Working as a dietitian in long term care or within a skilled nursing facility is a special job. You are getting to work with a population that has very real nutrition needs and most likely has nutritional deficiencies and/or weight loss. In fact, the most common issue you will see within this population is weight loss. How can we fight against this? Even prevent it? The answer- food first. The food first philosophy aims at increasing calorie/protein/nutrient intake while preserving quality of life; something that is very important in all stages of life, but especially this stage.
So, what does “food first” mean? Well, it means exactly what it says. When trying to increase calorie/protein/nutrient intake utilize real food first before turning to oral supplements. Dietitians can sometimes come under the stereotype “supplement pushers.” But we are so much more than that. And yes, oral nutrition supplement have a very real place in our job and in some cases are the most appropriate option. But the food first philosophy encourages us to exhaust all real food options first (if appropriate) before recommending an Ensure, Boost, Magic Cup, etc.
Below are some tips to help you implement the food first philosophy in your facilities:
Food Preferences: Don’t neglect collecting food preferences for all new patients. This is crucial. This ensures the patient is getting foods and beverages he/she actually likes, getting them off on the best food possible. If your CDM gathers the food preferences, make sure and references these when making a recommendation for a patient. You don’t want to add fortified oatmeal at breakfast if the patient dislikes oatmeal.
Fortified Foods: Speaking of fortified oatmeal… Utilize the fortified foods offered at your facility (or talk with the CDM/FSM about adding some to the menu). Fortified foods are simply foods with a little extra bang for their buck. Examples include cheesy eggs, fortified potatoes (made with butter, sour cream, etc.), fortified oatmeal (made with butter, brown sugar, etc.), fortified soup (usually a cream based soup with added protein).
Energy Dense Foods: Educate the patient on energy dense food choices and/or make recommendations on how they can add them to their daily meal plan. Two examples of energy dense foods include nuts/nut butters and full fat dairy foods/butter.
If a patient still has poor PO intake or is still losing weight after utilizing all real food options, then you move to oral nutrition supplement choices. These include but are not limited to Ensure/Boost, Magic Cup, Ensure pudding, MedPass 2.0, or TF if medically appropriate. Be sure and consult the patient before making a recommendation for a certain supplement. Always be sure they are on board! The good news is, we have a lot of tools in our tool box when it comes to helping fend off weight loss and increase PO intake in the geriatric population; it’s just important to know which tools to use first.