Helping older adults meet nutritional challenges.

Prevention of premature chronic diseases is an important component of healthy aging. Nutrition education can help to reduce the risk of premature chronic diseases in some older adults. Home delivered meals and congregate dining services assist vulnerable elderly persons by providing opportunities for nutritional and social support. Screening and assessment tools identify factors affecting nutritional health and can also provide specific directions for planning, implementation, and evaluation of tailored interventions. Dietitians and allied health professionals are well positioned to assist a heterogeneous population of older adults in securing nutritional adequacy.

Symptom relief and adherence in the rotary diversified diet, a treatment for environmental illness.

CONTEXT: The rotary diversified diet, which involves food elimination and rotation of remaining allowed foods, is commonly used in the management of environmental illness. No studies have considered patient adherence while evaluating the effectiveness of the diet in controlling symptoms. OBJECTIVE: The study examined the severity of patients' perceived symptoms and dietary adherence during treatment with a rotary diversified diet. DESIGN: A prospective and exploratory study using purposive sampling and the following data collection methods: personal interviews, symptom severity questionnaires, and food records to assess dietary adherence. SETTING: Private clinic of a Toronto, Ontario physician specializing in environmental medicine. PATIENTS OR OTHER PARTICIPANTS: Twenty-five female residents of Toronto, Ontario (aged 25-67 years) diagnosed with environmental illness. INTERVENTION: Patients were treated with a rotary diversified diet for 16 weeks. MAIN OUTCOME MEASURES: Symptom severity and dietary adherence were assessed after 4, 10, and 16 weeks of treatment. Adherence was assessed by comparing food records to the diet prescription. RESULTS: At 16 weeks, patients reported a 50% decline in symptom severity for 5 of the 6 symptom categories assessed and for all categories combined. Those with closer elimination and rotation adherence reported a greater decline in gastrointestinal symptoms at 4 and 10 weeks of treatment, respectively. Improvement in total symptom severity was associated with closer rotation adherence at 10 weeks. Patients experienced difficulties in adhering to the diet. CONCLUSIONS: Results suggest that the diet, if followed, is beneficial, especially in improving gastrointestinal symptoms. Further evaluation of its effectiveness is limited by its complexity and the nature of environmental illness. Because the diet is difficult to follow over time, patients require extensive nutritional counseling and support.

Tailoring of nutritional support for older adults in the community.

A study in Ontario, Canada of 137 elderly home delivered meal recipients, 90 women and 47 men, confirmed the expected nutritional risk factors of living situation, functionality, morbidity and medication use. They were more pronounced among women than men. Seven-day food records showed energy intakes below the average for healthy Canadians of a similar age and gender. The probability of nutritional risk was highest for calcium, magnesium, zinc and folate with some gender differences, except for folate. While home delivered meals, if fully utilized, can provide considerable nutrition support, energy/nutrient inadequacies may persist among recipients unable to complement the meal appropriately. These older adults may require diet counseling and additional support including targeted nutritional supplementation.

Dietary adequacy of the rotary diversified diet as a treatment for "Environmental Illness".

The rotary diversified diet, used in the management of environmental illness, consists of eliminating prohibited foods from the diet and rotating remaining non-prohibited foods and their "food families" within a regular cycle. We assessed the adequacy of nutrient intakes in 22 women prescribed the diet, described the nature of supplement use, and assessed the relationship between adherence and nutrient intake levels. Except for calcium and folacin intakes, mean nutrient intakes met or exceeded recommended levels. No subjects had calcium intakes above the adequate intake for calcium; 72.7% had folate intakes below the estimated average requirement. Intakes of other nutrients, except thiamin and magnesium, were below the estimated average requirement in less than 25% of the sample; 31.8% and 45.5% of subjects, respectively, had thiamin and magnesium intakes at this level. Those who adhered more closely to the rotary diversified diet had higher intakes of vitamin C, vitamin B6, folate, and fibre than did those who followed the diet less closely. Supplements conferred some nutritional benefits; however, supplemental niacin and magnesium intakes exceeded tolerable upper intake levels. Those prescribed the rotary diversified diet require nutrition counselling from dietitians to cope with the complexity and restrictiveness of the diet.