Published:

03/09/2017 10:58pm

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

Richard is an 88 year old male who was hospitalized post myocardial infarction (MI) for placement of a stent and management of heart failure. Other than a diagnosis of hypertension which has been under control with medications since age 70, he had been healthy and living independently with his wife in their home. Prior to the MI, he was eating a regular diet and either walking or using a stationary bike daily. However since the MI, his cardiologist has drastically restricted his physical activity, and ordered a low fat, low cholesterol, 2 gram sodium diet. 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 Concerns
Medical 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 Adults
A 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 are