When balancing the clinical needs, requests and preferences of each resident in-conjunction with their right to choose, a number of factors need to be taken into consideration. We all recognise that theory and practice can change over time so when I asked Liz Beaglehole (Registered Dietitian) her professional view on this topic is, she offered the following:
The recommendation for older adults with diabetes in aged care facilities with stable diabetes is to provide an unrestrictive diet as much as possible. The notion of a ‘diabetic diet’ is outdated due to the increased risk of hypos and unwanted weight loss.
This is very individual however, a frail 80 year old woman with diabetes will likely have no diet restrictions however an obese 70 year old who may be otherwise stable would benefit from a more restrictive diet. Advice from a dietitian for individuals is recommended.
Overall, guidance from the resident about their wants is probably what determines the diet provided. This may be in accordance with recommendations or not.
Generally, the medications should be fitted to the usual eating pattern of the resident. In aged care facilities there are regular meals and generally balanced carbohydrates over the main meals (assuming good food intake) so usually this is fine. If someone has a reduced food intake, and is on insulin then a unrestrictive diet would be best.
For my menu planning I tend not to plan any special diabetic options on the cycle menus. I may include a low fat / low sugar dessert option if sites request, but generally my philosophy for aged care is not to restrict foods!
Liz is involved with a PEN (practiced based evidence in nutrition) review of the question ‘Do institutionalized, older adults (65 years of age or older) who closely follow a diet prescription have better control of their chronic disease (e.g. diabetes) than those who do not?‘ This is due by the end of March so further practice updates from this review may be available then. Liz noted that generally the evidence suggests there are no benefits with a prescriptive diet vs a more liberal one.