By Dr. Amy Ehrlich, MD
"My elderly mother isn't eating and she has lost a lot of weight. Should I give her a nutrition supplement drink to replace the meals she should be eating?"
Under-nutrition due to lack of eating is a common problem among elderly people. It is also dangerous. Under-nutrition and extreme thinness can lead to higher mortality rates, according to a study published in the American Journal of Clinical Nutrition. It is a problem that can't be ignored.
Geriatricians (specialists in treating the elderly) take weight loss among the elderly very seriously and caregivers should, too. However, some caregivers feel that feeding their parent a nutrition supplement drink, such as Boost, in lieu of meals ensures the elderly loved one is getting the nutrition they need. This isn't the case, according to Dr. Amy Ehrlich, Associate Professor of Clinical Medicine and Interim Division Head of Montefiore Medical Center's Geriatrics Division.
"Just giving them a can of Ensure for dinner isn't enough," she says. "It is always better to try to use regular food to maintain a person's weight." If a caregiver wants to use nutrition drinks, they should be used between meals, as a snack or supplement to add calories to the senior's diet – not as a meal replacement.
Work with a Doctor to Determine an Elder's Nutrition Needs
Weight loss is a marker of frailty. However, it is not a normal part of aging. Dr. Ehrlich stresses that it is critical to find out what is causing the senior's loss of interest in food. A doctor should conduct a detailed medical evaluation to determine the cause of loss in appetite and weight loss. "There are a variety of treatable conditions that could be the culprit: ulcers, thyroid disease, dementia, depression, even ill-fitting dentures. All are treatable, so rather than immediately turning to a supplement, work with your doctor to address the cause of the problem," Dr Ehrlich says.
If a caregiver does decide a nutrition drink is right for their elderly loved one, a doctor should still be consulted to determine the type of supplement to use. For example, diabetics must choose a low-sugar product.
The Elderly Have Different Nutrition Requirements
There is a misperception that frail seniors should adhere to the same low-fat, low-calorie diet that is recommended for the general population. However, Dr. Ehrlich says that for frail elderly who have substantial weight loss, the opposite is true. "I'll see a 94-year-old person who is losing weight and he is restricting everything, eating a low-calorie, low-fat diet. It would be better to eat a bowl of ice cream, for the caloric intake!"
Elders who have experienced weight loss should eat what they like. And don't be afraid to incorporate eggs, cheese, peanut butter…even ice cream into the diet. There is no need for low-fat milk or cheese.
Elders often can't (or don't want to) eat three large meals a day. Rather, encourage them to have smaller, more frequent meals, including snacks, even before bed.
Nutrition Drinks and Supplements Can Interact with Medications
Supplements, including nutrition drinks, can cause dangerous drug interactions in the same way prescription medications do.
If an elder is taking prescription and over-the-counter drugs and supplements, the drugs may conflict and, basically, go to war against each other, while also damaging otherwise functioning body organs and systems. Check with your doctor to avoid interactions. "I encourage my patients to bring in all their medications, supplements and vitamins, so I can check for possible interactions. I call it the 'brown bag visit,' " Dr. Ehrlich says. As an example, vitamin supplements may negatively interact with blood thinners like Coumadin.
The bottom line is that nutrition drinks are a not a magic fix for lack of eating or under-nutrition. These products are not bad when used as a dietary aid and supplement to regular meals. However, they should not be used as a meal replacement for elders – especially those who are frail or thin.
Dr. Amy Ehrlich MD is Geriatrics Fellowship Program Director for Montefiore Medical Center's Geriatrics Division in New York and an Associate Professor of Clinical Medicine. She is board certified in Geriatric Medicine and Internal Medicine.