Dietician

Definition

Dietitians working with the elderly provide nutrition counseling education, and consulting services. They may participate in menu planning, supervision of food preparation, diet therapy, nutrition counseling, and nutrition education. By promoting healthy eating habits and recommending dietary modifications, they help to prevent and treat illnesses.

Description

A dietician specializing in nutrition for the elderly addresses the special dietary requirements of this population group. Among independent senior citizens, approximately 3% of men and 6% of women are underweight, while in nursing homes the percentages of persons underweight rise to 16% of the men and 15% of the women. Although wise food choices and a balanced diet are essential for older adults to maintain a healthy lifestyle and to promote longevity, there are various obstacles that prevent or limit seniors from practicing and benefiting from good eating habits. Such obstacles include:

• loneliness and isolation
• depression
• economic concerns
• lack of cooking skills or desire to cook
• inadequate nutritional knowledge
• reduced capacity to absorb and utilize nutrients
• oral/dental problems and difficulty in chewing
• loss of manual dexterity
• loss of appetite and diminished sensory abilities (both taste and smell)
• eating/nutrient complications due to the use of various medications

In addition, older adults need certain vitamins and nutrients to aid in the maintenance of their health.

Work settings

Dietitians may work as clinical dietitians in hospitals, nursing homes, or other health care facilities. They assess the nutritional needs of the patients, develop and implement nutrition programs, and evaluate the results of the nutrition programs. They may also be responsible for the food service department of a smaller health care facility, participating in menu planning and overseeing the preparation of food. Clinical dietitians may specialize in the management of the weight of overweight patients or in the care of patients with kidney disease, diabetes, or other illnesses.

Community dietitians, working in public health clinics, outpatient care centers, or with home health agencies or health maintenance organizations , teach individuals or at-risk groups of senior citizens about nutritional practices that prevent disease and promote health.

Management dietitians are responsible for large-scale meal planning and preparation in health care facilities, cafeterias, prisons, and schools. They hire, train, and oversee other dietitians and food service workers, prepare food budgets, and purchase food, equipment, and supplies, They also enforce sanitary and safety requirements, keep records, and prepare reports.

Consulting dietitians work in private practice or under contract with health care facilities. They counsel patients on diet-related concerns such as weight loss , diabetes control, and cholesterol reduction and cardiovascular health or may be involved in wellness programs for the elderly. They also perform nutrition screening for their patients.

Some dietitians may work in the offices of physicians or other health care providers. Most dietitians work a standard 40-hour week in the United States, although some may work weekends.

In 2006 there were 57,000 dietitians and nutritionists working in the United States. More than half worked in hospitals, nursing care facilities, outpatient care centers, or offices of physicians or other health care practitioners.

Salaries for dietitians vary by experience, education level, and by geographic region. In May 2006 the median salary for dietitians and nutritionists was $46,980 in the United States. According the American Dietetic Association, salaries for Registered Dietitians were:

• $53,800 working as consultants or for businesses
• $60,000 working in food and nutrition management
• $60,200 working in education and research
• $48,000 working in clinical nutrition and ambulatory care
• $50,000 working in clinical nutrition and long-term care
• $44,800 working in community nutrition
• $45,000 working in clinical nutrition and acute care

Care team role

A dietitian works with physicians and other health care professionals to evaluate and coordinate the medical and nutritional needs of patients.

Education/Training

Dietitians need at least a bachelor's degree in dietetics , foods and nutrition, food service systems management, or a related area. Some dietitians may receive graduate degrees in nutrition-related areas. As of 2007, there were 281 bachelor's degree programs and 22 master's degree programs approved by the Commission on Accreditation for Dietetics Education of the American Dietetic Association.

Forty-eight states and jurisdictions have laws governing dietetics. Thirty-five require licensure, twelve require certification, and one requires registration. In states requiring licensure, only licensed individuals can work as dietitians and nutritionists. States with statutory certification limit the use of occupational titles to people who meet requirements; individuals without certification can practice as a dietitian or nutritionist but cannot use certain titles.

Registration is the least restricted form of regulation unregistered persons are allowed to work as dietitians or nutritionists.

An individual may voluntarily become accredited as a Registered Dietitian through the Commission on Dietetic Registration of the American Dietetic Association. After completing academic coursework and a supervised internship, the dietitian must pass a comprehensive nationally-administered examination. To maintain status as a Registered Dietitian, the person must complete at least 75 hours in approved continuing education classes every five years.

KEY TERMS

Nutrition —The science of food, and the nutrients and other substances contained in food; their action,

interaction, and balance in relation to health and disease and the processes by which the person ingests, digests, absorbs, transports, utilizes and excretes food substances. There are six categories of nutrients that the body needs to acquire from food: protein, carbohydrates, fat, fibers, vitamins and minerals, and water.

There are two ways to complete the supervised internship required to become eligible to take the examination to become a Registered Dietitian:

• Completion of a coordinated bachelor's or master's degree program, combining classroom and practical experience, generally lasting four to five years, and accredited by the Commission on Dietetic Registration. As of 2007, there were 53 accredited programs combining academic and supervised practice.
• Completion of an accredited academic program leading to at least a bachelor's degree, followed by 900 hours of supervised practice in one of 265 accredited internships. These internships may be full-time programs lasting six to twelve months or part-time programs lasting two years.

The difference between a nutritionist and a dietitian is that there are no requirements for education or training to use the title of nutritionist. Therefore, persons considering consulting professionals concerning dietary needs should verify the professionals' qualifications. Registered Dietitian is a nationally recognized title for a nutrition expert, reflecting a high level of training and experience in the nutrition and health field.

Family teaching

Dietitians often work with patients and their families, assessing individual needs, developing nutritional care plans for specific conditions, and instructing individuals and their families in specific diets as well as good dietary practices. They may also provide instruction on grocery shopping and food preparation.

Resources

BOOKS

American Dietetic Association. Nutrition Diagnosis: A Critical Step in the Nutrition Care Process. Chicago, IL: American Dietetic Association, 2005.

Bales, Connie W., and Christine S. Ritchie, (eds). Handbook of Clinical Nutrition and Aging. Totowa, NJ: Humana Press, 2003.

Bernhardt, Nancy E., and Artur Kasko, (eds). Nutrition for the Middle Aged and Elderly. Hauppauge, NY Nova Science Publishers, 2008.

Brown, Judith E., Janet Isaacs, Nancy Wooldridge, Beate Krinke, and Maureen Murtaugh, Nutrition through the Life Cycle. Belmont, CA: Wadsworth Publishing, 2007.

Chernoff, Ronnie. Geriatric Nutrition, Third Edition: The Health Professional's Handbook Sudbury, MA: Jones and Bartlett Publishers, Inc., 2006.

Morley, John E., and David R. Thomas, (eds) Geriatric Nutrition (Nutrition and Disease Prevention). Boca Raton, FL: CRC Press, 2007.

ORGANIZATIONS

American Dietetic Association, Suite 2000, 120 South Riverside Plaza, Chicago, Illinois, 60606-6995, (800) 877–1600, [email protected], http://eatright.org.

International Confederation of Dietetic Organizations, http://www.internationaldietetics.org.

Judith L. Sims