Attempts should be made to meet nutrition needs with foods
first (such as adding additional protein and calories to favourite
foods). Only if this approach fails, or in the case of more severe
undernutrition, high-energy and/or high-protein oral nutritional
supplements (ONS), usually provided in liquid form, can be
considered, as a quick and generally well-tolerated way of improving
nutritional status. For older undernourished people ONS improve
energy and nutrient intake, maintain or improve nutritional status,
and reduce mortality. For older undernourished people with
dementia, evidence is less extensive and has yet to be synthesised
in a definitive review. However, it does appear that ONS is feasible,
and can improve nutrition, but there is no evidence that it improves
overall function or prolongs life. Tube feeding, usually in advanced
dementia, is much more controversial, and the benefits are not clearly
established; decisions are complex and difficult, and should be made
with regard to quality of life, prognosis, and patient preferences,
involving relatives, legal custodians, doctors and therapists, and,
sometimes, following legal advice.