CMS Manual System - Louisiana Department of Health and Hospitals

calorie and nutrient intake. Since some research suggests that caloric intake may increase
if nutritional supplements are consumed between meals, and may be less effective when
given with meals, the use of nutritional supplements is generally recommended between
meals instead of with meals. 24 Taking a nutritional supplement during medication
administration may also increase caloric intake without reducing the resident‘s appetite at
mealtime.
Examples of interventions to improve food/fluid intake include:
Fortification of foods (e.g., adding protein, fat, and/or carbohydrate to foods such
as hot cereal, mashed potatoes, casseroles, and desserts);
Offering smaller, more frequent meals;
Providing between-meal snacks or nourishments; or
Increasing the portion sizes of a resident‘s favorite foods and meals; and
providing nutritional supplements.
Maintaining Fluid and Electrolyte Balance
If a resident has poor intake or abnormal laboratory values related to fluid/electrolyte
balance, the care plan addresses the potential for hydration deficits. 25 Examples of
interventions include adjusting or discontinuing medications that affect fluid balance or
appetite; offering a variety of fluids (water, fruit juice, milk, etc.) between meals, and
encouraging and assisting residents as appropriate. Serving (except to those with fluid
restrictions) additional beverages with meals will also help increase fluid intake.
Examples of ways to encourage fluid intake include maintaining filled water pitchers and
drinking cups easily accessible to residents (except those with fluid restrictions) and
offering alternate fluid sources such as popsicles, gelatin, and ice cream.
Use of Appetite Stimulants
To date, the evidence is limited about benefits from appetite stimulants. While their use
may be appropriate in specific circumstances, they are not a substitute for appropriate
investigation and management of potentially modifiable risk factors and underlying
causes of anorexia and weight loss. 26
Feeding Tubes
Feeding tubes have potential benefits and complications, depending on an individual‘s
underlying medical conditions and prognosis, and the causes of his or her anorexia or
weight loss. Possible feeding tube use, especially for residents with advanced dementia
or at the end-of-life, should be considered carefully. The resident‘s values and choices
regarding artificial nutrition should be identified and considered. The health care
practitioner should be involved in reviewing whether potentially modifiable causes of
anorexia, weight loss, and eating or swallowing abnormalities have been considered and
addressed, to the extent possible. For residents with dementia, studies have shown that
tube feeding does not extend life, prevent aspiration pneumonia, improve function or
limit suffering. 27