“My elderly mother refuses to eat and she has lost a lot of weight. Should I give her a nutrition supplement drink to replace the meals she should be eating?”
Undernutrition due to lack of eating is a common and dangerous problem among seniors. According to a 2014 study published in the American Journal of Clinical Nutrition, decreasing body mass index (BMI) and malnourishment can contribute to frailty and higher mortality rates.
Geriatricians take weight loss very seriously and caregivers should, too. Family members may be at a loss when it comes to enticing a loved one to eat more (or at all), and many resort to using nutrition supplement drinks, such as Boost or Ensure, in lieu of meals. It is a common misconception that these drinks are a complete source of nutrition.
How to Use Nutrition Drinks Properly
When elders lose their appetites, caregivers typically offer countless preparations of “real” foods to try to revive their interest in eating and provide them with the calories and nutrients their bodies need. All too often, this does not work, so the last resort is sweet, easily digestible nutrition shakes. However, these products are not intended to replace all a person’s meals.
Just giving a senior a can of Ensure for dinner isn’t enough. In fact, relying on these drinks can cause digestive issues like diarrhea. It is always better to try to use regular food to maintain a person’s weight. If a caregiver wants to use these products, then they should be served between meals as a snack or supplement to add calories and nutrients to the senior’s diet, not as a complete meal replacement. If you are starting to rely solely on these kinds of drinks or shakes, it is crucial to speak with your loved one’s doctor or a dietitian.
Determine the Cause of a Senior’s Dwindling 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 loss of interest in food. 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.
If it is determined that a nutrition drink is right for a senior, it is still important to consult their doctor when deciding what type of supplement to use. For example, diabetics must choose a low-sugar product like Glucerna to avoid blood sugar spikes.
The Elderly Have Different Nutrition Requirements
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 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!
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 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. Elders 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.
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.
Nutrition Drinks and Supplements Can Interact with Medications
Lastly, nutrition 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. 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.
The bottom line is that nutrition drinks are a not a magic fix for loss of appetite or undernutrition. These products are not bad when used as a dietary aid and supplement to regular meals. However, they should not be used as meal replacements for elders. 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://academic.oup.com/ajcn/article/99/4/875/4637868); 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)