Dietitians Advancing health through food and nutrition

Nutrition plays an integral role in healthy aging, as well as in managing chronic diseases and improving quality of life for the elderly. In upcoming articles we’ll review the latest research on the impact of nutrition on health, and share strategies for providing optimum nutrition care to seniors. An introduction to dietitians seems appropriate to set the context.

In all provinces, the term “dietitian” is protected by legislation, meaning that only people who have met specific training and education requirements are allowed to use the title. Dietitians must complete a four year undergraduate degree in foods and nutrition from an accredited university, plus a supervised practical program and/or graduate degree.

Dietitians of Canada, the national professional association for dietitians, is the accrediting body for academic and practical programs. The final step in becoming a registered dietitian, with the right to practice the profession, is to write the Canadian Dietetic Registration Examination; successfully passing the exam allows registration with the provincial regulatory body, such as the College of Dietitians of Ontario.

Dietitians provide food and nutrition expertise to seniors in many ways: in the community, in hospital, and in long term care homes. In primary care, dietitians at a health centre or physician’s office, help clients choose nutritious foods to meet their specific needs.

Homecare agencies also employ dietitians to provide in-home counselling for clients at risk of poor nutrition, or who need help with managing their medical conditions through diet.

Many homecare clients are nourished through a feeding tube (enteral nutrition); the dietitian ensures that the proper formula is given through the tube at the appropriate rate for meeting nutrition needs.

In the hospital, dietitians work as part of the interprofessional care team to treat acute and chronic illnesses, and plan diets for patients to follow after discharge. Some dietitians specialize in foodservice administration and manage the foods and nutrition department within hospitals, long term care homes, or other institutions.

Residents of long term care homes, who are often at risk of poor nutrition, benefit from dietitians’ expertise in menu development, food preparation and individualized nutrition care planning and evaluation.

The basis for the nutrition advice or individualized care plan developed by the dietitian is a comprehensive nutrition assessment. Components include a review of documentation from other health professionals to find information on diagnoses, medications, and current treatments. Anthropometric measures, such as height and weight, and any laboratory reports such as blood sugar levels, are also used. A detailed diet history (a record of the usual foods and amounts eaten) is taken, and knowing the regular meal pattern of a client and their food preferences helps the dietitian make an individualized and realistic nutrition care plan.

When applicable, the client’s ability to shop and to prepare food is also assessed. Observing the client eat helps the dietitian identify any issues with self-feeding ability or swallowing difficulties, which can then be addressed through changes to the diet or use of adaptive feeding aids.

An individualized nutrition care plan will have several components, based on the client’s preferences and the nutritional risk factors identified in the assessment.

For a senior living independently and preparing their own meals, the dietitian will offer advice on the types of foods that will help meet their nutritional needs, with special emphasis on foods high in specific nutrients, or low in substances that the client needs to avoid.

If there are issues with chewing or swallowing, the dietitian will suggest foods that are also safe to chew and swallow. Vitamin and mineral supplements may also be recommended, as appropriate.

Within a long term care home, the dietitian will work with the resident and the dietary department to translate the resident’s specific needs into the menus and meal service of the operation, as well as with the interprofessional team for other supports that may be needed such as feeding assistance.

In future issues we’ll explore the role of different nutrients and foods in maintaining health, and the unique nutritional requirements of seniors.

Nutrition information for all ages, and interactive tools to help you plan healthy meals, are available at the Dietitians of Canada website: www.dietitians.ca.