What are some things a CNA can do to promote drinking and eating in a resident?

According to research, a significant portion of older adults may be chronically dehydrated or malnourished. Learning what are some things a CNA can do to promote drinking and eating in a resident is a critical skill for improving their overall well-being and preventing serious complications.

Quick Summary

CNAs can promote resident eating and drinking by creating a positive mealtime experience, offering preferred foods and fluids, providing adaptive tools, and ensuring residents are properly positioned and monitored for intake and swallowing difficulties.

Key Points

• Positive Mealtime Atmosphere: Create a calm, social, and pleasant environment by reducing noise and distractions.

• Frequent, Small Meals: Offer nutrient-dense snacks throughout the day, as large portions can be overwhelming for residents with a diminished appetite.

• Prioritize Hydration: Offer fluids frequently, especially water or hydrating snacks like popsicles, and ensure liquids are easily accessible.

• Use Adaptive Equipment: Provide specialized utensils, cups, and plate guards for residents with physical or cognitive limitations.

• Ensure Proper Positioning: Always feed residents in an upright position (45-90 degrees) to prevent choking and aspiration, especially those with dysphagia.

• Personalize Food Choices: Offer residents their favorite foods and choices to increase their willingness to eat and provide a sense of control.

• Monitor and Report: Accurately track food and fluid intake and report any significant changes, weight loss, or signs of dehydration to the supervising nurse.

Understanding the 'Why' Behind Poor Intake

Before a CNA can effectively promote drinking and eating, it's crucial to understand the underlying reasons why a resident might have a poor appetite or refuse fluids. These reasons are often complex and can involve a combination of physical, psychological, and environmental factors.

Physical and Medical Factors

• Difficulty Chewing or Swallowing (Dysphagia): Age-related changes or medical conditions like stroke, dementia, or Parkinson's can weaken the muscles used for swallowing. Without proper accommodations, this can lead to fear of choking and reduced intake.
• Medication Side Effects: Certain medications can cause dry mouth, nausea, or a metallic taste, which can significantly reduce a resident's appetite.
• Reduced Thirst and Appetite Sensation: As people age, their sense of thirst can diminish, leading to a higher risk of dehydration. Appetite also naturally decreases with age, and a larger portion of food can be overwhelming.
• Chronic Illness: Conditions that cause pain, fatigue, or discomfort can make eating a chore. Poor dental health or ill-fitting dentures can also make chewing difficult.

Psychological and Environmental Factors

• Loneliness and Social Isolation: Many residents eat alone, which can make mealtimes feel like a chore rather than a social event.
• Cognitive Impairment: Residents with dementia or other cognitive issues may become distracted, forget to eat, or have difficulty recognizing food.
• Loss of Control: In a long-term care setting, residents often lose control over many aspects of their lives. Refusing food can be one way for them to assert their independence.

Foundational Strategies for Successful Mealtimes

Creating a Positive Environment

A calm, pleasant, and social atmosphere can make mealtimes more appealing and less stressful for residents. CNAs can make a significant difference with a few simple actions.

• Reduce noise and distractions by turning off televisions or radios.
• Make mealtimes social by sitting with the resident, engaging in pleasant conversation, or encouraging them to join others in a common dining area.
• Respect a resident's pace. Never rush them, and allow plenty of time for chewing and swallowing.
• Ensure the resident is comfortable and properly positioned in an upright position (at least 45-90 degrees) to reduce the risk of choking and aid digestion.

Enhancing the Sensory Experience

• Visual Appeal: Use colorful dinnerware and ensure plates are not cluttered. Colorful foods are more visually stimulating and can encourage a resident to eat.
• Temperature: Check that food is served at the right temperature—not too hot or too cold. Explain what foods are on the tray to engage the resident.
• Personalization: Offer residents choices and ask about their food preferences. Serving favorite foods can greatly increase their willingness to eat.
• Oral Hygiene: Offer oral care before meals. A clean mouth enhances taste and can help stimulate appetite.

Techniques to Promote Eating

Adaptive Tools and Techniques

For residents with physical limitations, providing adaptive equipment can empower them to eat more independently.

• Offer specialized utensils with large handles, plate guards to prevent spills, and non-slip placemats.
• Cut food into bite-sized pieces or offer finger foods that don't require utensils, like sandwiches or cheese cubes.

Assistance and Monitoring

• Feed slowly, offering small bites and sips of liquid alternately. This prevents overwhelming the resident and helps with swallowing.
• Always check that the resident has swallowed before offering another bite.
• Record food and fluid intake accurately to monitor for any significant changes in eating patterns.

Key Interventions to Boost Hydration

Proper hydration is critical for overall health, preventing urinary tract infections, and maintaining cognitive function.

• Offer Fluids Frequently: Make it a habit to offer water or other liquids every time you enter a resident's room.
• Provide Hydrating Treats: Incorporate fluids in more appealing forms like popsicles, jello, ice cream, or fruit sorbet.
• Ensure Accessibility: Keep a water pitcher and cup within easy reach of the resident and ensure it's light enough for them to lift comfortably.
• Manage Thickened Liquids: For residents with swallowing difficulties, thicken all liquids according to the care plan to prevent aspiration. Always use the prescribed consistency.
• Make it a Team Effort: Coordinate with other staff members and family to create a consistent hydration schedule throughout the day.

Comparison of Strategies: Poor Appetite vs. Dysphagia

Strategy	Resident with Poor Appetite	Resident with Dysphagia (Difficulty Swallowing)
Portion Size	Small, frequent, and nutrient-dense portions.	Small, controlled bites to ensure proper chewing and swallowing.
Mealtime Environment	Social, pleasant, and engaging to stimulate interest.	Calm and focused to minimize distractions and prevent rushing.
Food Consistency	Wide variety of favorite foods, textures, and flavors.	Texture-modified foods (e.g., pureed, soft) and thickened liquids as prescribed.
Fluid Intake	Offer a variety of beverages like juice, milk, and smoothies frequently.	Stick strictly to prescribed thickened liquids and monitor closely.
Positioning	Sit upright in a comfortable chair or elevated bed.	Must be positioned at 90 degrees during meals and for at least 30 minutes afterward.
Key Action	Offer choices and engage socially.	Observe for signs of aspiration (coughing, wet voice) and report immediately.

Conclusion

Promoting adequate drinking and eating in a resident is a multi-faceted and essential part of a CNA's role. It requires patience, keen observation, and a person-centered approach. By focusing on creating a positive environment, offering choices, and adapting techniques to a resident's specific needs, CNAs can significantly improve a resident's nutritional status and overall quality of life. The consistent effort and attention to detail from the CNA are what truly make the difference, ensuring residents feel cared for and receive the nourishment they need to thrive.

For more information on standard practices and regulations for nursing assistants, visit the National Council of State Boards of Nursing (NCSBN).

Frequently Asked Questions

What are some of the first signs of dehydration in an elderly resident?

Early signs can include dry mouth, decreased urine output, dizziness, lethargy, and dark-colored urine. A CNA should report these observations to a nurse immediately.

How can a CNA help a resident with a poor appetite who refuses food?

Offer small, visually appealing portions of their favorite foods. Make mealtimes social by engaging in conversation. Offer nutrient-dense snacks between meals, as small amounts throughout the day can be less intimidating than a large meal.

What should a CNA do for a resident with dysphagia?

A CNA should follow the care plan for modified food textures and thickened liquids. Ensure the resident is positioned upright during and after eating, provide small bites and sips, and monitor for signs of aspiration like coughing or a wet voice.

How can CNAs make hydration more appealing to residents?

Vary the beverages offered by including juice, milk, and broth. Serve hydrating snacks like popsicles or gelatin. Some facilities use a 'hydration cart' or have non-alcoholic 'happy hour' events to make drinking more fun and social.

Is it okay to feed a resident while they are lying in bed?

No, a resident should be in an upright position of at least 45 to 90 degrees while eating to prevent choking and aspiration. This position should be maintained for at least 30 minutes after the meal.

What role does oral hygiene play in promoting eating?

Good oral hygiene is crucial. A clean mouth enhances the resident's sense of taste and can stimulate appetite. Offering oral care before meals is a simple but effective strategy.

How can a CNA empower a resident to eat more independently?

Encourage the resident to do as much as they can for themselves. Offer adaptive utensils, open containers, and place food within easy reach. Respecting their autonomy helps boost morale and engagement.