A specific diet is prescribed to every resident or patient upon admission to a skilled nursing facility or hospital.

Therapeutic diets are prescribed to manage diseases such as diabetes and heart failure.

Although they are designed to improve health, they can be overly strict and limiting — especially for older adults living in long-term care.

This article explains five benefits of liberalized diets in older adults.

The Importance of Individualizing Diets

A therapeutic diet controls the intake of certain foods or nutrients.

As a modification of a regular diet, a therapeutic diet may be modified for nutrients, texture, food allergies, and food intolerances.

Unfortunately, therapeutic diets are commonly prescribed based on residents’ medical condition rather than residents’ individual goals, preferences, and informed decisions.

For many older adults, the benefits of liberalized diets outweigh the risks (1).

Diet Liberalization

Diet liberalization refers to relaxing the original diet prescription meant to mange medical conditions.

For example, a resident with high blood pressure or a history of heart disease may be prescribed a low-sodium diet to control blood pressure or reduce the risk of further heart problems.

But using medications rather than dietary changes to manage these conditions can enhance the joy of eating and reduce the risk of malnutrition in older adults.

Besides, many therapeutic diets fail to provide any measurable health benefits in this population (2, 3, 4).

That said, there are several benefits of liberalizing strict therapeutic diets of older adults living in long-term care.

1. Decreased Risk of Malnutrition

The prevalence of malnutrition is common in older adults, affecting an estimated 25-65% (5).

Although there are several risk factors of malnutrition in older adults, overly strict therapeutic diets are a major contributor.

Therapeutic diets often make food less palatable by limiting nutrients important for taste and texture such as sodium, fat, and sugar (1).

Consequently, this can lead to poor food intake, unintentional weight loss, and an increased risk malnutrition.

Liberalized diets, however, have been shown linked with increased food intake and reduced risk of malnutrition (1).

2. Improved Quality of Life

Liberalization of the diet may improve older adults’ quality of life.

This is because strict therapeutic diets can take the joy out of residents’ dinning experiences leaving them isolated in their rooms for meals.

Diet liberalization, however, can encourage residents to dine in the common dinning area promoting socialization.

The social aspect of dinning can improve quality of life by increasing pleasure in eating and psychosocial health, which in turn, can increase food intake.

3. Decreased Risk of Pressure Ulcers

Pressure ulcers are injuries to the skin or underlying tissue resulting from unrelieved pressure on the skin.

Nutrition and hydration plays an important role in the treatment and prevention of pressure ulcers (6).

Diet liberalization can increase food intakes by improving the flavor and variety of foods offered.

In turn, this can decrease residents’ risk of pressure ulcers through enhanced nutrition and hydration status.

4. Decreased Risk of Dehydration

Older adults are prone to dehydration due to the various physiological changes that occur with aging.

One way to combat dehydration is through diet liberalization, particularly for those who have swallowing problems.

Liquids may be thickened to a honey- or nectar-like consistency to reduce the risk of aspiration pneumonia in people with dysphagia, or difficulty swallowing.

Not all residents with dysphagia, however, aspirate and not all aspiration results in pneumonia (7, 8).

Plus, these thickened drinks are often poorly tolerated and can contribute to poor hydration status.

That said, the reduced risk of aspiration pneumonia that may come from thickened liquids may not outweigh the benefits of improved hydration status through liberalization.

5. Decreased Costs

Liberalizing diets can reduce costs as a result of decreased supplement use.

Supplements — such as ensure or boost — are commonly prescribed to residents who aren’t meeting their nutritional needs through food alone.

Although these supplements have been shown to improve nutritional status, they are costly and not preferred if food intake can be improved through diet liberalization (9).

Therefore, it’s beneficial to minimize diet restrictions consistent with residents’ care plan before using costly supplements.

The Bottom Line

Therapeutic diets are designed to improve health outcomes in older adults, when in fact they might do just the opposite.

Overly strict therapeutic diets are often viewed as unpalatable and can significantly reduce the joy of eating in older adults living in long-term care.

Consequently, this can lead to weight loss and other associated health complications such as malnutrition and increased risk of falls.

Therefore, people transitioning into long-term care should receive a regular diet unless there is a strong medical reason for a restricted diet.