Liberalized Diet vs. Therapeutic Diet: Discover the Ultimate Balance for Health and Happiness in Long-Term Care

As healthcare professionals, we constantly seek methods to enhance the health and overall quality of life for our patients and clients. In long-term care settings, the debate between liberalized and therapeutic diets is central to this pursuit. Liberalized diets are gaining recognition as a beneficial approach to support individuals in care settings, helping them maintain autonomy, nutritional status, and quality of life. This article explores the nuances of liberalized diets versus therapeutic diets, providing insights into their applications, benefits, and potential challenges.

Understanding Therapeutic Diets

A therapeutic diet is a prescribed meal plan designed to manage specific medical conditions by controlling certain aspects of nutrients and/or foods. These diets are a key component of medical nutrition therapy and aim to support and improve conditions like kidney disease and diabetes. Limitations and restrictions are inherent in these diets.

Common types of therapeutic diets include:

Diabetic Diet
No Concentrated Sweets
Low Sodium
No Added Salt
Low Fat
High Fiber
Calorie Controlled
Renal Diet
Cardiac Diet

Often, two diets will be combined and ordered as such, like a carbohydrate consistent/heart healthy diet. In this case, a patient may have a medical history that includes diabetes and hypertension, two separate conditions that require two different therapeutic diets.

The effectiveness of a therapeutic diet hinges on the resident's willingness and ability to comply with the diet recommendations. Therapeutic diets are commonly ordered in post-acute care settings such as long-term care, rehabilitation, and home care. Healthcare providers with appropriate delegation may prescribe therapeutic diet interventions for individuals with chronic conditions, including diabetes, chronic kidney disease, and cardiovascular disease.

What is a Liberalized Diet?

A liberalized diet relaxes the restrictions of therapeutic diets, allowing individuals to eat a more "regular diet" that includes foods they enjoy. This approach aims to improve nutritional intake and overall quality of life.

The American Dietetic Association supports individualized nutrition approaches for older adults, recognizing the risks of malnutrition in post-acute care settings and the potential benefits of liberalizing therapeutic diets to enhance quality of life.

Advantages of Liberalized Diets

Liberalized diets offer several potential benefits, particularly in long-term care settings:

Improved Nutrient Intake: Older adults in care settings often struggle to consume enough nutrients. By relaxing dietary restrictions, a wider range of foods and nutrients becomes accessible, reducing the risk of deficiencies and malnutrition.
Enhanced Quality of Life: Autonomy in food choices can significantly improve the quality of life for individuals in care settings. The ability to eat preferred foods can lead to greater satisfaction and fulfillment, reducing feelings of deprivation or frustration associated with strict dietary restrictions.
Increased Socialization: Mealtime is often a social event. A wider variety of food options can facilitate socialization and increase enjoyment during meals, which is particularly important for older adults living alone.
Potential for Improved Health: A liberalized diet may be more appealing to older adults than a strict, regimented diet. By allowing choices within an overall nutritious menu, individuals may be more likely to adhere to dietary recommendations.
Cost Savings: Liberalized diets can save costs in the long run due to decreased supplement use, and they can also decrease overall healthcare costs.

Situations Where Liberalized Diets are Appropriate

There are various situations in long-term care where a liberalized diet can lead to better outcomes. Consider a 90-year-old man with a history of diabetes, hypertension, and chronic kidney disease who has a poor appetite and is at risk of weight loss. In such cases, liberalizing the diet can be the best practice. The primary goal is to encourage eating and prevent the negative consequences of a prolonged poor appetite, such as weight loss and skin breakdown.

How to Implement Liberalized Diets

Implementing a liberalized diet involves several key steps:

Assessment: Dietetics professionals should assess and evaluate the need for medical nutrition therapy based on each person's individual medical condition, needs, desires, and rights.
Individualization: Nutrition should be individualized to increase the desire to eat and improve quality of life.
Education: Educate capable clients/patients, their families, and secondary decision-makers on the benefits and reasons for diet liberalization.
Collaboration: Work with other healthcare professionals, such as speech-language pathologists (SLPs), to liberalize diets safely, especially for individuals with dysphagia who may need texture modification.
Person-Centered Care: Involve residents in decisions about schedules, menus, and dining locations.
Consider Preferences: Learn residents' food preferences to create a healthy, delicious diet based on what they enjoy.

Challenges to Implementing Liberalized Diets

Despite the benefits, several barriers can hinder the implementation of liberalized diets:

Training and Resources: Healthcare team members may require training on supporting autonomy over food choices while ensuring nutritional needs are met. Additional staff resources and training can be challenging in some care settings.
Concerns About Safety: Colleagues may worry that a liberalized diet could harm the health of individuals with medical conditions.
Regulatory and Legal Issues: Care facilities are subject to various regulations and legal requirements that may complicate implementation.
Cultural and Dietary Preferences: Accommodating certain dietary preferences in a care setting may not always be possible.
Lack of Family Support: Family members may resist a liberalized diet for their loved one, particularly if they are concerned about safety or effectiveness.

To overcome these challenges, it's essential to:

Consult with all individuals involved in the care of the client/patient.
Review charts to determine overall health and nutritional status.
Maintain thorough documentation to advocate for the client/patient successfully.
Create a supportive and empowering environment that promotes better health and well-being.

Liberalized Diets in Various Practice Settings

Liberalized diets are not limited to post-acute care settings. Emphasizing flexibility and inclusivity rather than strict rules can be a departure from traditional diets that focus on eliminating certain foods. Promoting a more balanced and intuitive approach to eating may help individuals develop a healthier relationship with food and their bodies and eat without guilt or shame. This can increase satisfaction with eating and may lead to the intake of more nutrients and a more nutritious diet overall.

Individualized Approach

Nutrition is all about individualization and customization. Some individuals may wish to follow a therapeutic eating pattern, such as a diabetic diet, which should still be respected.

Remember, a resident's condition and mindset often change over time. Each follow-up visit, the plan of care should be reassessed to ensure it remains appropriate. Take the liberty to make changes and individualize a resident's plan of care.

Read also: Weight Loss Meds & BCBS

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