BEST PRACTICES FOR NUTRITION, FOOD SERVICE, AND DINING IN LTC HOMES
2019
DIETITIANS OF CANADA
I
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• Fibre is added gradually to avoid flatulence, cramping and bloating, and distention. Increasing fibre is not advised
in a person who is immobile or bedbound, especially with limited fluid intake; this is to avoid impaction or
obstruction. Loose bran should be avoided as it absorbs too much liquid and could worsen constipation.
• Gradually increase fibre intake to 20–30 grams/day from fruits, vegetables, and legumes. Other food items include
flax flour, pea flour, and commercial or in-house high fibre products.
• Provide fibre supplements such as “power puddings”, “fruit spread” and fibre-dense commercial products. These
products have been used successfully to increase fibre intake in combination with a high fibre diet.
• Provide adequate fluids to manage constipation. An intake of 1500 mL fluid per day is normally cited as the
minimum amount of fluid required for normal physiological functioning of the body. Individual estimation of fluid
requirements is calculated for each resident.
• Fruits such as apples; pears; stone fruits, such as peaches, apricots and nectarines; and dried fruits, such as prunes,
dates and raisins contain sorbitol and may help manage constipation.
• Probiotics in the elderly may both shorten bowel transit time and soften stools, most likely by the increased short
chain fatty acid concentration.
Policy Development
Policies include:
• Bowel management as part of initial nutrition assessment and ongoing screening and /or assessments.
• Responsibilities of the Interdisciplinary Care Team in the management of constipation.
Nutrition Supplements and Food First Approach
• The concept of the Food First approach is to enhance quality of life for residents by normalizing their food and fluid
intake. This promotes the pleasure of providing foods and fluids over commercial nutritional supplements to meet
nutritional needs. This is often a first approach but requires evaluation on an individual basis.
• Residents receive protein and micronutrients and other food components (e.g. fibre, phytochemicals etc.) to
maintain or improve muscle mass and strength, as well as immune status, skin integrity, promote wound healing,
bone health, normalize blood pressure and achieve an appropriate weight. Nutrients are most potent when they
come from food, as they include many beneficial naturally occurring substances, such as carotenoids, flavonoids,
fibre, minerals, and antioxidants that are not in most supplements. There may be less need for medications for
constipation with a food first approach and possibly less waste of food/fluids and of oral nutritional supplements,
leading to better cost management.
• An adequate intake of all nutrients is important for the prevention of nutritional deficiencies and malnutrition. If
residents are not eating sufficient food provided at meals and regular snacks, then additional Calories, protein and
other nutrients are encouraged as required through individualized snacks, fortified food items and/or oral nutritional
supplements, according to residents’ health and nutritional status.
• Studies involving frail elderly have shown that adding flavor enhancers to food may improve intake, which may in
turn positively affect immune function. Flavour enhancement can include the addition of spices, herbs, salt or any