Retirement Essentials Toolkit

Nourished Aging Toolkit

for Special Diets

Message From Sysco’s Nutrition Services Team

Older adults living within senior living may require special diets, food and fluid modifications, and/or specific nutrient requirements to help support healthy aging.

This resource will provide suggestions for menu development in retirement living and feature topics such as:

Canada's Food Guide and Menu Planning in Retirement Living

Essential Vitamins and Minerals for Healthy Aging

Common Diet Types, Diet Textures, and Fluid Consistencies Top 10 Food Allergens

Also included are product listings, recipes, and food lists. Please reach out to your Sysco Sales Representative for more information.

Note: The information provided within this toolkit are suggestions and should be implemented in consultation with a Registered Dietitian or Nutrition Manager and in accordance with your home specific policies

- Sysco Canada’s Nutrition Services Team

Eating Well with Canada’s Food Guide (CFG)

In 2019, Health Canada released an updated version of CFG for Canadians to use as a tool to help make healthy food choices. Healthy Eating recommendations include:

• Focusing on the proportions of food to build a healthy plate (i.e., ¼ whole grains, ¼ protein foods, ½ fruits vegetables)2

• Eating plenty vegetables and fruits, whole grains, and protein foods (choose plant-based protein more often)

• Limiting highly processed foods

• Using food labels and being more aware of marketing messages on packaged foods

• Promoting water as the drink of choice with other options such as low-fat milk, unsweetened fortified milk alternatives, and unsweetened tea and coffee2

Food Behaviours

CFG also recommendations for food behaviours including:

• Being more mindful of your eating habits

• Cooking more often

• Enjoying your food

• Eating meals with others

CFG and Menu Planning

The Menu Planning in Long Term Care Guidelines (2020) incorporates key principals of CFG to meet residents’ overall nutritional requirements in LTC. There are menu considerations that can be applied to a retirement menu. These include:

• Offering a variety of desserts daily including nutrient rich desserts3

• Including plant-based protein entrees at least twice per week or based on documented preferences of resident population3

• Ensuring that a minimum of 2000 ml beverages per day (both nutrient-containing and nonnutritive) at and between meals3

• Providing a variety of dairy and non-dairy calcium-fortified plant-based alternatives in adequate servings to meet calcium requirements3

• Including a variety of fruit in various forms (fresh, frozen, canned) 3

• Primarily choosing whole grain foods unless changed based on documented preferences of the resident population3

• Considering the cultures/ethnicities of the resident population and including appropriate cultural foods on the menu3

• Choose nutrient-dense foods that are easily consumed, taking into consideration common eating related barriers (e.g., poor oral health, low appetite, early satiety, fatigue, taste and sensory changes) 3

Essential Vitamins and Minerals for Healthy Aging

Vitamin B6

Vitamin B12

Vitamin D

Calcium

• Maintain a healthy immune system

• Needs increase after the age of 50

• Maintain nerve function

• Up to 30% of older adults above the age of 50 have difficulties absorbing B12 due to poor diet or decrease in stomach acid

• Help body absorb calcium to maintain healthy bones and teeth

• Maintain function of muscles, nerves, and immune system

• Help maintain strong bones

• Potatoes, beans, meat, chicken, fish, bananas

• Meat, fish, poultry, eggs, dairy products

Male >70 years: 1.7 mg

Female >70 years: 1.5 mg

Male and Female >70 years: 2.4 mcg

Iron

• Used to create blood cells that carry oxygen throughout the body

• Required for growth, development, and formation of hormones

• Milk, eggs fish, fortified beverages

Male and Female 51-70 years: 600 IU

Male and Female >70 years: 800 IU

• Dairy products, fortified beverages, almonds

• Meat, fish, poultry, eggs, whole grain breads and cereals

Male 51-70 years: 1000 mg

Females 51-70 years: 1200 mg

Male and Female >70 years: 1200 mg

Male and Female >70 years: 8 mg

**Please note that following CFG can help you meet your nutrient requirements, however, you may require multivitamin if your intake is low or your food choices are not nutrient dense. Please ensure that you are assessed by a registered dietitian and medical team to confirm that you receive appropriate dietary interventions based on your needs

Diet Type Definitions

The Diet Definitions are designed to guide menu planning. Each Diet Type typically has nutritional parameters set to aid in meeting general nutrition recommendations for people assigned to that diet type. Individual nutritional requirements should always be considered, and personalized nutrition interventions should be implemented in addition to the standard diet type, as necessary.

Nutritional Interventions

Unable to tolerate lactose

Diet Type

Lactose Restricted, Lactose Intolerant

Diet Definition Notes

• For people who have a reduced tolerance with digesting lactose.

• Lactose sensitivity will vary from person to person; therefore, this diet should be individualized

• Lactose-containing ingredients in recipes and prepared foods are minimized but may not be fully eliminated in healthcare settings.

• Includes low lactose options: Reduced-lactose milk, aged cheeses, cream cheese, cottage cheese and non-dairy creamers or whipped toppings.

• Includes lactose-free options: Lactose-free or plant-based milk beverages or dairy options (cheese, sour cream, yogurt) such as, almond, oat, rice, coconut, soy, etc.

Unable to tolerate gluten

Gluten Restricted, Celiac Disease

Vegetarian Lacto-Ovo, Pescatarian, Lacto vegetarian

• For people with gluten sensitivity, gluten intolerance or a personal preference to reduce gluten.

• Restricts foods and beverages containing key sources of gluten, such as wheat, rye, and barley.

• Healthcare settings typically implement gluten restricted rather than a gluten free diet.

• Lacto-Ovo vegetarian diet allows plant-based foods, dairy products, and eggs. It excludes meat, poultry, fish, seafood, and their derivatives

• Pescatarians are vegetarians who also include fish, dairy and seafood in their diet

• Lacto vegetarians allow dairy products but exclude meats, poultry, fish, and eggs

Vegan

• Vegan diet avoids all animal products including meat, milk, dairy products, eggs, honey, and gelatin

• Restricts key sources of gluten including wheat, rye and barley

• Includes naturally found glutenfree options like corn. flax, buckwheat, quinoa, rice, tapioca or commercially prepared gluten-free substitutions.

• Include more fruits, vegetables, legumes, nuts, seeds, whole grains, calcium/vitamin D fortified foods and beverages

• Meal Suggestions: Vegetarian Chicken Casserole, Tofu and Vegetable Stir-fry, Chili, Cheese and Vegetable Frittata, Vegetable Quiche, Falafel, Aloo Matar Curry, Vegetable Lasagna, Vegetarian Meatballs or Sausages, Vegetarian Pot Pie or Shepards Pie, Vegetarian Omelette, Vegetable Stews, Salad bowl

• Only consumes fruits, vegetables, whole grains, and protein alternatives (i.e. Tofu, vegan burgers, vegan patties, vegan meat crumbles, vegan sausages, etc.)

• Customized menus may be required for Vegans or those who have more food restrictions

• Meal suggestions: Butternut Squash Curry with Cashew and Chickpeas, Cauliflower Curry, Tofu Scramble, Spaghetti Marinara, Vegan Pad Thai

*Always consult with your Registered Dietitian, Speech Language Pathologist, or Primary Care Professional before changing or modifying a person’s diet texture or fluid consistency to reduce the risk of complications

Diet Type Definitions Cont'd

Nutritional Intervention Diet Type Diet Definition Notes

Sodium, Potassium, and Phosphorus restriction

Reduce consumption of added sugars and/or fats

Kidney Diet, Renal Diet

Reduce consumption of sodium and fat

Diabetes Management

• This diet is considered a liberal renal diet for individuals receiving dialysis. Energy, fat, and protein requirements are similar to the regular diet. High phosphorus, sodium and potassium foods are restricted and substituted as needed.

• This diet is for people with diabetes. Carbohydrates are modified by limiting items high in added sugar and utilizing reduced calorie items as necessary (ex. diet jam, sugar substitute, low calorie drinks). In addition, smaller portions of foods high in added sugar may be provided.

Refer to Appendix for food list for renal friendly food options

Heart Healthy

Weight Management High calorie/protein diet

• This diet modifies the fat and sodium content in the diet by providing substitutions or removal of high fat and sodium foods.

Refer to Nourished Aging Toolkit: Diabetes Management for more information to manage high and low blood sugars

Reducing

• This Diet aims to provide at least 120% of the Recommended Dietary Allowances for energy and protein for individuals with increased caloric and protein needs.

• Calories and protein are modified by adjusting portion sizes, using fortified recipes, and utilizing nutrient dense food sources.

• This diet is for people who require a reduced portion size for weight management or for individuals who have requested smaller portions

• It follows the regular diet guidelines but portions are reduced and/or substitutions are provided when needed to meet the reducing diet’s parameters

• Limit intake of concentrated sugars by using lower calorie beverages, jams, syrups, and desserts

• Limit consumption of gravies and sauces/condiments, added fats (i.e. butter, margarine, cream, etc.), and high fat foods (cookies, fish and chips, etc.)

• Consume more low sodium soups (i.e. use low sodium broth for the soup base)

• Increase fibre intake (i.e whole grains, fruits & vegetables, etc.)

Refer to Malnutrition in older Adults: Optimizing Food & Fluid Intake toolkit for more information

Examples of weight management strategies:

• ½ portions of desserts and sweets

• Reduced o low calorie beverages

• Encouraging fruits for snack instead of cookies

*Always consult with your Registered Dietitian, Speech Language Pathologist, or Primary Care Professional before changing or modifying a person’s diet texture or fluid consistency to reduce the risk of complications

Diet Textures

Food texture modification is often required for individuals who develop chewing and/or swallowing difficulties as a result of an incident, disease process, or natural aging. Tolerance to texture is very individualized and therefore, it is likely that some generally accepted practices may not be acceptable or appropriate for every individual.

Diet Texture Definition

• Normal, everyday food of various textures that are developmentally and age appropriate.

• Food may be of a range of sizes.

• Any method may be used to eat these foods.

Regular

Soft/Diced

Minced

Minced Meat

Pureed

Finger Foods

• Foods that are hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or have crumbly bits are allowed. Foods may include pips, seeds, pith inside skin, husks, or bones. Foods including “dual consistency" or “mixed consistency” are allowed.

• Foods that are easy to chew

• Designed primarily for people with poor dentition; however, it may be used for people with other physical conditions.

• Mixed consistencies, for example, cereal and milk or soup with grains are tolerated on this texture

• Foods may be naturally soft, cooked, or cut into small pieces. Bread products may contain small amounts of nuts, seeds, or dried fruit.

• Foods that are moist, soft, and require little or no chewing.

• Gravy or sauce is mixed with minced meats to easily be formed into a bolus

• Foods are soft, easy to swallow and must be easily mashed with a fork

• Mixed consistencies are tolerated on this texture

• Bread products without nuts or seeds are served without modification. Coarse textures and nuts are avoided

• Provides meats that may be minced, ground, or mashed in a moist form that require little or no chewing

• No other foods are modified or restricted in this texture

• Foods that have no lumps, are not sticky and have no separate thin liquids.

• Chewing is not required

• Foods are usually eaten with a spoon (a fork if possible)

• Foods cannot be drunk from a cup or sucked through a straw

• Foods will fall off a spoon in a single spoonful when tilted and continues to hold shape on a plate

• Foods can be piped, layered, or molded on a plate.

• Foods in forms that are conducive to self-feeding without utensils

• Goal is to maintain nutritional status and to foster independent feeding for individuals who have limited use of eating utensils or may refuse to use adaptive equipment

• Foods are easy to pick up with the fingers

• Fruits and vegetables are served drained or replaced with a fresh cut up version

• Meats are bite size and gravy, or sauce is served on the side for dipping

*Always consult with your Registered Dietitian, Speech Language Pathologist, or Primary Care Professional before changing or modifying a person’s diet texture or fluid consistency to reduce the risk of complications

Fluid Consistency

Fluid consistency modification is required for individuals who are at risk for aspiration on thin liquids. Foods and beverages which are considered thin liquids at room temperature (water, milk, gelatin, ice cream) need to be thickened to the appropriate viscosity before service or substituted with an appropriate alternative.

There is a wide variety of thickeners on the market, and each type possesses unique properties in terms of thickening ability. Several factors can influence the outcome of a thickened liquid such as fluid type, temperature, concentration, acidity, mixing time and method, and holding time of the food or liquid being thickened.

Diet Texture

Regular/Thin Fluids

Definition

• The Regular/Thin Liquid Fluid Type is for individuals without any fluid consistency limitations

• Fluids should flow quickly like water and should be easily consumed through any type of straw, cup, or nipple as appropriate for skill level and age

Slightly Thick

Nectar Thick Fluids/Mildly Thick

Honey Thick Fluids/Moderately Thick

Pudding Thick

Fluids/Extremely Thick

Fluid Restrictions

• This fluid type is characterized as thicker than water and will require a little more effort to drink than thin liquids

• Slightly Thick fluids will flow through a straw, syringe, teat/nipple. Note: This fluid consistency is not managed at Sysco Synergy Tech Suite® Database

• The Nectar Thick/Mildly Thick Fluid Type is a liquid that flows quickly off a spoon and is able to sipped from a cup

• It requires effort to drink this thickness through standard bore straws (standard bore straw = 0.209 inch or 5.3 mm diameter)

• Cannot be piped, layered or molded on a plate or eaten with a fork

• The Honey Thick/Moderately Thick Fluid Type is a liquid that can be drunk from a cup, eaten with a spoon and requires some effort to suck through a standard or wide bore straw (wide bore straw = 0.275 inch or 6.9 mm)

• This thickness is smooth in texture with no ‘bits’ (lumps, fibers, bits of shell or skin, husk, particles of gristle or bone)

• Cannot be piped, layered, or molded on a plate or eaten with a fork

• The Pudding Thick/Extremely Thick Fluid Type is a liquid that needs to be consumed with a spoon and is too thick to drink or sip through a straw

• This thickness is not sticky, has no lumps and liquid must not separate from solids

• This thickness will fall off a spoon in a single spoonful when tilted and continues to hold shape on a plate

• It can be piped, layered or molded on a plate.

• Fluid Substitutes Grid for Fluid Restrictions is not managed within the Sysco Synergy Tech Suite Database, because this is considered a completely person-centered action

• It is best practice to modify the people profile according to a person’s individual preferences to carry out fluid restriction orders.

**NOTE: Thicken liquids using thickener according to the product's preparation instructions. The amount of thickener needed may vary depending on type of liquid, portion size and thickening product. Liquids will thicken differently depending on type, concentration, mixing method, and temperature**

Be allergy aware! Learn about the priority allergens and their potential food sources to prevent reactions. If an individual experiences food allergy symptoms, such as hives, itching, shortness of breath, throat tightness, nasal congestion, and trouble swallowing, call 911 immediately . Health Canada has identi ed the following foods as priority food allergens.

1 EGGS

Potential Food Sources

• Baked foods and baking mixes

• Battered or fried foods

• Cream- lled desserts (e.g. meringues)

• Confectionary like candy and chocolate

• Creamy dressings, spreads, mayonnaise and sauces (e.g. hollandaise)

Other Names for Eggs

• Albumin/Albumen

• Conalbumin

• Eggnog

• Globulin

2 MILK

Potential Food Sources

• Butter, buttermilk and ghee

• Cheese, curds

• Cream, ice cream

• Ke r

• Kumiss

Other Names for Milk

• Beta-lacktoglobulin

• Casein, caseinate, and rennet casein

• Delactosed or demineralized whey

3 MUSTARD

Potential Food Sources

Condiments and sauces

Salad dressings

Spices, avouring or seasoning

Curries and chutneys

Pickled products

Processed meats

Other Names for Mustard

• Mustard seeds – white, yellow and brown

• Mustard powder

• Prepared mustard

4 PEANUTS

Potential Food Sources

• Peanut butter, our, meal, oil and sauce, crushed peanut as topping, etc.)

Other Names for Peanut

Arachis oil Beer nuts and goober nuts

Ground nuts

• Meat products with llers (e.g. meatballs) and imitation meats

• Quiches and sou és

• Pasta (e.g. egg noodle)

• Livetin

• Lysozyme

• Ovo (means egg), e.g., ovalbumin Vitellin

6 SESAME SEEDS

Potential Food Sources

Breads, cereals, snack bars, and crackers

• Dips and spreads, like hummus Sesame oil and salt

• Sour cream

• Yogurt

• Infant baby cereals and formula

• Baked foods, cereals, chocolate, cookies and crackers

• Hydrolyzed casein and hydrolyzed milk protein

Tahini

Tempeh

Vegetarian burgers

Other Names for Sesame Seeds

• Benne, benne seed, benniseed Gingelly, gingelly oil Seeds

Sesamol, sesamolina

7 SOY

Potential Food Sources

• Bean sprouts

• Bread crumbs, cereals and crackers

• Imitation dairy food

• Hydrolyzed plant or soy protein

Other Names for Soy

Sesamum indicum

Sim sim

Tahini, tahina Til

• Lactalbumin and lactalbumin phosphate

• Lactoferrin and lactoglobulin

• Whey and whey protein concentrate

Seeds or plants in the Brassicaceae family (e.g. broccoli)

Canola meal or protein

Cold-pressed canola/rapeseed oil

• Almond and hazelnut pasta, nougat

• Baked goods and snack foods (e.g. trail mix)

Kernels

Nut meats

Valencias

5 FISH, CRUSTACEANS & MOLLUSCS (SEAFOOD & SHELLFISH)

Potential Food Sources

• Asian dishes (e.g. fried rice, spring rolls and sushi)

• Fish based sauces (e.g. oyster sauce and marinara)

• Combination foods (e.g. paella and seafood stew)

• Combination foods (e.g. fried rice, paella and spring rolls)

• Gelatin, marshmallows

• Sushi, surimi, kamaboko

• Garnishes, salad dressing, sauces and spreads

Other Names for Crustaceans and Molluscs (Seafood & Shell sh) Eel

• Crustaceans: Crab, cray sh, lobster, prawns, shrimp

• Molluscs: Abalone, clam, cockle, conch, limpets, mussels, octopus, oysters, periwinkle, quahaugs, scallops, land and sea snails (escargot), squid (calamari), whelks, geoducks

• Anchovy

• Basa

• Bass

• Cod

• Bean curd (dofu, kori-dofu, soybean curds, tofu)

• Edamame

• Kinako

8 TREE NUTS

Potential Food Sources

• Baked foods, granola bar, snacks

• Vegetarian dishes and Asian dishes

• Mortadella

• Pralines

Other Names for Tree Nuts

• Almonds

• Brazil nuts

• Cashews (or Anacardium nuts)

• Hazelnuts (or Filberts)

SULPHITES

Potential Food Sources

• Alcoholic and non-alcoholic wine, beer and cider

• Bottled lemon and lime juices and concentrates

• Condiments, vinegar and wine vinegar

• Cereal, cornmeal, cornstarch, crackers & muesli

• Dried, canned and frozen fruits and vegetables (including tomato)

• Soy beverages

• Soybean paste

• Soy sauce

• Tempeh, miso and tofu

• Infant formula and meal replacements

• Natto

• Nimame

• Okara

• Soya, soja, soybean and soyabeans

• Yuba

• Tree nut oils

• Cocoa-based and/or nut-based spreads and paste

• Macadamia nuts (or Queensland nuts)

• Pecan

• Pine nuts

• Pistachio nuts

• Walnuts

• Dried herbs, spices and teas

• Fruit and vegetables juices

Fresh grapes

Fruit llings and syrups, jams, jellies and other preserves

Dehydrated, mashed, peeled and pre-cut potatoes

• Sugar syrups and glaze

Tomato pastes, pulps and purees

Other Names for Sulphites

Food labels in Canada will only use the word “sulphites”

• However, if you have sylphite sensitivity, please also avoid: E 220, E 221, E 222, E 223, E 224, E 225, E 226, E 227, E 228 (European names for the di erent types of sulphites)

10 WHEAT & TRITICALE

Potential Food Sources thickener (e.g. gravy, salad dressing, soy sauce) Gravy mixes,

Breads and baked goods Flour, gluten, baking mixes & powder Batter-fried foods Beer, cereal-based co ee substitutes, and instant cocoa

Other Names for Triticale

Haddock mahi-mahi Pollock

Tilapia

Tuna Trout White sh, etc.

Atta Bulgur Couscous Durum Einkorn

• Emmer

• Farina

Hydrolyzed plant protein

Imitation bacon Snack foods (e.g. pretzels, granola, candy) Sauces, pie llings, pudding, and seasonings

• Fu Graham, high-gluten and high-protein our Kamut

Seitan Semolina Spelt (dinkel, farro)

Recipe Ideation

Looking for new recipes to feature on your menus?

Check out our quarterly installments of Nourishing Kitchen!

Get inspired with recipes like Green Curry Basa, Salmon Breakfast Frittata, Chia Tea Pudding and much more!

Speak with your Sysco Representative today to learn more about our complimentary Nourishing Kitchen resource.

Additional Resources

Looking for more reliable information on the topics discussed in this toolkit?

Check the resources below:

Canada's Food Guide

Canadian Society of Nutrition Management

Celiac Canada

Diabetes Canada

Dietitians of Canada

FODMAP Diet – Monash University

Health Canada

Heart and Stroke Foundation

IDDSI

Kidney Foundation

Ontario Seniors Nutrition & Advocacy Committee (OSNAC) & Food & Nutrition Advisory Team (FNAT)

Research Institute for Aging Seasons Care

RENAL MENU RESOURCE

Ham

Scrambled Egg

Bacon Hard Boiled Egg

Breakfast Sausage & Sausage Patty Fried Egg

Yogurt Poached Egg

Cheese Plain Omelette

Oatmeal Cream of Wheat

All Bran Special K

Bran Flakes Rice Krispies

Raisin Bran Corn Flakes

Soup Cream-based/Tomato Soups Low Sodium Broth/Broth-based Soups*

Corned Beef

Hot Dog or Sausage

Roast/Baked Beef

Roast/Baked Pork

Liver Roast/Baked Chicken

Breaded protein

Deli Meat (Ham, Pastrami, Bologne, etc)

Peameal Bacon

Roast/Baked Turkey

Roast/Baked Veal

Roast/Baked Lamb

Dairy based (Cheese or Yogurt) Egg based (omelette, frittata, strata, quiche) * Seafood (baked fish, shrimp, crab)

Tomatoes Broccoli

Peas (served alone)

Mushrooms

Bok Choy Corn

Beets

Zucchini Squash

Acorn/Butternut Squash Carrots

Brussel Sprouts Green & Wax Beans

Spinach

Parsnips

Lima Beans

Peppers

Cauliflower

Turnips

Sweet Potato Cabbage

Cucumber

Cooked Kale

Onions

Sugar Snap Peas

Potatoes Sub Double Boiled Potato or Potato f/Pearls

Whole Wheat Bread White Bread

Whole Wheat Pasta/Noodles Plain Pasta/Noodles

Brown Rice Rice

Raisin Bread Barley

Croissant Couscous Tea Biscuit

Pudding/Mousse/Custard Gelatin

Bread Pudding Cakes (white, fruit, vanilla)

Cream Pies

Fruit Pies (apple, blueberry, strawberry, cherry, pecan)

Ice Cream/Sherbet Sorbet

Cheesecake Bars*

Chocolate Desserts Bakes/Crisps*

Apricot Apple

Banana Berries (strawberry, blueberry, raspberry)

Cantaloupe

Orange

Honeydew

Pears

Peaches

Pineapples

Prunes Watermelon

Cherries

Raisins

Guava Mango

Kiwi

Papaya

Passion Fruit

Fruit Cocktail

Grapes

Plums

Rhubarb

Mandarin Oranges

*Please review recipe ingredients to ensure "foods to limit" are not used.

Note: The information provided within this resource are suggestions and should be implemented in consultation with a Registered Dietitian & Medical Team in accordance with your home specific policies​.

The Essential Guide for Renal Dietitians. (2020). Canadian Association of Nephrology Dietitians.