At age 88, Richard was hospitalized postmyocardial infarction (MI) for stent placement and management of heart failure. Other than hypertension, he’d been healthy, eating a regular diet, and either walking or using a stationary bike daily.
Following the MI, his cardiologist restricted his physical activity and ordered a low-fat, low-cholesterol diet with no more than 2,000 mg sodium. Richard takes 75 mg atenolol and 80 mg Lipitor daily, 40 mg Lasix twice a day, and several other medications.
At 5’5” tall and normally 145 lbs, he has gradually lost weight and is now down to 106 lbs. Although his food intake is only fair, his cardiologist emphasized the need for a low-sodium diet and daily weigh-ins to monitor for fluid shifts.
Almost 20% of older adults are readmitted to the hospital within 30 days of discharge,1 so assuring Richard receives good advice is essential. He will be returning home with his 88-year-old wife, who’s overwhelmed, nervous about preparing his food, and has limited help from family.
Nutrition 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 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 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’s critical to individualize nutrition interventions to ensure 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 Evidence Analysis Library, more liberal diets are associated with increased food and beverage intake in older adults.2
MNT for CVD
Lowering blood pressure can help reduce risk of stroke, MI, heart failure, and renal disease. All adults with hypertension should modify their lifestyles in conjunction with pharmacological treatment.3 To maintain nutritional status, older adults may need a more liberal approach to sodium restriction, especially if they’re already frail.4
More than 50% of heart failure patients are readmitted within six months of hospital discharge.5 Treatment includes medications, a reduced-sodium diet, and daily physical activity.6 A 2,000-mg sodium limit and 2,000-mL fluid restriction is typically prescribed7,8; however, recent evidence shows that intake of 2,700 to 3,000 mg sodium daily may decrease hospital readmissions and mortality in patients with compensated congestive heart failure.9
Current guidelines for older adults with atherosclerotic heart disease recommend a focus on overall risk factors rather than specific parameters for blood lipid levels.10 It’s unclear whether modification of blood lipids is effective to prevent CVD in older adults.11 Lipid levels can be controlled by medications while allowing an older person to enjoy food.
How Should You Counsel Richard?
In Richard’s case, dietary changes should be balanced with his condition, prognosis, threat of malnutrition, cardiac cachexia, and individual food preferences. Counsel Richard on eating to maintain health and on enjoying his meals. The Dietary Guidelines for Americans, DASH (Dietary Approaches to Stop Hypertension) diet, or a Mediterranean-style diet are all good eating patterns for Richard. If his food intake is poor or he’s resistant to these suggestions, a more individualized eating pattern that includes his favorite foods may be needed—even if those favorites are high in sodium or fat.
Evidence suggests that frail older adults often need a less restrictive diet to offset the risks of unintended weight loss and malnutrition.
For more information on this topic, refer to Diet and Nutrition Care Manual: Comprehensive Edition from Becky Dorner & Associates, Inc.
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long-term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable resources dedicated to improving quality of life for older adults. For valuable resources for health care professionals, visit www.beckydorner.com and sign up for free membership.
- Krumolz HM. Post-hospital syndrome — an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100-102.
- Unintended weight loss in older adults. Academy of Nutrition and Dietetics Evidence Analysis Library website. http://www.andeal.org/topic.cfm?menu=5294. Published 2009. Accessed December 30, 2016.
- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013;311(5):507-520.
- Pioneer Network Food and Dining Clinical Standards Task Force. New dining practice standards. http://www.pioneernetwork.net/Data/Documents/NewDiningPracticeStandards.pdf. Published August 2011. Accessed December 15, 2016.
- Desai A, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126(4):501-506.
- Heart failure fact sheet. Centers for Disease Control and Prevention website. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Updated June 16, 2016.
- Nutrition Care Manual. Academy of Nutrition and Dietetics website. www.nutritioncaremanual.org. Accessed December 30, 2016.
- Hypertension. Academy of Nutrition and Dietetics Evidence Analysis Library website. http://www.andeal.org/topic.cfm?menu=5285. Accessed December 30, 2016.
- Sodium. Academy of Nutrition and Dietetics Evidence Analysis Library website. http://www.andeal.org/topic.cfm?menu=5293. Accessed January 7, 2017.
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-S45.
- 11. Goldberg JP, Chernoff R. Cardiovascular disease in older adults. In: Chernoff R. Geriatric Nutrition: The Health Care Professional’s Handbook. 4th ed. Burlington, MA: Jones & Bartlett Learning; 2014:277-296.