Therapeutic Diets in The Elderly

Therapeutic Diets in the Elderly
Therapeutic Diets in the Elderly

Despite popular beliefs, diets aren’t just for weight loss. They can be
an important tool to help with food intolerances or medical conditions.
Diets can help support health by reducing symptoms of chronic
illnesses, countering inflammation, or supporting brain functioning and
overall health.
Therapeutics Diets
There are many types of therapeutic diets. For example: clear liquid
diet, full liquid diet, a low-fat diet, gluten-free diet, low-FOMAP diet,
diabetic diet, renal diet, and heart healthy diet.
Be sure to check with your health care team before implementing any
diet changes.
What is a Therapeutic Diet?
Therapeutic diets incorporate an individual’s nutritional assessment,

nutritional status, and illness. Registered dietitians work with
physicians to identify risk factors and unfavorable outcomes for
chronic diseases to determine the nutritional requirements for each
client.
Data from clinical information, body composition, lab tests, and

medical history are all used to create the best therapeutic diet for the
individual (1).
Therapeutic diets customize nutrients and food textures to help

address food allergies, intolerances, or medical conditions (2). A
registered dietitian will create a plan with a controlled intake of certain
foods and nutrients to reduce negative symptoms and bring the body
back into balance.
The length of the diet depends on the individual’s response and any
improvements in health conditions. The diet is not permanent unless
the restricted foods can cause allergies, sensitivities, or any negative
symptoms.
Why Do I Need a Therapeutic Diet?

Therapeutic diets are helpful for a variety of purposes. Many
conditions are treated or improved with therapeutic diets.
For Food Allergies or Intolerances
The elimination diet is the gold standard for identifying food allergies
and intolerances as it removes foods known to cause symptoms. It
usually takes around 5-6 weeks to help improve the gut and alleviate
bloating, gas, constipation, diarrhea, and nausea.
In the first 2-3 weeks, suspected foods are removed to check if the
symptoms are from foods or something else entirely. Then, the
reintroduction phase happens over the next 2-3 days as the eliminated
foods are gradually included in the diet.
Registered Dietitians and physicians will watch for changes in any

stomach pain, cramps, rashes, bowel movements, or joint pain (3).
Foods that are commonly removed include citrus, legumes, meat and
fish, dairy, sugars or sweets, and nightshade vegetables like
eggplants, tomatoes, and potatoes. Nuts and seeds are also
commonly removed.
Through this entire process, symptoms like eczema, chronic

migraines, and other irritable bowel syndrome symptoms can be
reduced.
For a New or Chronic Medical Conditions
Nutrition is important in all aspects of health, but it is especially

important in managing various chronic conditions. For example, poor
appetite and weight loss can occur with cancer and its treatments.
Therapeutic diets focused on maintaining nutritional needs ensure that

cancer patients can handle their treatment as best as possible.
With other chronic conditions like lung disease or chronic obstructive

pulmonary disease (COPD), consuming high-carbohydrate foods can
make it difficult for some people to breathe since they produce more
carbon dioxide through digestion.
Therapeutic diets can help transition these patients to replace these

high-carbohydrate foods with healthy fats (4)
Examples of Common Therapeutic Diets

Some examples of common therapeutic diets include:
 The Diabetes Diet

 The DASH Diet for hypertension and heart disease
 The Renal Diet for chronic kidney disease
 The Dysphagia Diet.
These therapeutic diets were created for the most common chronic
conditions, but therapeutic diets for many other medical conditions
exist.
Diabetes
The therapeutic diabetes diet is essentially a healthy eating plan —

one that anyone can benefit from. However, it is especially helpful for
people with diabetes or prediabetes who must watch their
carbohydrate intake and insulin levels.
The diabetic diet typically includes three meals in the day made up of
balanced, consistent, and measured portions. Fiber-rich foods are
prioritized, as they give lasting energy throughout the day and do not
cause as high of an insulin spike.
Whole grains, vegetables and fruit, mono- and poly- unsaturated fats,
and heart-healthy fish are key foods in this diet.
Hypertension and Heart Disease
The DASH diet, which stands for Dietary Approaches to Stop

Hypertension, consists of lower-sodium choices and more potassium-
rich foods.
This helps control blood sugar levels and reduce cholesterol levels.
Ideally, the goal is to reduce fat and sodium intake, since these can
increase blood pressure, hypertension, and plaque buildup in arteries.
In general, your registered dietitian may recommend 6-8 servings of

whole grains, 4-5 servings of vegetables, and 4-5 servings of fruit. 2-3
servings of dairy can also be recommended, while red meat, fats, oils,
and sweets are reduced.
For the standard DASH diet, there is a maximum of 2300 milligrams of

sodium allowed per day, while only 1500 milligrams are allowed for
the low-sodium DASH diet (6).
Usually, no more than 25-35% of daily calories should be from fat, and
registered dietitians will highly recommend that patients avoid trans
fats as much as possible (5).
The DASH diet can help prevent diabetes, cancer, heart disease, and
osteoporosis since these conditions can result from hypertension.
Chronic Kidney Disease

The DASH diet can also be a therapeutic diet for chronic kidney
disease. The DASH diet has been recommended by the National
Kidney Foundation and approved by The National Heart, Lung, and
Blood Institute (6).
People with kidney disease should avoid excess potassium intake

because the kidneys can fail and no longer remove excess potassium.
Potassium levels can build up in the body causing muscle weakness,
or an irregular heartbeat. Those who are on dialysis should not use
the DASH diet since they have special dietary needs.
With chronic kidney disease it is especially important to see
a registered dietitian to create an individualized therapeutic diet.
Dysphagia
Individuals with dysphagia have difficulty swallowing, so a therapeutic

diet with thicker liquids and different textures of food can make it
easier to chew and safer for them. Signs of dysphagia include
drooling, choking or gagging, poor chewing ability, or taking longer
than ten seconds to swallow. Thicker liquids can help reduce the risk
of liquid going into the windpipe and eventually into the lungs (7).
The risk for dysphagia can increase after a stroke, muscular

dystrophies, or throat cancer. Registered dietitians will usually
recommend an individual to eat small, frequent meals since they are
unable to eat large meals.
Three stages of the dysphagia diet include:
 First stage -pureed or smooth foods like pudding, yogurt, or

mashed potatoes.
 Second stage -foods that require some chewing and soft or
cooked vegetables and fruits.
 Third stage -meats, fruits, and vegetables that are easy to
cut or mash are gradually added to the diet
 Regular diet -all foods are included, but thickening agents
can continue to be added to liquids (8).
There is a global initiative in process to standardize dysphagia diets
across the world called the International Dysphagia Diet
Standardization Initiative or IDDSI. Learn more about that in my
article here.
Benefits of Following a Therapeutic Diet
We have covered many of the ways therapeutic diets can help so far.
Improving or maintaining health is another benefit.
Preventing the progression of a disease can extend lifespan and

improve quality of life. When dealing with a disease that can progress
quickly without careful attention, a healthy diet can directly impact the
risk of complications and symptoms.
Nutrition impacts our mental, emotional, and physical health in many

ways, and removing or focusing on certain foods can help improve
overall health.
Barriers to Following a Therapeutic Diet

Although a therapeutic diet can seem straightforward since an
individual is counseled on what he or she can eat, it can be difficult to
maintain at times.
Restrictive Food Choices

Therapeutic diets can eliminate or decrease food choices to improve
someone’s health. Sometimes, comfort foods can be restricted, which
can be a barrier to following a therapeutic diet.
If a menu focuses only on the health issues of the individual, then he

or she may be unhappy with the variety of choices during each meal.
The person may not eat as much, leading to malnutrition or weight
loss. The reduction or elimination of certain foods can be a big change
in a person’s lifestyle, but a registered dietitian can help make
adjustments as needed.
Quality of Life
Food often helps people make memories and socialize with others.
When someone feels restricted from certain food types, it may
decrease their quality of life. They cannot enjoy the same foods they
associated with happy memories. However, finding similar substitutes
or menu options that work within their limits can help individuals follow
their therapeutic diet as needed.
What If I Don’t Want to Follow a Therapeutic Diet?

In times of extreme illness, end-of-life situations, or when working with
elderly family members or patients, keeping a patient on a strict
therapeutic diet may not be a good choice. If they eat or drink less
because they don’t enjoy the food choices, it could quickly lead to
malnutrition or dehydration. Another option is a liberalized diet.
Liberalized Diet
A liberalized diet is essentially a non-restrictive diet or a non-

therapeutic diet. It allows the patient to actively make more decisions
about what and when they eat.
When people actually like the diet that they are going to eat, they can
look forward to meals. The elderly can continue to maintain their
health while having the freedom to choose their food.
To learn more about liberalized diets, check out our article
on Liberalized Diets for Older Adults.
Goals of Care
The goal of liberalized diets is still to meet nutritional needs of the

person. Working with a registered dietitian can help keep meals
interesting yet nutritious. People can openly express their choice
about their health care and food options.
End of Life
Liberalized diets can be used for the elderly in hospice or palliative

care. Comfort is the goal of this type of care. It is important to
minimize pain and support the current quality of life. Offering the
freedom of food choice can help meet these goals.
Role of a Geriatric Nutritionist
Registered dietitians are the best qualified professionals to assess a

senior’s nutritional status in order to create and implement a nutrition
treatment plan.
Geriatric registered dietitians have specialized experience with the

elderly population and understand how aging and longevity can affect
nutritional needs.
Learn more about the importance of seeing a registered dietitian here.

Guidance and Education with Food Choices
Registered dietitians can help guide older adults to choose better

options in either their liberalized or therapeutic diet.
They can also help educate seniors or their caregivers on how

different nutrients affect the body in different ways. Understanding
how each component of food impacts overall health can be crucial in
maintaining health.
Strategies to Optimize Intake
Working with a registered dietitian can help take the weight of

improving intake and nutrition off an elderly person’s shoulders. A
dietitian can help come up with health affirmations and enhance their
overall quality of life.
Individualized Plan
There is no one-size-fits-all model for any type of diet. Dietitians can

create an individualized plan based on genetics, lifestyle, goals and an
individual’s daily eating preferences. The wrong diet can be the source
of symptoms, while the right one can help a person recover from
illnesses, autoimmune issues, and inflammation.
Conclusion
Nutrition and diet play an important role in maintaining one’s health
status. Care for individuals, especially the elderly, must maintain or
improve health and quality of life. By working with a registered dietitian
to understand health history and risks, therapeutic diets can be
implemented to result in better health.

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Therapeutic Diets in the Elderly

Therapeutic Diets in the Elderly

What is a Therapeutic Diet?

Therapeutic diets incorporate an individual’s nutritional assessment,

Data from clinical information, body composition, lab tests, and

Therapeutic diets customize nutrients and food textures to help

Why Do I Need a Therapeutic Diet?

For Food Allergies or Intolerances

Registered Dietitians and physicians will watch for changes in any

Through this entire process, symptoms like eczema, chronic

Nutrition is important in all aspects of health, but it is especially

Therapeutic diets focused on maintaining nutritional needs ensure that

With other chronic conditions like lung disease or chronic obstructive

Therapeutic diets can help transition these patients to replace these

Examples of Common Therapeutic Diets

 The Diabetes Diet

The therapeutic diabetes diet is essentially a healthy eating plan —

Hypertension and Heart Disease

The DASH diet, which stands for Dietary Approaches to Stop

In general, your registered dietitian may recommend 6-8 servings of

For the standard DASH diet, there is a maximum of 2300 milligrams of

Chronic Kidney Disease

People with kidney disease should avoid excess potassium intake

Individuals with dysphagia have difficulty swallowing, so a therapeutic

The risk for dysphagia can increase after a stroke, muscular

Three stages of the dysphagia diet include:

 First stage -pureed or smooth foods like pudding, yogurt, or

Benefits of Following a Therapeutic Diet

Preventing the progression of a disease can extend lifespan and

Nutrition impacts our mental, emotional, and physical health in many

Barriers to Following a Therapeutic Diet

Restrictive Food Choices

If a menu focuses only on the health issues of the individual, then he

What If I Don’t Want to Follow a Therapeutic Diet?

A liberalized diet is essentially a non-restrictive diet or a non-

The goal of liberalized diets is still to meet nutritional needs of the

Liberalized diets can be used for the elderly in hospice or palliative

Role of a Geriatric Nutritionist

Registered dietitians are the best qualified professionals to assess a

Geriatric registered dietitians have specialized experience with the

Learn more about the importance of seeing a registered dietitian here.

Registered dietitians can help guide older adults to choose better

They can also help educate seniors or their caregivers on how

Strategies to Optimize Intake

Working with a registered dietitian can help take the weight of

There is no one-size-fits-all model for any type of diet. Dietitians can

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