As long-term care clinicians, we manage a complex interplay of chronic disease, cognitive decline, and frailty. But one factor consistently tied to outcomes—and often underemphasized—is nutrition. For many of our residents, poor nutrition isn't just a consequence of illness; it’s a cause of functional decline, infections, and hospitalization.

Malnutrition remains widespread in long-term care (LTC), affecting up to 60% of residents. Drivers include anorexia of aging, cognitive impairment, medication side effects, and swallowing difficulties. When we neglect nutrition, we accelerate sarcopenia, reduce immune resilience, and compromise healing. Current guidance from ESPEN supports protein intakes of 1.0–1.2 g/kg/day, and higher for those with illness, wound healing or rehabilitation needs. Since oral intake is often inadequate, physicians should proactively support protein supplementation and encourage dietary to incorporate high-protein fortification strategies.

Vitamin D is another concern. Sunlight exposure is minimal for most LTC residents, and dietary sources fall short. Daily supplementation of 800 to 1,000 IU is typically needed to maintain serum 25(OH)D levels of at least 30 ng/mL, per the Endocrine Society and American Geriatrics Society (AGS). This supports bone density, neuromuscular health, and fall prevention—key outcomes in this population.

Diabetes care, too, requires a shift in mindset. Tight glycemic control is not appropriate for many older adults. Choosing Wisely and AGS recommend A1C targets of 7.5–8.5% for most residents, depending on comorbidity and cognitive status. We should work closely with dietary to provide consistent, nutrient-dense meals without overly restrictive regimens, especially when intake is poor.

Residents with dementia present additional challenges. As feeding abilities decline, we must shift from control to comfort. Nutritional strategies include offering finger foods, reducing mealtime distractions, using visual cues, and transitioning to modified-texture diets when needed. In advanced stages, the focus should be on preserving dignity and pleasure in eating.

So, how can clinicians lead this effort?

Physicians play a critical role in setting expectations and priorities for nutrition. We can:

• Clearly document nutrition-related diagnoses (e.g., malnutrition, sarcopenia, vitamin D deficiency) to justify interventions.

• Collaborate directly with dietitians on individualized care plans, ensuring medical conditions and goals of care are reflected in dietary choices.

• Educate nursing staff on clinical warning signs—such as poor intake, weight loss, or dehydration—and set thresholds for when to notify the medical team.

• Encourage regular interdisciplinary huddles where nutrition is discussed, not as an afterthought, but as a core topic alongside medications and vitals.

• Reinforce liberalization of diets when appropriate, particularly in residents with dementia or at end of life, aligning nutrition with comfort and quality of life.

Hydration must also remain top of mind. Many residents don’t request fluids due to impaired thirst or cognition. Nursing teams should be supported in offering fluids regularly, documenting intake, and tailoring strategies to individual habits and preferences.

Nutrition is not ancillary—it is therapeutic. If we treat it as central to clinical care, we can meaningfully improve outcomes, reduce complications, and enhance daily life for our residents.