A prospective study of the use of liquid oral dietary supplements in nursing homes.

OBJECTIVE: To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight. DESIGN: A prospective, descriptive, anthropological study. SETTING: Two proprietary nursing homes with 105 and 138 beds. PARTICIPANTS: Purposive sampling was used to select 40 residents from among the 100 residents who were not eating well. Dietary data were collected on this sub-sample of 40 residents. MEASUREMENTS: Participant observation, in-depth interviews, event analysis, bedside dysphagia screenings, oral health examinations, body weight, body mass index (BMI), and chart review were used to collect data. Dietary data were collected over a 3-day period, and data were gathered on how supplements were ordered, served, and consumed. RESULTS: Supplements had been ordered for 29 of the subsample of 40 residents. Only nine of 29 residents were served the correct number and type of supplements as ordered by their physicians, and only two residents consumed the full amount of supplement as ordered. The overall mean percentage of supplement consumed compared with that ordered was 55.1%. Although supplements were ordered primarily to prevent weight loss and to facilitate weight gain, nearly half (n = 14) of the residents continued to lose weight. Supplements were ordered without investigating the underlying factors contributing to weight loss, such as inadequate staffing and lack of supervision at mealtime, undiagnosed dysphagia, and poor oral health. Without evaluation of these factors, it is unknown which residents might benefit from oral supplements. CONCLUSION: Findings indicate that supplements were used nonspecifically as an intervention for weight loss in nursing home residents without regard to dose, diagnosis and management of underlying problem(s), amount of supplement consumed, and outcome. Further research is needed to establish when supplements should be ordered, how to ensure that they will be taken, and whether they are effective.

Dysphagia among nursing home residents.

As part of a larger study that investigated the social, cultural, clinical, and environmental factors that influenced nutritional intake in two proprietary nursing homes, 82 of 100 residents who were not eating well received a bedside dysphagia screening evaluation by a speech pathologist. This article reports on the dysphagia evaluation results and the consequences of swallowing disorders for nursing home residents. Forty-five of the 82 residents (55%) had some degree of dysphagia, ranging from mild to profound, but only 10 of these 45 residents (22%) had been referred for a dysphagia evaluation. Unrecognized and unmanaged dysphagia may lead to dehydration, malnutrition, aspiration pneumonia, and asphyxiation. Assessment and management of dysphagia also are discussed.