Cath Lab Digest

  “You can lead a horse to water but you can’t make him drink.” Or can you? In an ideal world, the registered dietitian (RD) dispenses nutrition advice to eager patients who listen attentively and then follow the instructions to the letter. In the real world, this usually does not occur. The typical patient has fears, food beliefs, logistical concerns, cultural and religious ideals, and many other individual factors that all play a role in lifelong eating habits. This makes giving “simple” nutrition advice much more complicated than it appears.
  Patients who do not follow recommendations are termed nonadherent. Although conveying the importance of adherence is relatively easy when the consequences are immediate (such as with an allergy that causes an anaphylactic reaction), adherence is much more difficult to achieve when the outcomes are 10 or 20 years down the road, as in diabetes. In other cases, such as patients with chronic wounds, it may be difficult to show how food and nutrition are connected to healing. In addition, patients may not believe that small changes such as a modest 5% weight loss can have any effect on their conditions. In order to deal with these issues, clinicians must understand the different causes of nonadherence, the stages of behavior change, and some techniques that can be used overcome resistance.


Causes of Dietary Nonadherence
  Researchers have explored three categories of variables that appear to be associated with nonadherence: demographic characteristics, psychological variables, and social variables. Demographic characteristics include educational level, financial considerations, and access to healthcare. Some patients may not have prior knowledge of proper nutrition and others might not have the financial resources to purchase more costly fresh fruits and vegetables and lean cuts of meats.
  Psychological variables include depression, anger, feelings of loss of control, denial, hostility, and embarrassment about being ill. A patient may feel that having an illness is his fault and that may put him on the defensive. Sometimes a patient may feel embarrassed about being overweight or allowing his blood sugar to get out of control. Quite often, a patient may feel that nothing is going to help and be too depressed to try yet another intervention or fail at another diet. In long-term care, residents often are depressed and feel they are at the end of life so why make the effort. Others may be very hostile and angry and attempt to exert control over the situation by challenging the advice given by the healthcare practitioner.
  The third category of nonadherence involves social variables. These include lack of a support system, isolation, poor family relationships, and poor relationships with healthcare providers. Isolation has been linked to decreased meal intake; if a patient lives alone with limited ability to shop, prepare meals, and socialize, meal consumption may suffer. In long-term care, residents may isolate themselves because of the assistance they require and refuse to go the dining room.