealtimes are not just about nutrition. The social aspect of dining promotes a social connection, comfort, pleasure, and security. While working as a consultant dietitian, I often found the most successful LTC dining facilities had a resident-centered approach when it came to mealtimes.

In one building, every dining room had a rotating theme, based on the resident’s preferences that they would vote on. In another, the caregivers became wait staff during mealtimes – they would take each resident’s orders, and serve them as if in an actual restaurant. And the meal was composed of three courses: appetizer, entrée, and then dessert. I rarely found unintentional weight loss in those residents that dined in that particular dining room.

A culinary approach

The recent trends in food include using more fresh ingredients, incorporating the farm-to-fork mentality, and cooking more items from scratch. More recently, these trends are also being implemented in senior living and long-term care communities.

For many older adults in LTC facilities, they too cooked from scratch in their own homes so it only makes sense to offer them food similar to what they knew from the past. Flavor, palatability, texture, and color should all play a role in the menu development by the culinary and RD team. This attention to the quality of ingredients and the preparation conveys a resident-centered approach to the dining program, which in-turn leads to increased resident and family satisfaction.

Highlighting the expertise of your culinary team can also be very beneficial. In one LTC facility, the food service manager and I would develop a special menu for a monthly event called ‘Candlelight Dinner.’ We would focus on providing a high quality meal with numerous appetizers, choice of entrée, and desserts that differed from the in-house rotating menu.

The dining room would be decorated with white tablecloths, cloth napkins, china, etc. mimicking a scene from a higher-end restaurant. Residents were even encouraged to invite family members/friends to attend. This event became known as a socially inviting and nutritionally satisfying experience not only for the residents and their family/friends, but also for our department.

Minimizing the impact of dietary related problems among America’s growing elderly population could have a significant impact on both the quality and quantity of life. Incorporating some of these key changes to enhance the mealtime experience in long-term care aims to improve the health and quality of life of persons living, working, and visiting the facility.

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References:

Ducak K, Keller HH. Menu planning in long-term care: toward resident-centered menus. Can J Diet Pract Res. 2011;72(2):83.

Older Americans Month 2018. https://oam.acl.gov/. Updated 2018. Accessed May 3, 2018.

R Byington, S Epps, S Keene, E Verhovsek, S Crandell. Liberalized Diets for the Promotion of Overall Wellness for the Elderly. The Internet Journal of World Health and Societal Politics. 2008 Volume 7 Number 1.