“My elderly mother refuses to eat and she has lost a lot of weight. Should I give her a nutritional supplement drink to replace the meals she should be eating?”

Questions like this one abound in the Caregiver Forum and for good reason. Undernutrition due to lack of eating is a common and dangerous problem among older adults. According to a 2014 study published in the American Journal of Clinical Nutrition, decreasing body mass index (BMI) and malnourishment in older adults can contribute to frailty and higher mortality rates.

Geriatricians take weight loss very seriously and caregivers should, too. Family members are often at a loss when it comes to enticing loved ones to eat more (or at all), and many resort to using nutrition supplement drinks, such as Boost or Ensure, in lieu of meals. Unfortunately, it is a common misconception that these drinks are a complete source of nutrition.

Determine the Cause of a Senior’s Loss of Appetite

Weight loss is a marker of frailty, but it is not a normal part of aging. It is critical to find out what is causing a senior’s decreased appetite. Their doctor should conduct a detailed medical evaluation to determine the root of the issue. There are a variety of conditions that could be the culprit, such as ulcers, thyroid disease, dementia, dysphagia, depression, dulled senses of smell and taste, and even ill-fitting dentures. All these causes are either treatable or can be accommodated. Rather than immediately turning to a supplement, work with your loved one’s doctor to address the underlying problem.

Read: Why Seniors Refuse to Eat and What You Can Do About It

Nutritional Needs of Older Adults

A low-fat, low-calorie diet is recommended for the general population to maintain a healthy weight, but the opposite is usually recommended for seniors—especially those who are frail or unintentionally losing weight. Sometimes I’ll see patients in their eighties and nineties who are losing weight and still restricting their calorie and fat intake. In many cases, it would actually be better for them to just eat a bowl of ice cream!

Read: Daily Dietary Guidelines for Individuals Age 51 and Older

Keep in mind that eating three large meals each day can be overwhelming for seniors. Instead, encourage them to consume smaller, more frequent meals and snacks, even before bedtime. Petite portions are less intimidating for many older individuals.

Elders who have experienced weight loss should eat what they like—within reason. Don’t be afraid to incorporate eggs, cheese, peanut butter and even treats like ice cream into their diet. There is usually no need for low-fat dairy products. If foods in liquid form are easier for them to consume, try making your own healthy smoothies or shakes with wholesome, fresh ingredients. Seniors tend to prefer sweets as their senses of taste and smell dull, but it is easy to “hide” high-calorie and nutrient-dense foods in smoothies and still have them taste sweet and delicious. Try adding a spoonful of nut butter, half an avocado or a handful of spinach to a blended drink for a boost of nutrients.

If it is determined that a nutritional drink is right for a senior, it is still important to consult their doctor when deciding what type of supplement to use. There are a wide variety of pre-made options out there. Your loved one’s nutritional needs and taste preferences are important factors to consider when incorporating liquid supplemental drinks in a senior’s diet. Consider the following pros and cons before buying a nutritional drink for a senior.

Dangers of Nutritional Drinks for Seniors

High Sugar Content

When elders lose their appetites, caregivers typically offer countless preparations of “real” foods to try reviving their interest in eating and provide them with the calories and nutrients their bodies need. All too often, this approach does not work, so the last resort is sweet, easily digestible nutritional shakes. Check nutrition labels for both total and added sugars, and skim ingredient lists to be sure a protein or fruit is listed first instead of sugar or corn syrup. Sugar content is especially problematic for diabetic seniors, so look for specific low-glycemic formulas developed for people with diabetes.

Digestive Upset

Just giving a senior a bottle of Ensure for dinner isn’t enough. In fact, relying on these drinks can cause digestive issues like diarrhea. Lactose intolerance increases with age, therefore any nutritional shake made from milk proteins may cause flatulence, nausea, constipation or diarrhea. Look for formulas that are sensitive to any existing dietary concerns.

Nutrition Drinks & Liquid Meal Replacements Can Interact with Medications

Nutritional drinks often contain high (sometimes even excessive) amounts of vitamins and minerals that can cause dangerous drug interactions with a senior’s prescription medications. Many older individuals take a regimen of prescription and over-the-counter drugs and perhaps vitamins and supplements, too. One study found that thirty-nine percent of seniors report taking five or more prescription medications in an average 30-day period. These medication regimens can be problematic on their own, producing dangerous adverse effects and possibly damaging otherwise functioning organs and systems.

The high levels of vitamins and minerals in nutritional drinks can add to this mix within the body and cause further complications, especially if a senior is consuming multiple drinks per day. For example, an 8-ounce nutritional drink can contain up to 40 percent of a senior’s daily requirement for vitamin K. This sounds healthy, but vitamin K can directly affect the efficacy of blood thinners like warfarin (Coumadin).

It is important to check with your loved one’s doctor before altering any medications, supplements or diet plans to avoid medication-related problems. 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.” Seniors and their caregivers can also make an appointment with a pharmacist for a brown bag check-up. Medicare beneficiaries who are in a Medicare Prescription Drug (Part D) Plan are often eligible for free reviews of their medications and personalized action plans to optimize their regimens. Medicare Part B also covers nutrition therapy services for seniors with diabetes and kidney disease.

Supplements Are Not the Same as Whole Foods

Drinks that are fortified with minerals, vitamins and supplements still won’t contain all the nutrients that a whole food source provides. According to geriatrician Dr. Suzanne Salamon, “People see a lot of vitamins and minerals and think more is always better.” As an alternative to a processed nutrition drink, a homemade or refrigerated fruit smoothie may contain less supplemental ingredients. Supplementing the daily diet with a nutrition drink as a snack or single meal won’t hurt, but efforts to find real foods to make up the majority of a senior’s diet will lead to the best source of nutrition.

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Benefits of Nutrition Drinks for Seniors

Nutrition Shakes Help Stop Unintended Weight Loss

Supplemental nutrition made up of a balance of protein, carbohydrates and fat may be the most palatable way for a senior to ingest calories. For example, the aptly named Boost product is a very high calorie drink, boasting 550 calories in an 8-ounce serving. Seniors who need to stop unintended weight loss or re-gain weight may benefit from easy access to a significant source of calories. Increasing caloric intake may also lead to improved mood and energy levels.

Nutrition Drinks Are a Helpful Source of Protein and Nutrients

Loss of appetite and/or trouble preparing healthy meals may lead to malnourishment in older adults. Nutritional drinks that balance fats, carbohydrates and protein also contain calcium, vitamins, nutrients and fiber. It’s important to look for a formula that addresses a senior’s dietary shortfalls. For elders who struggle to prepare proper meals, adding an easy-to-consume source of protein to their daily diet may help support muscle health and overall strength. Protein also acts within the body to carry oxygen, repair damaged tissues and create antibodies to fight infection.

Supplemental Shakes Are Ready Made and Easy to Use

What is perhaps the biggest benefit of using nutritional supplement drinks or shakes is the ability to easily ensure that seniors who have swallowing difficulties or no longer find eating pleasurable are getting enough calories and vitamins. These products are easy to find in grocery stores and are designed to meet the goals of boosting calories and nutrition with rich, appetizing flavors. A ready-made product that helps get a senior with no appetite to eat is a welcome relief for caregivers faced with this daily challenge.

The Right Way to Use Nutritional Drinks for Seniors

If a family caregiver wants to use these products, then they should be served between meals as a snack or source of supplemental calories and nutrients, not to completely replace all meals. Caregivers who find they are starting to rely solely on these kinds of drinks or shakes for their loved ones’ meals should consult with a doctor or dietitian.

The bottom line is that nutrition drinks are a not a magic fix for loss of appetite or undernutrition in seniors. However, these products can certainly play a helpful role as part of the overall nutrition plan for an older adult. Consult with your loved one’s doctor and/or a registered dietitian to address the underlying causes of their weight loss and develop a safe and healthy eating program.

Sources: BMI and all-cause mortality in older adults: a meta-analysis (https://doi.org/10.3945/ajcn.113.068122);Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010 (https://dx.doi.org/10.1093%2Fgerona%2Fglv013); Medication Therapy Management Programs for Complex Health Needs (https://www.medicare.gov/drug-coverage-part-d/what-drug-plans-cover/medication-therapy-management-programs-for-complex-health-needs); Nutrition Therapy Services (https://www.medicare.gov/coverage/nutrition-therapy-services)