Nutrition for Older Adults
This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.
In this podcast, Lisa Jones, RDN, LDN, FAND, speaks with Liz Friedrich, MPH, RDN, CSG, LDN, FAND, NWCC, about best practices for creating an individualized nutrition care plan for older adults, common misconceptions about food and older adults, and new ways of thinking about nutrition for older adults.
Additional Resources:
- Friedrich Nutrition Consulting. Accessed February 6, 2023. https://elizabethfriedrich.com/
- Healthy Aging. US Department of Health and Human Services. Published May 2, 2022. Accessed February 6, 2023. https://www.hhs.gov/aging/healthy-aging/index.html
Liz Friedrich, MPH, RDN, CSG, LDN, FAND, NWCC, is president of Friedrich Nutrition Consulting, which provides a variety of nutrition consulting services with a focus on gerontological nutrition (Salisbury, NC).
Lisa Jones, MA, RDN, LDN, FAND, is a registered dietitian nutritionist, speaker, and author (Philadelphia, PA).
TRANSCRIPTION:
Speaker 1:
Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions for Consultant360.
Lisa Jones:
Hello and welcome to Nutrition411: The Podcast where we communicate the information you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is about geriatric nutrition. The elderly need love too, and good food. Today my guest is Liz Friedrich. Liz is the President of Friedrich Nutrition Consulting, which provides a variety of nutrition consulting services with a focus on gerontological nutrition. Liz has more than 25 years of experience as a hands-on clinician in long-term care facilities. She's authored or co-authored numerous articles and journals and magazines on topics related to nutrition and aging, and she also is an accomplished speaker on those same topics. Welcome, Liz.
Liz Friedrich:
Thank you, Lisa. I appreciate being asked to be here.
Lisa Jones:
Yes, we're excited about today. So let's dive right in. Oh, before I begin, Liz, do you have any disclosures that you want to mention?
Liz Friedrich:
I do. I'm a member of the Hormel Health Labs Advisory Council. The company manufactures nutrition supplements, thickened liquids, et cetera, et cetera, and I sit on their advisory board and just provide input to them about products and services.
Lisa Jones:
All right, perfect. Thanks for letting us know. We will dive right into the questions that I have for you today. So, the first one is please tell us and our audience about the health concerns that should be considered when creating a nutrition plan for the elderly.
Liz Friedrich:
Well, before we can do that, Lisa, I think it's important to try to define what elderly means, and that's kind of loosey, goosey in the literature. But I think most people agree that the elderly are broken down into different categories. For example, the young old, roughly between 65 and 74 years of age, the middle old between 75 and 84, and the old, old older than 85. So of course the nutrition concerns can be vastly different for those three different categories of old or elderly. So it's a complicated question and it really varies depending on how old and in what kind of health condition people are. But of course, we always think about the usual cast of characters, hypertension, diabetes, heart disease, and kidney disease. One thing that's often, frequently overlooked is something called sarcopenia, which is a loss of muscle mass. And in the past, they used to say that was caused by aging or due to aging, but now it's being looked at in a broader sense as illness or aging can cause this loss of muscle mass.
So, if you think about older adults who are sick and getting old, they really can be subject to sarcopenia, which can have a lot of consequences for the way they live their daily lives. So I think that one is definitely something that a lot of people may not think about. It's also important to think about an older person's ability to function because that affects their health status and their nutrition. So a young old person might drive their car to the grocery store and bring their groceries home and unpack them, et cetera, et cetera, whereas someone who's much older may have frailty or sarcopenia or difficulty performing their ADLs and procuring and or preparing foods. So I think it's important we think about those aspects of health as well when we talk about a nutrition care plan.
Lisa Jones:
Well, thank you for that because as I'm listening, there are probably many dieticians that aren't even aware that there are three categories of elderly. And I think back to long ago when I was in my graduate program when we were learning about it, and I don't even remember, maybe they did go over the three categories, but thank you for pointing that out because that just goes to show about specialties and specialty areas amongst dietetics.
Liz Friedrich:
Yeah, well, I'm not sure those areas are well-defined, but certainly as a practitioner and a speaker working with the elderly, and you start looking at the literature and you realize, and people do point out, the needs are so different depending on the age and abilities of the older adult.
Lisa Jones::
So it's really like that case-by-case basis and kind of looking at who that particular patient is or client that you're working with, and then assessing from there based on some of the things that you mentioned.
Liz Friedrich:
Absolutely. And of course, individualized nutrition care is something we all know about, but I think it comes into play much, much more with older adults than with some of our other populations.
Lisa Jones::
Yeah. And now I know when I will be called old, old, I have to be 85 or older. So,
Liz Friedrich:
Well, I'm pushing young, old, so.
Lisa Jones::
I thought it was when you got invited to AARP at 50, but I guess not. So thank you for that answer. Let's talk about some common misconceptions about eating, because I'm sure there are a lot in general, but then let's take it into this area with the elderly.
Liz Friedrich:
Okay.
Lisa Jones::
What would you say are some common misconceptions?
Liz Friedrich:
Yeah, and thinking about this, I think the key point here, and we've sort of touched on it already, is one size does not fit all. And everybody's an individual and has their own needs. But again, it's particularly critical in the elderly that we look at their abilities and their medical history, and their desires before we start generating plans of care for nutrition. You can't just say every person who's 70 and has diabetes needs to have their blood sugars at X level and should eat accordingly. It's way more complicated than that. So that's important. And of course, I think across nutrition care, no matter what the age, some people tend to focus more on individual nutrients. And if you think about the elderly, you often hear iron and calcium and vitamin D tossed around. But I think it's safe to say that the overall eating pattern and overall healthy diet are what's most critical rather than focusing on individual nutrients.
And again, I think that's more common with all adults, nutrition care of all adults in this day and age. But I think especially for the elderly. For example, their iron level is low. Well, why is it low? Is it necessary to give them an iron supplement or ask them to eat high-iron foods? The overall eating pattern plays much more of a role there. And then I think another thing that's really critical is obesity. Excuse me, overweight and obesity in older adults, and a lot of people, dieticians included, tend to think everyone should lose weight.
And for older adults that may not be necessary, but it could also be unsafe because if you're cutting back the number of calories they're eating, they could be missing out on important nutrients. And also they could start losing muscle mass if they're not getting enough calories, which can contribute to or exacerbate the sarcopenia we already talked about. So no, I really think that the thought that everybody who's overweight or obese and is older, the thought that they need to lose weight is a real misconception. That we as a profession really and all healthcare professionals kind of need to be aware of and address.
Lisa Jones::
Yeah, that's a really great point that you bring up because it goes back to it being customized for that person and it's not one size fits all, and that goes across the board. And then the other thing I was thinking of as you were talking, and I'm wondering with all your expertise, you mentioned those categories, have you noticed differences between the categories with some of the misconceptions, like maybe the young old think something different than the old, old? Have you seen anything like that in your experience?
Liz Friedrich:
Oh, absolutely. I think that the old, old are, they've not given up, but I hear so many times from people who are really old, I've been eating this way the rest of my life, and I'm just not going to change. And I look at myself as a 25-year-old, 30-year-old dietician, I practiced very differently back then. And I probably would've gone into that room and said to that person, well, here, let's talk about what changes we can make. But if they're not interested or able to change their diet at this age and stage in life, we need to accept that and move forward with that. And actually, what I'm seeing around misconceptions, a lot of the younger old, I think, fall prey to a lot of vitamin supplements to help prevent cancer or herbal supplements for this or that. And they're at that age where they've started recognizing they're getting old and they want to make sure they stay healthy as long as possible. And so that age group, I think, tends to be more interested in nutrition to help prevent disease and or extend their life.
Lisa Jones::
Yeah, that's so true. As you were talking, I was thinking about when I used to do home care, and I had this one consult that I distinctly remember because she was like 94. They wanted me to go talk to her about a low-sodium diet. I walked into her house, I had the low sodium handout ready, and she was smoking a cigarette, and she had all these canned items because that was easier for her to do. She lived by herself, and she basically said, you're wasting your time here. I'm 93, I'm not going to start following a low-sodium diet now, and I'm going to continue smoking. And at that point I kind of said, okay, well, how do you argue with that? It kind of goes back to if it was a young old person, it'd be a little different, but I still went over some things she could do, like some smaller changes, but she still at the end was basically said, I'm not going to follow this.
Liz Friedrich:
Yeah. Well, I think that goes back to recognizing choice and all individuals have the right to make a choice and to reject healthcare, whether it be nutrition, surgery, or medication. But also I work in long-term care. I see young, old and old, old in all health situations. And for so many people that quality of life is important. And who am I to judge if that 93, 94-year-old woman wanted to smoke her cigarettes and eat her high-sodium foods at that point. It makes her happy. So sometimes as dieticians, I think we need to adjust the way we look at those sorts of things when we're dealing with older adults.
Lisa Jones::
Yes, so true. Well said. Because who am I to take away her Campbells. I don't want to be the person that's like, no, you can't have those, but here are some alternatives if you want to mix them in every once in a while.
Liz Friedrich:
Right, right.
Lisa Jones::
Yeah, that's such a great point though. So thank you for that and the misconceptions. Great conversation about misconceptions. So Liz, what would you say about best practices? So you have so much experience in this area, and I'm sure over the course of your practice you have experimented doing different things and then maybe you tried something else. What would you say would be some of the best practices that have led to your success that could potentially help other colleagues working with the elderly population?
Liz Friedrich:
Well, I think we've touched on several of them. One of course is to individualize the care and look at what the patient needs and wants and is able to do, rather than just spouting off our, I'm using the word rules about how to eat healthily. I have to say, I go into a lot of rooms of patients who are in a nursing home, maybe there for a few days or maybe there for the rest of their life. And when I say I'm the dietician, a lot of times I see this thing in their eye like, oh no, what's she going to tell me? What's she going to tell me not to eat? Or if they're overweight, she's going to get on me about my weight. So really individualizing that care, listening to the person. And I always use the terminology, meet them where they are, not where you think they need to be.
And those are two very different things. I'm not saying we shouldn't encourage them to make changes, but I'm saying we need to look at where they are and what changes they're interested in and capable of and work on those instead of across-the-board, sweeping changes that we think might benefit them. And then, of course, the quality of life thing is ultimately important. And especially in someone who's in a post-acute care setting, they have no control, those patients over anything in their life really, who their roommate is, what time they eat their meals, et cetera, et cetera. So, if their food can be a source of quality of life, that is just really, really huge. And I think that applies to even the elderly who live at home who may not go out much or have much company or be lonely that food is their friend. And I think our best practices need to recognize that and allow them to embrace it and not be judgmental about it.
Lisa Jones::
Yeah. Some great suggestions there: meeting them where they are. And then the other thing is, a lot of times what you were saying is one of the things that they're like, everything's controlled. And then the one thing, if they have a choice in their food, that helps them with a better quality of life. So great suggestions. Yes. And about, have you heard of any new interventions coming out that would support some of the nutritional challenges that the elderly face that you've mentioned?
Liz Friedrich:
Well, I was thinking about that, and I'm not sure I can come up with new interventions, but I do think that we need to kind of move forward with older adults with a new way of thinking. And again, we've kind of touched on that, but focusing on nutrient density. We need fewer calories as we age. So it's important that what calories are consumed are as healthy as possible. So fruits and vegetables, whole grains, lean protein, the whole thing that we all know. Another new way of thinking is that maybe our patient has eaten this way their entire life if they're 65, maybe for 50 years, if they're 85, maybe for 60 or 70 years.
So for us to suggest or expect changes that we think are important might just not be very realistic. So I think a new way of thinking is for us to consider when we're working with older adults, is there really a need to change? And certainly, in many cases, there is. And if the person is willing and able, we can be very successful at helping them make those changes. So not necessarily new interventions, but I think new thought processes.
Lisa Jones::
Yes, new thought processes. And the other thing I was hearing was just the freedom to be creative in some of the approaches.
Liz Friedrich:
Yes.
Lisa Jones::
How to.
Liz Friedrich:
Yes.
Lisa Jones::
And then going back to that customizable, like always thinking in that mindset.
Liz Friedrich:
Yes.
Lisa Jones::
All right. Great. Would you share a story about your work in particular, like if you have an example showcasing your work in the past that you want to share with our audience?
Liz Friedrich:
Most of what I do now, or a lot of what I do now, is kind of mundane clinical care with older adults who are ill. And so there's not a lot to showcase. But I think for me as an individual, I get such pleasure and professional pride out of when I go into a patient's room and I would've used, for example, a patient with diabetes and I find out it might be an 80, 85-year-old woman or man who's been really watching what they eat for the last 15 years since they got diagnosed. And if they're on insulin and taking medications, the school of thought now is the complications of elevated blood sugars at that age, the long-term complications are minimal. We don't want to ignore the diabetes, but we also don't want to over-treat the diabetes. So we want to give them the freedom to maybe eat more freely than they had in the past.
And I just see that and I have these conversations with many patients and sometimes they think they're supposed to tell me that they're eating very carefully. And when I kind of give them the freedom to confess, the light goes on in their head and they're just happy. Yeah, I'm 85. I'm going to enjoy what I eat and I'm not going to overdo it, but if I want to have a piece of cake, I'm going to do it. And giving them that permission and making them happy is really a big victory for me. So something small to a lot of people, but a big victory for me.
Lisa Jones::
Yes. And that makes me happy to hear too, like giving them freedom. And then have your cake and eat it too. It's okay.
Liz Friedrich:
There you go. Yes.
Lisa Jones::
You don't need to worry about it.
Liz Friedrich:
Yes.
Lisa Jones::
So is there anything else that you would say to dieticians working in this population or those dieticians thinking about going into geriatric nutrition that you haven't mentioned at this time? Is there anything else that you can share?
Liz Friedrich:
Well, there's a great need for dieticians who are skilled in working with older adults, particularly working in post-acute care settings. As I understand it, there's quite a shortage. So, it's a rewarding career to work with older people. You can learn so much from them and you can see how much they appreciate help when it's given. And so you can see how much they appreciate advice, like enjoy your food and enjoy being with your friends and enjoying food with your friends. So, I just think it's important that we really consider that our older adults are individuals and dieticians who might want to work in that age category, it's really worth taking a close look because it can be fun. It can be really sad and really hard, but it's also very rewarding.
Lisa Jones::
Yes, rewarding. Well, thank you for sharing all the great suggestions.
Liz Friedrich:
You are welcome.
Lisa Jones::
The last thing I want to ask you about this particular topic is if you could say just one, and you already mentioned this throughout, but the one that you would select from this will be the bottom-line takeaway that you would tell our audience. What should they do or continually be aware of? And I think I know the answer, but I want to hear it from you.
Liz Friedrich:
Meet your patient where they are not where you think they should be. Is that what you thought I would say?
Lisa Jones::
Yes. That's what I have on my paper, I wrote down, and I have it in the air quotes, so thank you.
Liz Friedrich:
Actually, that applies to all adults, though I think. I mean, I think we as dieticians sometimes forget that. We're really good at telling people what they should do without necessarily knowing what they are doing all the time.
Lisa Jones::
Yeah. So, sure. That is a great point because I think a lot of times, I mean, I can even relate that to my daughter who's four and a half. So I think, I always try to think, like meet her where she is. She doesn't want to eat her fruits and vegetables. How can I meet her where she is currently? Maybe it's not the whole portion. Maybe I just try to do a small amount. So I think at any stage of life, that is great advice.
Liz Friedrich:
Yeah. Yeah. One little quick story. I do a lot of work with wound healing, and one time I was giving a lecture on nutrition and wound healing to a group and somebody raised their hand and said, my patient doesn't want to do anything but eat McDonald's hamburgers. And I looked at them and I said, well, it's a hamburger, it's beef, so it contains some protein, so maybe we don't need to be so judgmental. And the look on the faces of the audience, they were mostly nurses and doctors were like, what? And I hope that look was not being appalled at me, but thinking, gee, I never thought of it that way before. We can't necessarily stop someone from eating at McDonald's, so we can help them figure out what to eat that's going to meet their nutritional needs.
Lisa Jones::
How to make good choices no matter where you are. And that basically goes back to what you're saying, is meet them where they are. Maybe they're at McDonald's that day. Right, Liz?
Liz Friedrich:
Right.
Lisa Jones::
That's where they were. All right. Well, I want to end with a fun lightning question round.
Liz Friedrich:
Okay.
Lisa Jones::
We'll talk about related to the elderly as well. So my first question is, what food or foods do you eat when you want to show yourself love?
Liz Friedrich:
You're asking me that question?
Lisa Jones::
Yes, for you.
Liz Friedrich:
Oh, when I want to show myself love. Gosh, I don't connect food with love. That's a hard question. A cup of hot chocolate.
Lisa Jones::
Okay. I like it. It's a good time of year for it too, right? Yeah. Nice and cold. How about what food or foods would you give someone to show them love? When you're working with one of your elderly patients and you want them to feel love, what food would you suggest or what food would you give them or tell them to eat if there was one food? You can mention more than one. I know that's probably hard to answer.
Liz Friedrich:
Oh, it's not hard at all. I would ask them what they want, what their comfort food is.
Lisa Jones::
Oh, there you go. Like soup, warm soup.
Liz Friedrich:
Right.
Lisa Jones::
Campbells, if it's that client I was mentioning,
Liz Friedrich:
Macaroni and cheese, who knows? Everybody's different.
Lisa Jones::
That's true. And since Valentine's Day is coming up in a couple weeks, what is your favorite Valentine's Day-associated food that you would eat or give or have talked about with your elderly clientele?
Liz Friedrich:
Dark chocolate.
Lisa Jones::
Very nice. All right, thank you. Well,
Liz Friedrich:
You're welcome.
Lisa Jones::
I appreciate everything that you've shared with our audience today. Thank you for being on our show and sharing your insights with us. And we'll make sure to share all the resources that we've talked about. And to our audience, thank you for listening, and please tune in again and share your comments and feedback on our site. Have a great day, and enjoy a healthier lifestyle with The 411 in mind.
Speaker 1:
For more nutrition content, visit consultant360.com