Educational Resources on Older Adult Nutrition

Like patients with any acute or chronic medical condition, MNT for post-Covid patients should be individualized. If the Covid case was mild, there may be no intervention needed. If it was severe, resulting in enteral nutrition, mechanical ventilation, or other invasive procedures, the patient may need more calories and/or protein to help mitigate the effects of the virus or treatments. If intake is good, they may be able to meet their needs with food alone. If not, oral nutritional supplements may be needed.

Ultimately, the decision lies with the patient’s family. You can certainly discuss the evidence and the risks and benefits of enteral nutrition in patients with advanced dementia with the family. But it sounds like they have made their decision, so it is up to you to move forward and develop a plan of nutrition care accordingly.

Many facilities stop weights on hospice patients to help keep them comfortable. Weight loss is usually expected as part of a patient’s decline in condition and having weights will probably not change interventions or the outcome. Some facilities and some hospice programs do require monthly weights. Check your facility protocols and make sure hospice and the patient are comfortable with stopping weights before doing so.

Based on what you have said, you are doing a good job of trying to meet this resident’s needs. It is important that you acknowledge to this resident that you know how difficult it must be for her to not have as much control as she would like over food selections. If you haven’t done so already, encourage her family to bring some favorite foods in for the resident. Include this resident in the planning of “resident’s choice” meals on your menu. To help manage potential citations, be sure that both you and the CDM document periodically in the medical record about your interactions. And talk to your care plan team about the possibility of care planning this resident for difficulty meeting her food likes and dislikes.

Many experts believe that the BMI parameters for a “healthy” weight (18.5-24.9) are considered too restrictive for older adults. The basis for that belief is that older adults with a higher BMI have better health and lower risk of mortality than those with lower BMIs. The parameters for a healthier BMI vary depending on the source, but somewhere between 23 and 32 is often mentioned. One recent systematic review and meta-analysis that discusses this topic suggests a BMI of 23-28 is the healthy range for older adults. (Dose-response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis – PubMed (nih.gov)).

It sounds like this patient got some good advice years ago about controlling her blood sugars through dietary change. However, not only has your patient aged, but our knowledge of strict diets for diabetes has changed as well. Yes, you should give your patient permission to be less rigid with her diet. Often all it takes is to explain that at this stage in her life the long-term consequences of elevated blood sugars (as long as she is asymptomatic) are not as severe as when she was young. Often the words “you should eat what you want and enjoy your food, as long as you control your portions” are all it takes for people to be willing to be less rigid. But for some people, making a change this late in life might seem drastic and uncomfortable. So, after you have provided education to your patient, it is her right to choose how she wants to eat.