Therapeutic Diets in the Elderly

Therapeutic Diets in the Elderly was written by Karina Chou, dietetic student at University of California, Berkeley.

Reviewed/edited by Janina Phillips, RD, LD and Katie Dodd, MS, RDN, CSG, LD, FAND

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.

References

Gomella, Leonard G., and Steven A. Haist. “Chapter 11. Nutritional Assessment, Therapeutic Diets, and Infant Feeding.” AccessMedicine, accessmedicine.mhmedical.com/content.aspx?bookid=365§ionid=43074920.
“Journal of Clinical Nutrition & Dietetics.” Therapeutic Diet, www.imedpub.com/scholarly/therapeutic-diet-journals-articles-ppts-list.php#:~:text=A%20therapeutic%20diet%20is%20a,modification%20of%20a%20regular%20diet.
Raman, Ryan. “How to Do an Elimination Diet and Why.” Healthline, Healthline Media, 2 July 2017, www.healthline.com/nutrition/elimination-diet#section7.
“Chronic Disease and Nutrition Question and Answers.” NCOA, 28 Aug. 2017, www.ncoa.org/healthy-aging/chronic-disease/nutrition-chronic-conditions/nutrition-tips-chronic-diseases/faqs-nutrition-chronic-conditions/.
“Cardiac Diet.” Memorial Sloan Kettering Cancer Center, www.mskcc.org/experience/patient-support/nutrition-cancer/diet-plans-cancer/cardiac-diet.
“The DASH Diet.” National Kidney Foundation, 24 Feb. 2020, www.kidney.org/atoz/content/Dash_Diet.
“Understanding the Basics of Dysphagia Nutrition – Thick-It.” Thick-It, 27 Apr. 2020, thickit.com/understanding-basics-dysphagia-nutrition/#:~:text=A%20dysphagia%20diet%20features%20different,which%20leads%20to%20the%20lungs.
“Dysphagia Diet.” Saint Luke’s Health System, www.saintlukeskc.org/health-library/dysphagia-diet.