Liberalize the diet
If the facility has salt shakers on the table, education is needed to discourage its use. A liberalized diet approach simply means relaxing the original diet prescriptions meant to control disease states like diabetes or hypertension. A high protein diet is needed because when dialysis is done, albumin is pulled out of the blood stream. No added salt is a liberalized low salt diet. Just a few bites of old favorites or family recipes may illicit memories from the past that help many older adults rediscover the enjoyment of dining experiences. The resident may need to have a consistency change such as mechanical soft or pureed. Other individual restrictions may be added such as lactose restricted. A large part of their recommendations include diet liberalization. The body will then try to take calcium from the bones making them weak. However, for those who reside in a senior living community due to physical and cognitive deterioration, liberalization of the diet may provide and increased quality of life along with other benefits. The goal is to promote quality of life and enjoyment of foods not previously permitted. When kidney function declines, the body has a difficult time keeping phosphorus and calcium in balance. This may be a low concentrated sweet diet or consistent carbohydrate according to your facility diet manual. The resident does, however, have the right to use it as desired. In long term care, the restrictions are liberalized. Using Liberalized Diets To Improve Quality of Life. A diabetic diet may be warranted if the resident has a history of diabetes. These diets often restrict many of the foods elders have enjoyed for years, beginning a gradual decline in quality of life due to lifestyle changes around dining. As a preventative measure, skilled nursing communities can adapt a liberalized diet approach so that upon admission, all residents are not ordered restrictive diets unless seen as absolutely necessary by the physician.
Salt increases thirst and can lead to drinking excess fluid, which can cause problems. The prevalence of malnutrition increases as older adults advance from independent and assisted living to skilled nursing. This can lead to swelling, high blood pressure, and further damage to the kidneys. These must be taken with meals to be effective. This excludes only a salt packet from the tray. During dialysis, albumin in the blood helps with fluid removal. Usually, medications such as PhosLo or Renvela are given to help block phosphorus absorption. When the kidneys are malfunctioning, they cannot get rid of excess sodium as efficiently. Malnutrition is a precursor of poor clinical outcomes and a major indicator of early mortality. The only way to replace the lost albumin is by eating more protein. As with all diet prescriptions, consideration of the individual is very important. A salt restriction helps with compliance to a fluid restriction. Those who previously remained isolated in their rooms for meals may now want to dine in the dining room. Albumin helps to maintain growth and tissue repair. For many seniors, heavily modified diets are prescribed by doctors and nutritionists as a way to combat disease. The combination of advanced disease states and an increased need for assistance with basic daily needs, such as bathing and eating, are major contributors an overall decline. A milk limit is necessary due to the high content of phosphorus. Your facility dietitian will be in communication with your local dialysis dietitian to determine this. The social aspect of dining promotes many positive attributes, including eating more and developing new friendships. Liberalizing diets is a philosophical approach and needs to be supported by all care givers and medical experts.
