Restrict or Liberalize? Therapeutic Diets for Older Adults with Cardiovascular Disease

His medications include 75 mg atenolol daily, 40 mg Lasix twice a day, 80 mg Lipitor daily, 8 mg warfarin daily, 75 mg Clopidogrel daily, and 80 mg low dose aspirin daily.

At 5’5” tall, normally 145#, he has gradually lost weight and is now down to 106#. Although his food intake is only fair, his cardiologist emphasized the need for a low sodium diet and daily weights to monitor for fluid shifts. His wife is overwhelmed and his daughter is nervous about how to shop and prepare for his meals.Knowing that almost 20% of older adults are readmitted to the hospital within 30 days of discharge (1), assuring Richard receives good advice is essential. He will be returning home with his 88-year old wife, who is overwhelmed and nervous about preparing his food and with limited help from family. How should you counsel Richard?Malnutrition ConcernsMedical nutrition therapy (MNT) recommendations for cardiovascular disease (CVD) in older adults vary based on diagnosis, age and risk of malnutrition. For frail older adults, unintended weight loss, malnutrition, sarcopenia, and frailty are genuine concerns. These conditions can lead to reduced functional ability and increased dependence, so preventing these complications is critical. Consuming nourishing food to prevent further decline is a major focus.

Health care providers mean well by ordering therapeutic diets to improve health, but in frail older adults, these diets can have a negative effect on the variety, flavor, and palatability of food. This can reduce enjoyment of eating, decrease food intake and lead to complications that could affect quality of life and longevity. It is critical to individualize nutrition interventions to assure the highest level of well-being for each person, and in many cases that means avoiding strict therapeutic diets. According to the Academy of Nutrition and Dietetics (Academy) Evidence Analysis Library, more liberal diets are associated with increased food and beverage intake in older adults (2).Medical Nutrition Therapy for Cardiovascular Disease in Older AdultsA risk factor for cardiovascular disease, hypertension affects approximately 64-78.5% of older adults (3). Lowering blood pressure can help reduce risk for stroke, MI, heart failure, and renal disease. For people 60 years or older, blood pressure (BP) goals areHeart failure (HF) is the leading cause of hospitalization among older adults in the U.S., and more than 50% of HF patients are readmitted within 6 months of hospital discharge (6). Treatment includes medications, a reduced sodium diet, and daily physical activity (7). A 2000 mg sodium, 2000 mL fluid restriction is typically prescribed (8), however recent evidence indicates that intake of 2700-3000 mg sodium daily may decrease hospital readmissions and mortality in patients with compensated CHF (9).

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