Practical training for geriatric nutritionists

The core value of practical training for geriatric nutritionists has never been to obtain a professional skills certificate and memorize a set of general dietary formulas marked with daily calories and grams of nutrients. It is to learn to find a practical plan that can not only meet the nutritional needs of different elderly people, but also make the elderly willing to eat and stick to it based on the individual differences, living habits, basic disease restrictions and even personality preferences of different elderly people. This is also the practical skill with the largest gap in the three types of domestic elderly care scenarios: home, community, and institution.

Don’t believe it, I met a community nutritionist who just took the exam a while ago. He prescribed a recipe according to the textbook to Aunt Zhang, who has been suffering from type 2 diabetes for 12 years. She was required to eat multigrain steamed buns, boiled eggs, and sugar-free soy milk in the morning. The results were followed up for 3 weeks. Aunt Zhang's fasting blood sugar was still high and low. After asking, I found out that Aunt Zhang had been eating brown sugar rice cakes for 40 years. She felt listless all day without taking a bite in the morning. She secretly replaced multigrain steamed buns with rice cakes, and ignored everything the nutritionist said. Later, we taught her to change the ingredients of the rice cake to 30% white rice + 70% miscellaneous bean flour, and replace the brown sugar with the same amount of xylitol. Only steam a palm-sized piece each time, and eat it with 150g of blanched spinach, which not only satisfied Aunt Zhang’s appetite, but also tested her blood sugar for 10 consecutive days, and the fluctuation range was more than half smaller than before.

At this point, I have to mention two schools that have been quarreling for several years in the field of nutrition training for the elderly. One school is the "indicator school" with clinical background. The plan relies entirely on the "Dietary Guidelines for Chinese Residents (Senior Edition)" and various chronic disease guide card values. How many grams of carbohydrates, salt should not exceed 5 grams, and oil should not exceed 25 grams. It is almost impossible. It is unprofessional to "open a back door" for the elderly.； The other group is the "care group" who has been on the front line of elderly care for a long time. They believe that the quality of life of the elderly, especially the elderly, disabled, and terminally ill, is a priority. There is no need for the elderly to change all their lifelong habits for a few indicators and eat whatever they want. Both sides have defensible evidence: the "indicators" have obtained public data and strictly follow the guidelines, the incidence of chronic disease complications can be reduced by 32%. ； “There are also real cases of "care-schoolers" who forcibly prevented an elderly person suffering from Alzheimer's disease from eating his favorite candied fruits, which actually made the elderly man irritable, his food intake plummeted, and he became severely malnourished.

Really reliable practical training never lets students choose one or the other, but teaches you how to find a balance in the middle. For example, when making a plan for an elderly person with terminal cancer, the indicators can be relaxed appropriately. First, ensure that he is willing to eat and can eat it, and then discuss the nutritional structure. ； For a young elderly person who has just been diagnosed with high blood pressure and is still in good physical condition, you can slowly help him adjust his eating habits instead of cutting off all his favorite foods at once. There are also many practical details that are not included in the textbooks: For example, when adjusting the consistency of food for elderly people with dysphagia, it is not just about "making it thicker", but it is necessary to compare it with the FOIS swallowing function grading. For levels 1-3, it should be like jelly, and for levels 4-5, it should be like yogurt, to avoid choking. ； When you meet an elderly person who looks fat but walks wobbly and has poor grip strength, you should first determine whether he or she has sarcopenia. Don’t tell them to eat less as soon as they come up. Instead, they should supplement more high-quality protein. ； When prescribing recipes for elderly people living alone, don’t make them freshly cooked three times a day. Instead, teach them how to pack chicken breasts and multi-grain rice and freeze them in the refrigerator. They only need to heat them for 3 minutes before eating. The difficulty of the operation will be reduced, and the execution rate will increase.

The biggest pitfall faced by many geriatric nutritionists in the market today is to use the nutritional system of ordinary adults by changing their age numbers, completely ignoring the special characteristics of the elderly. The most exaggerated thing I have ever encountered is that a training institution's textbook for students states that the recommended calories for a 70-year-old man are the same as those for a 30-year-old office worker. It does not take into account the problem of muscle loss and metabolic rate decline in the elderly. Based on this plan, the elderly are either malnourished or have excess calories. Other trainings are all theoretical, without even a real case of an elderly person. After the training, the trainees don’t even know how to communicate with the elderly. The first thing they say is, “You can’t eat this, you can’t eat that.” The elderly are annoyed and won’t cooperate at all.

I have been doing this for almost 7 years. Every time I start a class, I tell the students that you should first be the "chatting partner" of the elderly, and then be the nutritionist. You don’t even know whether he lives alone, whether his teeth are in good condition, whether he has a decades-old eating habit, or how often his children visit him. No matter how standard the recipe he prescribes, it is just a piece of useless paper. Last year, there was a doctor in the clinical nutrition department in our class. At first he looked down on what we said about "following the habits of the elderly" and thought it was not rigorous. Later, his grandmother had high blood pressure and insisted on eating dried radish pickled at home. He refused to eat it according to the textbook, and her grandmother made a fuss and refused to eat. Later, according to our teachings, Soak the dried radish three times in water, giving only 1 small strip at a time, and pair it with a large bowl of seaweed soup with high potassium content. It satisfied my grandma's taste. I measured my blood pressure for half a month, and it didn't rise at all. Later, he came back and gave us a banner, saying that what we learned before was too "floating", and this is something that can really be used.

Last month, we tracked the progress of 30 trainees who graduated last year. One trainee who was working in the community went back and started an "Old Taste Transformation Plan". He changed more than 100 favorite home-cooked dishes reported by the elderly in the community into versions that meet the requirements of chronic diseases. After half a year, the fasting blood sugar of the elderly in the community dropped by an average of 0.7mmol/L. There are also several elderly people who lost weight quickly, and their weight has increased by two or three pounds. To be honest, this is the most important meaning of practical training for geriatric nutritionists: not to pursue the perfection of indicators, but to really enable the elderly to eat comfortably, eat healthily, and live a good life.