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According to the Dietary Guidelines for Americans, 2020-2025, older adults tend to exceed dietary limits for added sugar, saturated fats and sodium. At Vytalize Health, we believe in being proactive than reactive. That is why we offer additional support that includes nutritional counseling to Vytalize partner providers and their patients in an effort to improve their quality of life.
Vytalize’s Senior Clinical Dietitian, Donna Peart tells us how she engages with patients in her role and ensures they are eating nutrient-dense foods that allow them to live better and healthier lives.
I receive consults through our Vytalize Case Managers and Nurse Practitioners. The patients I see have at least two chronic conditions, such as diabetes, prediabetes, BMI>30 or <18.5. Physicians enroll their patients into our Priority Care Program, which provides supplemental clinical and social services, and are aware that nutritional services are an option available to them. Both the physician and patient need to approve the nutrition consult before it is sent to me.
The patient’s chronic health conditions are the identifiers; these include diabetes, hypertension, obesity, pre-diabetes, hyperlipidemia, cancer, failure to thrive, irritable bowel syndrome (IBS) and food allergies.
After an initial telephonic consult – which is our longest session together – I typically meet with each patient one-on-one once a month. I have access to the patient’s records and Case Management notes, which ensures that everyone on the patient’s care team is on the same page. These notes also give me a good sense of what the patient’s current issues are, and helps the patient know we are approaching their care as a team. I can see a patient more often if they feel they need more support and accountability. The notes and patient education resources I enter in the chart give the case manager (CM) the opportunity to check in on the patient’s progress with their recommended meal plan, as well as their overall medical plan. The patient receives customized nutrition information either in the mail or via email based on their preferences. We have wonderful nutrition resources from overarching diet information based on disease state to recipes, customized meal plans, and individualized key points discussed. Patients usually get a combination of all of these based on their readiness and prior knowledge.
As my relationship with a patient grows and evolves, I can dive deeper into changes. Sometimes, we can only change one thing at a time. A mutually agreed upon goal might look like avoiding eating breakfast meat five out of seven days. We ensure that the patient is an active participant in the problem-solving progress, as ultimately it is up to them. Their goals should be achievable, so the patient feels empowered to move forward. Once they achieve one goal, we move on to the next one.
Handing a patient a sheet on a Low Sodium Diet is likely not going to be successful. But, when we are talking and the patient is in the kitchen and checks the label on their canned soups and sees 600 mg Sodium per serving... now that is impactful!
As our relationship grows, I can ask the patient how they changed their shopping habits and how that worked for them, and give them positive reinforcement for that. And, when they see their blood pressure go down, they see the direct cause and effect of lowering their Sodium intake.
Vytalize has recurring monthly meetings with our physician partners and practices, and our care management groups. Sometimes I’ll attend these meetings and relay any pertinent information, so they are kept up to date. Physicians also receive monthly care plan reports, which would include my progress notes on the patients I work with.
One cannot exist without the other – food is medicine. You can fight inflammation, which is thought to be the base cause of all chronic disease with your food choices. By having a diet rich in phytonutrients and antioxidants, you can fight disease at the cellular level. In other words, you can stop that cell from mutating from a healthy cell to a cancer cell that spreads.
Additionally, your body cannot repair itself or function correctly without the right foods. Foods that contain vitamins and minerals – as well as the macronutrients necessary to repair tissue, skin, and infections – are necessary on all fronts. If you are an athlete training for a marathon, which is an inflammatory process that food repairs, your muscles are breaking down and need to be built back up and repaired with needed protein, carbohydrates, and antioxidants.
The same could be said with the aging process. Adequate calories, protein and carbohydrates are necessary to keep the body going. With enough calories, but not enough protein, you will not be retaining muscle mass. Conversely, without enough calories, your body will break down its own protein (muscles). This becomes a problem because people lose muscle at a more rapid rate as they age. Nutrition partnered with weight-bearing exercise can help reverse that to some degree.
I often notice patients do not have the energy to bother with making food for themselves if they live alone, which leads to reliance on more processed foods, or tea and toast for supper. I also notice nutrient and protein-poor diets high in refined carbohydrates. Many of the patients I see also rely on takeout and fast foods because of convenience, which are often very high in sodium and fat content.
Additionally, when it comes to grocery shopping, I find that many patients aren’t paying attention to nutrition labels for sodium content. Elderly patients often do not want to be a bother to anyone else, so they try to make the easiest meals they can, which rarely provide nutrients needed to stay healthy – and often exacerbates their health conditions.
The last common theme I see is dehydration. If a patient has physical mobility issues, the last thing they want to do is get up and go to the restroom all the time. To avoid this, they minimize their fluid intake. However, this is detrimental on many fronts, leading to kidney issues, urinary tract infections, headaches, and lethargy.
Absolutely! The more active the patient is, the more likely it is that the patient will have healthier habits. Someone active will need more water and have a little more leniency with snacks. Someone with diabetes will need to be sure to have a meal an hour or so before exercise and carry snacks with them for possible low blood sugar reactions. Additionally, patients on hypertension medications often do not get their heart rate up to a working zone, so they need to know to pay attention to perceived exertion and not their heart rate. The more activity someone gets, the more calories someone burns – but the food consumed still needs to be nutrient-dense!
Physicians can ask their Case Manager to send a consult to the Vytalize Registered Dietitian. The patient referred must be enrolled in Priority Care for me to be able to see them. If the patient is in Home Care, I can partner with their Nurse Practitioner on any needed information.
To learn how Vytalize’s nutritional counseling can benefit your patients, contact us today!
