March is Nutrition Month and March 20th is Dietitian’s Day! Dietitians across Canada are celebrating by helping Canadians “Unlock the Potential of Food”. Food has the potential to fuel, discover, prevent, heal and bring us together (1). Here’s how dietitians in long-term care homes help residents optimize their health through food and nutrition.
The long-term care sector provides care for those requiring around-the-clock assistance for activities of daily living (ADL) such as grooming, feeding and mobility. It provides accommodation for one of the most vulnerable populations in health care, one which often requires complex clinical involvement to ensure resident health and quality of life are optimized.
As a Registered Dietitian working in long-term care, I monitor our residents’ nutritional status to prevent or delay health concerns such as malnutrition, skin decline, dehydration, and unintended weight loss. These are symptoms frequently seen with common diseases that affect long-term care residents, such as Alzheimer’s disease, dementia, Multiple Sclerosis (MS), and Parkinson’s Disease.
Dietitians are key to ensuring residents have options that meet their nutrition and hydration needs. For instance, residents with memory problems may forget when or how to eat; residents with MS may have limited ability to feed themselves; and residents who have Parkinson’s Disease often have swallowing difficulties that impact their ability to eat or drink safely, to a point where the resident is unable to eat enough food to maintain their health, requiring a feeding tube.
Because one-size doesn’t fit all residents, one of my main responsibilities is to promote person-centered care and ensure the needs of every resident are heard and given priority in our healthcare decision making.
To illustrate my role in person-centred care, I’ll share an experience with a resident under my care, I’ll call her Anne. Anne was diagnosed with Parkinson’s Disease, a condition that affected Anne’s nerve function and her body’s ability to control muscle movements. Anne arrived to our facility in her mid 60s, only requiring moderate assistance with daily tasks; over the years, her disease progressed to a point where she was no longer able to verbally communicate and had difficulty swallowing almost all of her food and fluid intake. Even when she wasn’t eating, Anne was at risk of choking as the muscles in her mouth were so damaged from the disease that she couldn’t manage her own salivary secretions. Anne was not able to consume enough food to manage her nutritional needs so the usual next step in this situation would be to provide her nutrition through a feeding tube. However, while Anne was still able to communicate, she informed us of her wishes to never get a tube feed under any circumstances. Our interdisciplinary team ensured her and her family’s specific wish for no tube feeding was followed.
It was tough watching Anne in the dining room the last few months of her life. She had an incredible appetite and was eager to attend all meals. She had been a “foodie” all her life. Anne was eager to feed herself (even in her final days), but her swallowing ability had declined so much she wasn’t able to trigger a safe enough swallow to get the food in her stomach. To combat at least some of her weight loss, I concentrated her intakes to maximal levels, providing very concentrated supplements throughout the day so that every spoonful of her intake would give her the most nutrition possible. And although at the end of her life, most of the eating she was doing was futile, it provided Anne some comfort in her ability to independently feed herself. A feeding tube may have slowed the progression of malnutrition, but it could have caused her discomfort and was definitely against her wishes. It was hard for us and her family watch Anne struggle with her intakes; however, our team’s efforts to ensure Anne’s wishes for her care were prioritized in her journey through her disease, and she had the autonomy over her care as she requested.
There are many more examples of patients who benefit from the care that Registered Dietitians provide. We often understand the importance of medications to manage certain health conditions but may overlook that without good nutritional intakes, patients can’t heal nor get enough energy to maintain their body during an illness. A Dietitian on your healthcare team is vital to help promote the needs of your patients, striving for person-centered care.
Iana Mologuina is an instructor in CHA Learning’s Food Service and Nutrition Management Program. Iana works in several nutrition sectors, including as clinical dietitian in long-term care, as a private practice dietitian, and teaching students for CHA Learning and George Brown College. She’s had quite a journey in the food service industry, but her favourite sector by far is long-term care, having gathered several experiences working as dietary aide, nutrition student, clinical dietitian, and dietary manager in long-term care homes all over the GTA. She is planning on extending her management commitments to become a long-term care home administrator in the future.