Top 5 Reasons You Need a Geriatric Nutritionist

A geriatric nutritionist isn’t just for the older adult. Often it is the family and caregivers of older adults who can benefit most from the guidance of a geriatric nutritionist. A geriatric dietitian nutritionist is a Registered Dietitian Nutritionist (RDN) who specializes in senior nutrition. They support you as you support them.

Good nutrition is an important part of aging. As a caregiver, you no doubt want to provide the very best care for the older adult in your life. Providing good nutrition is a vital component in caring for the elderly. The most important thing to know is what good nutrition looks like changes throughout the lifespan. Nutrition for older adults is different.

A geriatric nutritionist can help with both healthy aging and support of the older adult who may be sick, frail, and closer to end of life.

THE TOP 5 REASONS YOU NEED A GERIATRIC NUTRITIONIST

1. A Registered Dietitian Nutritionist is the nutrition expert
2. The physiology of aging is super complicated
3. Food plays an important role in healthy aging
4. Nutrition requirements are different for older adults
5. Frail, sick older adults have more complex needs

1) A Registered Dietitian Nutritionist is the Nutrition Expert

You may notice that I use both the terms “nutritionist” and “dietitian” interchangeably. The reason for this is simple. A dietitian can refer to themselves as either a Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN). It’s a little confusing, but hang with me, I’ll explain.

So, why don’t I just pick one term (dietitian or nutritionist) and stick to it for this blog? Because when people search for answers to their nutrition questions online, some people will search for “dietitian” and others will search for “nutritionist”.  And I want everyone to be able to find this information!

According to KeySearch, a keyword research website, people search for the word “dietitian” 90,500 times per month while people search for the word “nutritionist” 135,000 times per month (1). More people are familiar with the term nutritionist than dietitian.

However, when I received my degree in 2008, dietitian was the only term we used- so in my heart, I am a dietitian!  Next let’s look at the difference between a dietitian vs. a nutritionist and why the Registered Dietitian Nutritionist is the nutrition expert.

Dietitian vs. Nutritionist

A dietitian is a nutritionist, but a nutritionist is not always a dietitian.

A Registered Dietitian Nutritionist has completed a science-heavy bachelor’s degree at an accredited university or college. They have completed a year-long supervised practice program (or “dietetic internship”), which includes real life, on the job clinical experience. Finally, they have passed a national examination to confirm they know their stuff. All dietitians have to complete continuing education to maintain their credential (2).

Many continue their education, as I did, and obtain a Master’s Degree. Starting in 2024 all dietitians will be required to have a Master’s Degree.  The Master’s Degree requires 1-2 additional years of education: 6-7 years! Whew! That’s a lot of education and knowledge.

A dietitian has gone through a rigorous, evidenced-based training program. This credential is rooted in science and is committed to protecting the public. It’s takes a lot of hard work and commitment to call yourself a dietitian.

So, what does it take to call yourself a nutritionist? You simply tell anyone you are a nutritionist. There is no legal protection for the term “nutritionist”. If you eat and want to share your opinion about nutrition, you can call yourself a nutritionist. There are some nutritionist programs available online that can be completed in a short period of time, but these are no-where near as comprehensive as the dietitian track of 6 to 7 years.

You wouldn’t go to a self-proclaimed natural healer to treat your aggressive cancer- you’d see an oncologist! You wouldn’t get a cavity filled by a guy working out of his van-you’d see a dentist! So why would you settle for anything less when it comes to your nutrition? Yes, everyone eats, but nutrition is a science. A science that can lead to healing or harm, depending on who is practicing.

For the purpose of this website, when a geriatric nutritionist is discussed- they are always a dietitian.

Geriatric Certified Specialist

I hope that I have clearly defined why the dietitian is the nutrition expert. Dietetics is a comprehensive field. There are different types of dietitians. Some of us work in hospitals, schools, outpatient clinics, kitchens, public health agencies, government agencies, and beyond.

Not only do dietitians work in a variety of settings, but they also have many different specialties. A dietitian may specialize in diabetes, cancer, kidney disease, maternal health, sports nutrition, and of course geriatric nutrition, to name a few. Here I want to discuss the specialty of the geriatric nutritionist.

A geriatric nutritionist is a dietitian who specializes in nutrition for the elderly. They primarily work with older adults and know how to customize nutrition interventions to meet the need of aging seniors. While not all geriatric nutritionists have a geriatric certification, there is an additional credential available for dietitians who choose to go the extra step and become a geriatric certified specialist.

The Board Certified Specialist in Gerontological Nutrition (CSG) includes:

“RDs directly providing nutrition care to promote quality of life and optimal health for older adults across the continuum of care, including: acute care, post-acute care, primary care, long-term care, assisted living, home care, palliative care, community-based nutrition, food service, correctional facilities, and government programs. RDs indirectly working with gerontological nutrition through roles in management, industry, education, and research (3).”

How to Obtain Geriatric Certification

How does a dietitian become a CSG? First of they need to be a dietitian for at least 2 years. They need to have 2,000 hours of practice experience in this field. Finally, they must pass a challenging 150-item exam. Certification is for 5 years. The dietitian must re-certify every 5 years (pass a new current exam). (4).

I have described the steps it takes to become a dietitian. To become a CSG there are even more steps. While there are plenty of good geriatric dietitians out there, you can count on a dietitian with the CSG certification to have the experience and knowledge to provide expert level elderly care.

If you happen to be a dietitian reading this article and you work with older adults, consider taking the next step to obtain your geriatric certification! There is such a need for more dietitians with the CSG geriatric certification to pave the way as the geriatric nutrition expert!

If you are a dietitian and thinking of becoming a CSG, be sure check out the Top 5 Tips to Pass the CSG Exam.

How to Find a Registered Dietitian Nutritionist

Now that you know the Registered Dietitian Nutritionist is the nutrition expert- how do you find one? Dietitians can be found in most hospitals, outpatient clinics, and long-term care settings. Ask around in your health care community.

Or try searching on these websites:

• Find an Expert (apply a filter for “Gerontology Nutrition”)
• Nutritionist Near Me (Select “Geriatric” as a specialty)
• Board Certified Specialist in Gerontological Nutrition List by State
• You can also search on LinkedIn or Google!

If you aren’t able to find a geriatric nutritionist of your own, be sure to sign-up to receive the 10 Top Senior Nutrition Resources and follow along with us! This blog will have regular updates on senior nutrition written by a Board Certified Specialist in Gerontological Nutrition!

2) The physiology of aging is super complicated

Aging is a complicated process. Sure, you can see the differences on the outside when someone ages. Hair turns to beautiful shades gray and white. Wrinkles from a life well lived are evident in the face of an older adult. While these are thing you can see- there are even more differences on the inside of the body that you cannot see.

Physiology is a fancy word for the study of how something living normally functions. The physiology of aging tells what we can generally expect will happen to our bodies as we age. The physiology of aging is very complicated.

Aging in the United States

Rates of older adults in this country are rapidly increasing. In 2014, only 14.5% of the US population was age 65 or older. It is projected that this number will increase to 23.5% by 2060 (5). Another interesting fact is that an estimated 10,000 Baby Boomers will turn 65 years old every single day for the next 10 years. The number of older adults in our country will only continue to grow.

We also know that older adults are more likely to have 2 or more chronic diseases. These may include heart disease, cancer, lung disease, stroke, diabetes, & Alzheimer’s disease (5). Each of these conditions can have a negative impact on the quality of life for the elderly. These  conditions can affect how we provide elderly care.

The Physiology of Aging

The rate of elderly in this country is rapidly growing and older adults have higher rates of chronic disease. It is critically important that more people have access to a geriatric nutritionist. Below are changes that occur with normal aging. First, let’s look at changes to the gastrointestinal (GI) tract- the pathway of food from when it enters the body to when it exits.

Changes in the GI Tract (6):

• Dry mouth
• Problems chewing
• Difficulty smelling and tasting food
• More reflux and heart burn
• Increased gallstones
• The pancreas doesn’t work as well (this can lead to problems like diabetes)
• Medications might be absorbed as well
• Increased fecal incontinence

These are just some of the changes going on in the GI tract as a normal part of aging. You can likely see areas where a geriatric nutritionist can step in and provide assistance.

Additional Changes in the Aging Body (6):

• Higher risk of wounds (skin tears and pressure injuries)
• Vision decline or loss
• Hearing loss
• Decreased ability to breath well
• Kidney function declines
• Decrease in cognition and memory
• Loss of muscle
• Joint problems
• Weaker and frail bones

Whew, there is a lot going on with aging.  With genetics and lifestyle every single person will age differently. But these are the general themes we see in normal aging. You can imagine how things might be a little worse in the aging of a frail, sick older adult. These changes in the body reflect changes how we approach medicine, nutrition, and health care in general.

Geriatrics is a Specialty Area

Aging is a complex process. Because of this, geriatrics is truly a specialty area. Healthcare for older adults is different than for younger adults. There is a lot going on inside the body of an aging adult. It is for this reason that so many professions offer specialty geriatric certification.

Here are some of the other healthcare professionals also offer geriatric certification:

• Physician
• Psychiatrist
• Pharmacist
• Nurse practitioner
• Registered Nurse
• Dietitian (of course!)
• Social worker
• Physical therapist

There are many gerontology careers out there. When it comes to picking a food & nutrition specialist for the older adult, the geriatric nutritionist is the way to go.

3) Food plays an important role in healthy aging

What we eat matters. Like a car needs gasoline to function, our bodies require food and good nutrition to function. You can fuel your body with any type of food- but it doesn’t take an expert to know that some foods make you feel good, energized, well and other foods make you feel tired, cruddy, and sick. Of course, there is balance and room for all foods in your diet! But know that food plays an important role in healthy aging.

What is Healthy Aging?

What is health? In 1948 the renowned World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (7).” You may have heard this paraphrased as health isn’t just the absence of disease, it’s complete well-being.

Since this time there has been much debate about this definition. There is so much room for interpretation. I’m not sure how much the exact definition matters. I think your perception of health is entirely up to you. It’s your body, your life, and we are each so different.

I would say that healthy aging is living the best life you can based on your own set of values and beliefs. For me, a part of being healthy includes doing cross fit and running- because it’s what I love and it makes me feel good. But you definitely don’t have to do these things to be healthy! Do what works for you.

I believe that healthy aging involves these elements:

• Feeling satisfaction and joy in life
• Management of pain (if present)
• Maintaining function and the ability to move
• Maximizing independence
• Staying out of the hospital
• Preserving respect and dignity
• Feeling content and fulfilled in life

Every person has their own interpretation of healthy aging. Food and nutrition- they are always an important part of healthy aging.

The Risk of Malnutrition

When an older adult doesn’t get the food or nutrition they need, they are at risk for developing malnutrition. What is malnutrition? In a nutshell it’s when someone doesn’t get the food they need and they lose muscle and fat and are at a greater risk of injury or death. Yikes!

Unfortunately, in our country we almost always attribute weight loss as a good thing. But, intentional weight loss in the older adult can be detrimental. There is good chance that with weight loss, they are losing muscle. We need muscle to function, to get up in the morning, to get dressed, and most importantly to stay independent!

Malnutrition is a real threat for older adults in our country. Or to be honest, any country. Did you know that up to 1 in 2 older adults are at risk for malnutrition? Being malnourished leads to medical complications, increased fall risk, more time in the hospital, and more readmissions to the hospital (8). None of these are things you want to be experiencing in your golden years.

Defeat Malnutrition Today is a wonderful coalition of 80 organizations and stakeholders working to defeat older adult malnutrition. A geriatric nutritionist and the information in this website can help you to ensure the older adult in your life avoids the malnutrition trap.

What does a healthy diet look like?

OK, so we’ve established that food and nutrition matters. Not getting enough can lead to malnutrition and significant health risks. But what is the best food for seniors? What are the best meals for seniors?

I love the work that Tuft’s University has done on nutrition for the older adult. They recognize that the seniors are a unique population. Because of this they created MyPlate for Older Adults (9).

This tool is in line with the Dietary Guidelines for Americans. It is similar, but a little different, than United States Department of Agriculture’s Choose MyPlate. It’s a good model and a useful tool.

Tuft’s MyPlate for Older Adults provides real examples of foods that fit into a healthy well-balanced diet for older adults. They make it easy and show you to load up a healthy plate.

Half of a plate should include fruits and vegetables- they include pictures of fresh, frozen, and low-sodium canned/jarred options reminding us that all forms of produce count. One quarter of the plate should be whole grains. And finally, the last quarter is split between meat/eggs/nuts/legumes and dairy (9).

For each meal they recommend some type of beverage, but that can vary. In the tool you can see 6 options in the drinks section- and half of them are water. Water is important. In the middle of the plate are heart healthy oils that are used in cooking and salad dressing (9).

You can access handouts and additional information from Tufts by going to MyPlate for Older Adults.

Eating good food is so important for healthy aging. And a geriatric nutritionist can provide individual guidance on the best type of foods and meal patterns for the older adult to optimize aging.

4) Nutrition Requirements are Different for Older Adults

Did you know that the actual amount of nutrition you need changes as you age?

This is an important reason why you need a geriatric nutritionist. They know the ins and outs of nutrition through the life cycle. A geriatric nutritionist can identify key nutrients that may be missing in the diet of an older adult. They can also determine which nutrients need to be reduced in order to prevent overdose or interactions with other medications. A lot of older adults take supplements and sometimes too much of a “good thing” can be a bad thing. The geriatric nutritionist can help figure all of this out.

Let’s look at what nutrition requirements may be different in the older adult.

Macronutrients in Older Adults

Macronutrients are the pieces of nutrition that gives us energy or calories. They include protein, carbohydrate, and fat. Despite what the media or a trendy fad may tell you- all macronutrients are important for good health. And the amount and type you may need changes with aging.

One good example of changing needs with aging is with protein. The Recommended Daily Allowance (RDA) of protein for adults is 0.8 grams per kilogram body weight. However, research has shown this may not be enough protein for older adults. Good scientific evidence suggests that for older adults, they need between 1.0 and 1.3 grams of protein per kilogram body weight (10). Protein is important for the older adult!

Part of the reason protein is so important is because you lose muscle mass with aging. Protein and resistance exercise can help to preserve muscle (10). And we definitely want to make sure that we are protecting the muscle in an older adult.

Does this mean we just give a ton of protein to all older adults? No way. This is where a geriatric nutritionist comes in. Older adults with kidney damage may actually need less protein, so giving them too much can actually damage their kidneys. It’s like we mentioned above, nutrition is a science. We need to find the healthy balance for the individual older adult.

Micronutrients in Older Adults

Micronutrients include vitamins and minerals. They don’t provide calories or energy, but they provide a ton of good nutrition your body needs.

You can access tables for RDAs and Adequate Intakes (AI) for elements and vitamins online. You will see in these tables that the nutrition requirements vary by both age and gender. There are categories specific to ages 51-70 years and >70 years (11). This is because nutrition needs change with age. Examples of micronutrient needs that are different for older adults when compared to the younger or middle-aged adults include vitamin D, calcium, and vitamin B6 (11).

Loosen Up Those Dietary Restrictions

The last part to consider about how nutrition is so different for older adults is how strict diet recommendations are. And by diets, I don’t mean weight loss. I mean an eating pattern like: heart healthy, low sodium, diabetic, renal diet, etc. When it comes to the older adult, particularly the sick, frail older adult close to end of life, we always want to individualize our nutrition recommendations.

In many cases this means provide liberalized diets.  A liberalized diet is one without any specific dietary restrictions.

When it comes to nutrition for older adults we want to focus on person-centered care and quality of life. Sometimes a part of that is providing liberalized diets that allows for more choice and allows the older adult to eat the foods they want. Why? Because evidence has shown that restrictive diets in the older adult can actual increase risk of malnutrition and dehydration (12).

While the intent is to help, these restrictive diets can sometimes be hurtful and put the older adult at risk for medical complication.

An example would be a sick, frail older adult who is put on a heart healthy, low salt diet. They already have a decreased sense of taste and poor appetite. Now food doesn’t taste good (compared to what they may be used to). As a result, the older adult may not eat. This could lead to unintended weight loss, loss of muscle, and malnutrition. Suddenly, the dire consequences of malnutrition outweigh the potential benefits of that low salt diet.

A geriatric nutritionist knows when to loosen up those dietary restrictions. They can support families and caregivers in knowing that the best step in providing good nutrition looks like. They can advocate for the older adult and make sure they get the nutrition they actually need.

5) Frail, Sick Older Adults Have More Complex Needs

We are to our last reason why you need a geriatric nutritionist. This one ties into pieces we’ve already been hinting at throughout this whole post.

Frail, sick older adults have more complex needs. It’s not always as simple as providing a healthy, balanced diet. Food and fluids may need to be modified in those with problems chewing and swallowing. Steps may need to be taken to help older adults eat independently. How we approach food at very end of life is completely different. There are so many different considerations for nutrition in the older adult.

You Mean Eating Lots of Ice-cream Can Be Healthy??

What health looks like changes with age. We mentioned this earlier, but health is truly individualized.

In the frail, sick older adult close to end of life we are less concerned about preventing long term complications (that they will likely not live to see).

We are more concerned about improving their quality of life now. They should enjoy the life they have left and celebrate they years they have accomplished. Sometimes nutrition goals are very small and have very little to do with a restrictive “healthy” diet. They often have more to do with keeping an older adult living, healthy, and happy where they are at.

Sometimes my interventions for a frail, sick older adult may to find out what their very favorite foods are and have them eat more of that! Unintended weight loss and malnutrition can be detrimental for the older adult. If their favorite food is ice-cream and they are able to eat it- that might be my intervention!

This could be difficult for some to wrap their minds around, especially if they have preconceived ideas about what foods are healthy and unhealthy. But as I mentioned, the risk of unintended weight loss is real. If I’m dealing with an older adult who is losing muscle and becoming malnourished- they are literally facing a life and death situations. Life take priority and for them, a “healthy diet” may include eating lots and lots of ice-cream.

Health looks different at every age.

Nutrition at End of life

End of life nutrition is very different than normal nutrition. End of life care is the days, weeks, and even moments before death (13).   Reduced food intake that occurs in the dying process can be very difficult on the caregiver and/or family.  We associate food with nourishment with love.  And we don’t want our loved ones to suffer.

A geriatric nutritionist can provide education on what the eating and drinking looks like at end of life and can provide a great deal of support during an overwhelming time in life.

Maximizing independence

Another need of the frail, sick older adult is to maximize independence. This specific population may have a hard time eating on their own. It might seem “easier” to just spoon feed someone who is struggling- but first consider options to help the elderly stay independent with eating. Independence is so important to our aging seniors & they should always be treated with the utmost dignity & respect. Spoon feeding should never be the first “go-to”, it should be the last option.

The geriatric dietitian can help with identifying issues with eating. They can often recommend techniques and adaptive eating equipment that will enable the older adult to be able to eat and drink independently. For example, in older adult with a weak grip, there are utensils with straps that can help them eat independently.

Frail, sick older adults have complex needs and the geriatric nutritionist can help.

Helping the Elderly

Those are the top 5 reasons you need a geriatric nutritionist! I didn’t intend to write a novel, but there is so much to discuss about this topic! I hope this information was helpful to you and that you have a better understanding of not only what a geriatric nutritionist is, but why you need a geriatric dietitian. Even if you’re not an older adult yourself! A geriatric dietitian helps you in helping the elderly.

The whole purpose of The Geriatric Dietitian is helping the elderly by providing geriatric nutrition resources to families and caregivers. If you are an older adult reading this, that is wonderful. I hope you found some good takeaways. If you are a caregiver or family to an older adult, I hope this information helps you provide the very best nutrition care for the older adult in your life. Hold tight- there is more to come!

What to Expect from The Geriatric Dietitian

Expect to see regular blog posts on topics specific to geriatric nutrition. The Geriatric Dietitian believes everyone deserves access to a geriatric nutritionist. A specialist in nutrition for older adults who can support you as you support them. We are also creating items for purchase including our High Calorie SHAKES e-Cookbook and Weight Gaining SECRETS e-Book to serve even more people.

If you are a dietitian or caregiver, be sure to check out the e-products I have created at The Geriatric Dietitian Store on RD2RD Marketplace. And be sure to follow along with this blog for free information at your fingertips.

Join the Community!

Be sure to follow along and increase your knowledge in geriatric nutrition. Sign up for my email list where you can get regular updates on blogs and geriatric nutrition topics. As a free gift to you, I will send a copy of the 10 Top Resources for Senior Nutrition. If you are a dietitian on Facebook, join in on the discussion at The Geriatric Dietitian Community.

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We want to make sure this important information gets to you. And to many others who have never considered the role of food and nutrition in caring for the elderly.

Thank you so much for your support!

(Feel free to use this infographic; please link back to this post and give credit to The Geriatric Dietitian!)

REFERENCES

1. Keyword Research. KeySearch website. https://www.keysearch.co/. Accessed June 26, 2020.
2. What is a Registered Dietitian Nutritionist. Academy of Nutrition and Dietetics website. https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist. Accessed June 26, 2020.
3. Specialty Practice Experience. Commission on Dietetic Registration website. https://www.cdrnet.org/certifications/specialty-practice-experience#gerontological. Accessed June 26, 2020.
4. Board Certification as a Specialist in Gerontological Nutrition. Commission on Dietetic Registration website. https://www.cdrnet.org/certifications/board-certification-as-a-specialist-in-gerontological-nutrition. Accessed June 26, 2020.
5. Older Adults. Office of Disease Prevention and Health Promotion website. https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults. Accessed June 26, 2020.
6. Niedert K, Carlson M. Nutrition Care of the Older Adult. Chicago, IL: Academy of Nutrition and Dietetics; 2016.
7. Huber M, Knottnerus JA, Green L, et al. How should we define health? 2011 Jul 26;343:d4163.
8. Malnutrition: An Older-Adult Crisis. Defeat Malnutrition Today website. http://defeatmalnutrition.today/sites/default/files/documents/CMKT_15_00385a_Malnutrition_Info_Graphic_OnePage_Update_FA.pdf. Accessed June 26, 2020.
9. MyPlate for Older Adults. Tufts Hean Mayer USDA HNRCA website. https://hnrca.tufts.edu/myplate/. Accessed June 26, 2020.
10. Nowson C, O’Connell S. Protein requirements and recommendations for older people: a review. Nutrients. 2015 Aug;7(8):6874-99.
11. Nutrient Recommendations: Dietary Reference Intakes (DRI). National Institutes of Health website. https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx. Accessed June 26, 2020.
12. Dorner B, Friedrich EK. Position of the academy of nutrition and dietetics: individualized nutrition approaches for older adults: long-term care, post-acute care, and other settings. JAND. 2018 Apr 1;118(4):724-35.
13. NIH National Institute on Aging website. Providing Care and Comfort at the End of Life. https://www.nia.nih.gov/health/providing-comfort-end-life. Updated May 17, 2017. Accessed June 26, 2020.