This is great advice about shakes being supplements to meals and not meals themselves. I tell it to my mother EVERYDAY and her doctors tell her and her phys therapist tells her. But unfortunately, many times caregivers are dealing with stubborness in addition to all the phys and other problems and the only way to get them to get any calories is with these shakes. My mother's "logic" is that the shakes have a lot of calories (She is a rail so why should she even count?). What's that old saying you can bring a horse to water but you can't make him drink. Well, it may not be the best meal 'replacement; but it's all I got and it's better than nothing and since she's not going to listen to me, her doctors or her phys therapists (all of whom she loves by the way so you think she MIGHT want to listen- then I think it's pretty much out of my hands and into God's.
As with everything, this is so individual. Ensure is poison, in my opinion. Nasty, vile stuff. I use a superior quality undenatured whey protein drink. One time I gave a glass to a lady who was slumping in her seat looking like death warmed over. She suddenly sat up, eyes opened wide, and said "What IS that??" So; not all nutrition drinks are created equal!
I don't put anything into my body without knowing what it's made of first. That's why the shakes I make when I'm too exhausted to chew are as natural as can be: whole milk, a dollop of plain peanut butter, a banana, a couple scoops of ice cream, maybe some flaxseed oil.
I rarely eat out, and steer clear of fast-food joints and edibles whose labels I can't pronounce. Ensure, Boost, and some nutritional drinks might be okay for anorexics or people who've undergone a dramatic weight loss, but there's no substitute for chewing real, healthy food.
So yes, I urge everyone in this forum to exercise caution when administering nutritional drinks and/or shakes to the elderly under their care and supervision. When in doubt, consult a dietitian/nutritionist.
But if they don't want to eat at all sometimes Ensure or equivelant is the only thing I can think of right now that my mom will take. She really is winding down....
Tip: if the care receiver is on warfrin/Coumadin be careful about increasing the veggies; they can alter how much of the med is needed. Increase slowly and tell the health care professional who is monitoring the Coumadin levels.
My dad has alz and parkinsons so when my dad refused to get up and eat we used ensure to get food into him to get him back out of bed. We only give him an ensure when he absolutely refuses food. If he won't get out of bed in the morning and has missed breakfast we give him an ensure just to get him up and moving. Once he's up he wants to eat all day, his meal and everyone elses in the home. Dad walks around and is up and down all day including during meals. He doesn't have to have one often right now but it helps when needed. I agree though it can't be a complete meal replacement it's not enough calories.
Ah, we learn so much through our experiences... if any of this below sounds familiar please ask the Doctor for real solutions (and find a new doctor if you don't get a good response) to help your loved one have good quality of life!
My 87 yr old Mom with home care too was dealing with gradual weight loss and blood tests showed very low protein and iron count although her appetite always seemed very good to her and to us (the family). We just kept trying to get her to eat more and used 2CalHN as a meal supplement recommended by a Dietician which she loved (high calorie and high protein) and Pedialyte for fluid supplement. However, she is now on a PEG (feeding) tube and she/we didn't agree to it until the second attempt by Doctors to convince her/us she needed it. She gets 6 cans of Jevity and two high protein doses (Pro-Stat and Juven) per day. I'll tell you that Mom has made a quick turn around with her health as a result and believe me she loved to eat, that was not a factor.
The cause of all of this was, apparently, she was just not eating enough and was starting to cough more after drinking cold or hot drinks and then later with solid food. We found she was having swallowing troubles by getting a video swallow test. So while we we're struggling to get her all her needed nutritients, there was little time left for high calorie food. And although not uncommon, her need to urinate frequently caused her to stop (consciously) drinking in the evening resulting in a very dehydrated state. I can't say enough about hydration - everyone should monitor your Elder's fluids! We think the trouble swallowing is just one more of her Parkinson's symptoms besides her age. And I won't even go into the ill fitting denture!
She also has been dealing with a pressure sore for the past 6 months and needing HIGH protein for healing but developed an infection and then 3 weeks of Tygacil IV antibiotic which she was allergic to and then Dr prescribed a steroid (horrible). And even though she was given a pre-biotic, all that resulted in a UTI and Thrush as the swallowing worsened. Mom is normally coherent but all these infections caused some very strange behavior like hallucinations, weakness, fevers, words not making any sense, and severe difficulty in expressing herself. And then through a ROUTINE Cardiology appointment, we found she had contracted a blood bacteria and Endocarditis, leaving the other Doctors to believe this was her end and told us to put her in Hospice. NOT! - her family and Neurologist knew better (Mom's Parkinson's Dr is a God Send)!!
The Thrush still comes and goes and Nystatin rinse is a pain and we were told she SHOULD swallow it but how is that possible when we are worried about aspiration? 6 weeks of Vancomycin IV antibiotic and she has bounced back, gained a few pounds, and is getting physical, occupational, and speech therapy in a pretty good nursing facility; a family member is with her EVERY day - monitoring everything.
She had her first oral meal yesterday and did FINE! She's talking so much better! We are very hopeful that the PEG tube will one day be able to be removed although she is getting used to it. It would be a safeguard for her to get that added nutrition and fluid at times when her Parkinson's meds just aren't working that day and hampers her ability to eat what she needs and more! We look forward to positive results from her next Echo and then coming back home!
Regarding Medical POA - it's easy and a necessity if you want to monitor care and get explanations. Just get Mom to agree to sign, any lawyer can set it up. You can still consult with her or have her make decisions and sign documents. Financial POA is different and is when you need a Dr's statement of her mental state. Mom has a legal form identifying the Financial POA so it's ready but we have not enforced it.
Mom is a tough woman, 5'3'' Veteran WWII WAC and mother of 5 with 13 grandchildren and 16 great-grandchildren... she has a lot to live for and we won't take any less!! We've had some very difficult experiences with Geriatric Doctors and Nurses who don't understand Parkinson's or the related drug regimen. I feel horrible about the elderly population not getting the attention they need.
tpfzowie I continue to be amazed when I read the simularities between the life situations that our loved ones and ourselves as family/caregivers are facing. My mom as I've said earlier, is barely eating or drinking. She too has had a UTI which when treated by an antibiotic has now caused thrush in her mouth. This is being treated with the mouth rinse Nystatin which is causing nausea and flushing (because she is of course swallowing minimal amounts of it instead of spitting it back out. My mother's mental state and her mobility issues will prevent her from ever coming home and if a feeding tube is suggested my brothers and I have pretty much decided that we don't want to go that route -- there is no Healthcare POA so effectively that decision is going to be her's - we are trying to decide the proper/legal route to follow to have her declared incapable of making her own healthcare decisions. We know the facility physician will write a letter confirming this but it seems the only avenue, at least here in NC, is to go to court and have her declared incompetent. If anyone knows of another way to accomplish Healthcare POA assignment here in NC, please post something here. I will continue to read the responses of all of you who are dealing with the eating/drinking issues looking for things to try and will gladly post anything that I can that we find helps.
I understand all to well what happens when a parent stops eating. For half of the past year, my 86 year old mom would only eat a few bites of this or that, if we were lucky. The only things she wanted were cheese curls and chocolate.
She was so malnurished she could not fight off the urinary tract infection she got or the thrush that followed, thanks to antibiotics given to treat the UTI. The thrush (yeast infection) went throughout her body
We had difficulty realizing she had increasing swallowing problems, due to a prior stroke. The main clue is that she sarted coughind more and more after swallowing. I urge anyone with a reluctant eater to watch for this since a good speech therapist can help and aspiration pneumonia is a very real threat.
The doctor asked if she wanted a feeding tube and she agreed to try it. After a few days of discomfort she has tolerated it well and has started to look healthier, in general. It is not difficult to use and is giving her the opportunity to fight off infection. (I am sure there are other places to discuss the controversies around feeding tubes.)
The article about Ensure caught my eye because we will be bringing her home soon, with the feeding tube. Many people who have told us about tube feeding have said that Ensure or something similar is often used for home tube feeding. I will be interested to see what her doctor recommends. Thanks to the article I'll have more information to help push for other options.
If only one of the first ingredients in Ensure is simple sugar. It's not, it's corn syrup. Make a smoothie or a shake. Add protein powder. Or at least Oddwalla. But not that other processed crap.
Thank you for sharing this information. I think that many times we are not aware of the damages some nutritional supplements and medications can do, and this could possibly harm us or a loved one. I will pass this information on to my Twitter followers and my friends.
Beached Page, From my experience, my dad almost seemed to get "anorexia." He was literally afraid of eating anything, can't have ice cream - bad for my choelesterol, no fat from beef - will give me heart disease, must eat supplements - to kill antioxidants. Then he started to avoid food because everyone at the church lunch loaded his plate with vegetables and bland no-salt food. He got used to saying, "no thanks, too much."
But I also noticed that he snacked, like your mom -- so there is some appetite. What's up with that? I took him to McDonalds, and you know what - he finished a Big Mac Meal and the whole medium-sized coke. We went to El Pollo Loco for chicken and he finished the whole combo. Different environment, different behavior.
I noticed in your writing your mom might sometimes finish one dinner-time item. How about trying this, just put out one bowl of chowder soup (it's rich in calories) in a smaller soup bowl, and don't push. Just let her see it and eat on her own.
With each dinner, just put out one high-calorie item and make it a relaxing time. Tell her calmly, you're welcome to eat it -at your age you don't have to go on a diet.
The principle is to reduce the complexity and overwhelming mealtime experience and replace it with a simple high-calorie item, and allow her taste buds to come back. (One way to see if the food is tasty is to sample the nursing home's food yourself, and whittle it down to just the one item that tastes good! Serve ONLY that.)
Beached Page, I feel your pain. My 92-year old dad had lost most of his appetite as he neared the end of his life. It was tough to watch because he'd always loved food. I would offer to bring him his former favorites, but he just didn't want them and no longer liked most things he used to look forward to eating. I'm not suggesting that your mom is near the end, but it's hard to watch a parent with no appetite.
Now my 90-year old mom's appetite is starting to wane and it's hard all over again. I guess we just have to accept that we can do what we can and if a parent doesn't want to eat there's not much we can do, other than to offer healthy alternatives. I think it's nature's way of moving the person to the next phase of their life.
We've talked to the Nutrion staff and nursing staff about different ways to give my mom meals but so far we still haven't gotten them to a point where we think she might start to increase her appetite. My mother has never had a big appetite and to be faced with a plate full of food she just shuts down. So we asked for soups, ice cream, anything with gravy, and one other item -- she often sat down and ate one thing. She snacked throughout the day on candy, Pringles, donuts, etc. There was no three course meal. They make available to her the things she was snacking on at home but she has had no interest in them. I'm just at a loss as to what we should do next.
CALORIES ARE GOOD! - "There is a misperception that frail elderly people should adhere to the same low-fat, low-calorie diet that is recommended for the general population."
This is one of the first articles I have ever seen to mention this fact, that personally I know is true. Our society and media is so hung up on trying to get people to lose weight that many an elderly person has gone down the road of cutting out anything with calories in their diet in the name of "good health" and supplements. No wonder they shrivel up!
After my dad dropped 25 pounds and looked like a skeleton, I realized that his wife and he had cut out anything that tasted good in their diets. No ice cream, no skin on chicken, no butter, no meat, and no oil! What's left?
After I reintroduced the fried chicken, chocolate ice cream, beef, potatoes WITH butter that he loved, he regained his weight and vigor. At 86 there's no need to be trying to cut back. He's never in his life been near obese and isn't about to eat his way there now.
But media and all his overweight, diabetic, heart-disease ridden church friends warped his mind. Not to mention all the ponzi-scheme supplement programs that bombard them.
People out there, eat well for your own body's needs and what worked well for a lifetime! In moderation and with occasional splurges you can have your cake and eat it too.
This is an excellent article. I'm trying to keep my 90-year old mom eating well as her appetite starts to decline over time. For a while she wanted Ensure but I'm happy she's not asking for them any more. I'd rather see her eat "real food" than those highly processed synthetic meal replacements or supplements. Like the previous comment, good health requires real fruits and veggies.
i almost died drinking those. they are like slimfast. bones change after 50. it's good to use your chewing muscles. i think they atrophy if we don't use them.
It has been a while since I looked at the ingredient list of supplements such as Ensure. My recall is that the first ingredient is water and the second sugar. Making a healthy smoothie with whey powder would be a much better alternative. I recently discovered that 2 large kale leaves, 1 banana, 1 cup liquid (milk, soy milk, or rice dream etc.) and a scoop of protein powder is delicious and amazingly nutritious. It just requires a good blender, no fancy, expensive juicer is needed. I strongly believe that healthy aging requires that we consume fresh fruits and veggies. Maria
84 Comments
First Oldest
First
Think Twice About Nutritional Supplement Drinks for Elderly Loved Ones
I rarely eat out, and steer clear of fast-food joints and edibles whose labels I can't pronounce. Ensure, Boost, and some nutritional drinks might be okay for anorexics or people who've undergone a dramatic weight loss, but there's no substitute for chewing real, healthy food.
So yes, I urge everyone in this forum to exercise caution when administering nutritional drinks and/or shakes to the elderly under their care and supervision. When in doubt, consult a dietitian/nutritionist.
Happy eating!
-- ED
My 87 yr old Mom with home care too was dealing with gradual weight loss and blood tests showed very low protein and iron count although her appetite always seemed very good to her and to us (the family). We just kept trying to get her to eat more and used 2CalHN as a meal supplement recommended by a Dietician which she loved (high calorie and high protein) and Pedialyte for fluid supplement. However, she is now on a PEG (feeding) tube and she/we didn't agree to it until the second attempt by Doctors to convince her/us she needed it. She gets 6 cans of Jevity and two high protein doses (Pro-Stat and Juven) per day. I'll tell you that Mom has made a quick turn around with her health as a result and believe me she loved to eat, that was not a factor.
The cause of all of this was, apparently, she was just not eating enough and was starting to cough more after drinking cold or hot drinks and then later with solid food. We found she was having swallowing troubles by getting a video swallow test. So while we we're struggling to get her all her needed nutritients, there was little time left for high calorie food. And although not uncommon, her need to urinate frequently caused her to stop (consciously) drinking in the evening resulting in a very dehydrated state. I can't say enough about hydration - everyone should monitor your Elder's fluids! We think the trouble swallowing is just one more of her Parkinson's symptoms besides her age. And I won't even go into the ill fitting denture!
She also has been dealing with a pressure sore for the past 6 months and needing HIGH protein for healing but developed an infection and then 3 weeks of Tygacil IV antibiotic which she was allergic to and then Dr prescribed a steroid (horrible). And even though she was given a pre-biotic, all that resulted in a UTI and Thrush as the swallowing worsened. Mom is normally coherent but all these infections caused some very strange behavior like hallucinations, weakness, fevers, words not making any sense, and severe difficulty in expressing herself. And then through a ROUTINE Cardiology appointment, we found she had contracted a blood bacteria and Endocarditis, leaving the other Doctors to believe this was her end and told us to put her in Hospice. NOT! - her family and Neurologist knew better (Mom's Parkinson's Dr is a God Send)!!
The Thrush still comes and goes and Nystatin rinse is a pain and we were told she SHOULD swallow it but how is that possible when we are worried about aspiration? 6 weeks of Vancomycin IV antibiotic and she has bounced back, gained a few pounds, and is getting physical, occupational, and speech therapy in a pretty good nursing facility; a family member is with her EVERY day - monitoring everything.
She had her first oral meal yesterday and did FINE! She's talking so much better! We are very hopeful that the PEG tube will one day be able to be removed although she is getting used to it. It would be a safeguard for her to get that added nutrition and fluid at times when her Parkinson's meds just aren't working that day and hampers her ability to eat what she needs and more! We look forward to positive results from her next Echo and then coming back home!
Regarding Medical POA - it's easy and a necessity if you want to monitor care and get explanations. Just get Mom to agree to sign, any lawyer can set it up. You can still consult with her or have her make decisions and sign documents. Financial POA is different and is when you need a Dr's statement of her mental state. Mom has a legal form identifying the Financial POA so it's ready but we have not enforced it.
Mom is a tough woman, 5'3'' Veteran WWII WAC and mother of 5 with 13 grandchildren and 16 great-grandchildren... she has a lot to live for and we won't take any less!! We've had some very difficult experiences with Geriatric Doctors and Nurses who don't understand Parkinson's or the related drug regimen. I feel horrible about the elderly population not getting the attention they need.
I continue to be amazed when I read the simularities between the life situations that our loved ones and ourselves as family/caregivers are facing. My mom as I've said earlier, is barely eating or drinking. She too has had a UTI which when treated by an antibiotic has now caused thrush in her mouth. This is being treated with the mouth rinse Nystatin which is causing nausea and flushing (because she is of course swallowing minimal amounts of it instead of spitting it back out. My mother's mental state and her mobility issues will prevent her from ever coming home and if a feeding tube is suggested my brothers and I have pretty much decided that we don't want to go that route -- there is no Healthcare POA so effectively that decision is going to be her's - we are trying to decide the proper/legal route to follow to have her declared incapable of making her own healthcare decisions. We know the facility physician will write a letter confirming this but it seems the only avenue, at least here in NC, is to go to court and have her declared incompetent. If anyone knows of another way to accomplish Healthcare POA assignment here in NC, please post something here. I will continue to read the responses of all of you who are dealing with the eating/drinking issues looking for things to try and will gladly post anything that I can that we find helps.
She was so malnurished she could not fight off the urinary tract infection she got or the thrush that followed, thanks to antibiotics given to treat the UTI. The thrush (yeast infection) went throughout her body
We had difficulty realizing she had increasing swallowing problems, due to a prior stroke. The main clue is that she sarted coughind more and more after swallowing. I urge anyone with a reluctant eater to watch for this since a good speech therapist can help and aspiration pneumonia is a very real threat.
The doctor asked if she wanted a feeding tube and she agreed to try it. After a few days of discomfort she has tolerated it well and has started to look healthier, in general. It is not difficult to use and is giving her the opportunity to fight off infection. (I am sure there are other places to discuss the controversies around feeding tubes.)
The article about Ensure caught my eye because we will be bringing her home soon, with the feeding tube. Many people who have told us about tube feeding have said that Ensure or something similar is often used for home tube feeding. I will be interested to see what her doctor recommends. Thanks to the article I'll have more information to help push for other options.
Or at least Oddwalla. But not that other processed crap.
I will pass this information on to my Twitter followers and my friends.
From my experience, my dad almost seemed to get "anorexia." He was literally afraid of eating anything, can't have ice cream - bad for my choelesterol, no fat from beef - will give me heart disease, must eat supplements - to kill antioxidants. Then he started to avoid food because everyone at the church lunch loaded his plate with vegetables and bland no-salt food. He got used to saying, "no thanks, too much."
But I also noticed that he snacked, like your mom -- so there is some appetite. What's up with that? I took him to McDonalds, and you know what - he finished a Big Mac Meal and the whole medium-sized coke. We went to El Pollo Loco for chicken and he finished the whole combo. Different environment, different behavior.
I noticed in your writing your mom might sometimes finish one dinner-time item. How about trying this, just put out one bowl of chowder soup (it's rich in calories) in a smaller soup bowl, and don't push. Just let her see it and eat on her own.
With each dinner, just put out one high-calorie item and make it a relaxing time. Tell her calmly, you're welcome to eat it -at your age you don't have to go on a diet.
The principle is to reduce the complexity and overwhelming mealtime experience and replace it with a simple high-calorie item, and allow her taste buds to come back. (One way to see if the food is tasty is to sample the nursing home's food yourself, and whittle it down to just the one item that tastes good! Serve ONLY that.)
Let us know how it goes.
Finding that we aren't alone in these situations that we cannot control helps --- thanks for sharing.
Now my 90-year old mom's appetite is starting to wane and it's hard all over again. I guess we just have to accept that we can do what we can and if a parent doesn't want to eat there's not much we can do, other than to offer healthy alternatives. I think it's nature's way of moving the person to the next phase of their life.
Good luck and know that you're not alone.
This is one of the first articles I have ever seen to mention this fact, that personally I know is true. Our society and media is so hung up on trying to get people to lose weight that many an elderly person has gone down the road of cutting out anything with calories in their diet in the name of "good health" and supplements. No wonder they shrivel up!
After my dad dropped 25 pounds and looked like a skeleton, I realized that his wife and he had cut out anything that tasted good in their diets. No ice cream, no skin on chicken, no butter, no meat, and no oil! What's left?
After I reintroduced the fried chicken, chocolate ice cream, beef, potatoes WITH butter that he loved, he regained his weight and vigor. At 86 there's no need to be trying to cut back. He's never in his life been near obese and isn't about to eat his way there now.
But media and all his overweight, diabetic, heart-disease ridden church friends warped his mind. Not to mention all the ponzi-scheme supplement programs that bombard them.
People out there, eat well for your own body's needs and what worked well for a lifetime! In moderation and with occasional splurges you can have your cake and eat it too.
bones change after 50. it's good to use your chewing muscles.
i think they atrophy if we don't use them.