Oral liquid nutritional supplements for people with dementia in residential aged care facilities: a systematic review

Executive summary This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). Dementia is an umbrella term for a large group of conditions that cause a progressive decline in a person's functioning. There are different forms of dementia and each has its own causes[1]. Residents with Alzheimer's disease and dementia are particularly vulnerable to malnutrition and weight loss[2] because of increased energy demands due to pacing or wandering; food refusal due to lack of appetite, agitation or memory loss[3]; or physical deterioration leading to inability to self‐feed, chew or swallow, though these symptoms are not unique to persons with dementia. Maintaining adequate nutrition for persons with dementia in residential care, in the context of these special needs, presents an increased challenge. A comprehensive search of relevant databases, hand searching and cross‐referencing found 15 relevant articles from a total of 2910 possible results. Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. Thus, this review was unable to produce a definitive finding regarding effectiveness. Main findings Prescription of OLNS OLNS are most frequently prescribed by physicians, but also on occasion by dieticians. Poor oral intake and weight loss are the most common reasons for OLNS prescription. Most studies do not specify which OLNS brands are prescribed. OLNS may be more effective when given with medications rather than with food. There is little investigation of the reasons for weight loss before OLNS are prescribed Administration of OLNS Families seem to prefer that RACF providers use other strategies to address poor intake before having OLNS prescribed OLNS are ordered daily, three times per day, or four times per day, though they are not always provided to the person with dementia as per the order. There is evidence to suggest that staff assistance is an important factor in residents' consumption of OLNS Medication rounds (medication pass routines) for giving OLNS may decrease wastage and increase consumption Studies that address administration timing of OLNS generally recommend between‐meals administration A significant amount of the administered OLNS is never actually consumed by the person with dementia Assistance should be given to physically impaired residents to aid OLNS intake Effectiveness of OLNS There is no evidence that OLNS has an effect on the morbidity and mortality of people with dementia in RACFs. There is no evidence that OLNS has an effect on the functional status of people with dementia in RACFs. There is very slight evidence to suggest that OLNS may increase the energy intake of people with dementia in RACFs. There is some evidence that OLNS may promote increases in the body weight of people with dementia in RACFs however further research is needed. There is some evidence to suggest OLNS may improve the nutritional status and anthropometry of people with dementia in RACFs. There is very slight evidence that OLNS may arrest declines in the cognitive status of people with dementia in RACFs. There is no evidence that OLNS has any effect on the bowel function of people with dementia in RACFs. Conclusion From this systematic review it is clear that further research is required into the prescription, administration and effectiveness of OLNS. No definitive evidence of effectiveness for OLNS was found. However, our findings suggest that if administered with care and assistance and prescribed after investigation of the reasons for weight loss and/or poor oral intake, OLNS may play a role in maintaining protein and energy intake. Consequently, it can be inferred that OLNS may contribute to the promotion of healthy and optimal functioning in persons with dementia who are living in residential aged care.