“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 seniors. According to a 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 unintentional 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 serving nutritional 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, dysphagia, depression, dulled senses of smell and taste, and even ill-fitting dentures. All these causes can be treated or accommodated. Rather than immediately turning to a supplement, work with your loved one’s doctor to address the underlying problem(s) and see if their appetite improves.
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!
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, and your loved one’s nutritional needs and taste preferences are important factors to consider. Weigh the following pros and cons before incorporating a drink or shake into an elder’s diet.
Dangers and Drawbacks 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 consumed nutritional shakes. Check nutrition labels for both total and added sugars, and skim ingredient lists to be sure a type of protein or fruit is listed first instead of sugar or corn syrup. Sugar content is especially problematic for diabetic seniors, so look for low-glycemic formulas developed specifically for people with diabetes, such as Glucerna or Boost Glucose Control.
Just giving a senior a bottle of Ensure for dinner isn’t enough. In fact, overreliance on these drinks can cause digestive issues like diarrhea. Lactose intolerance increases with age as well, therefore any nutritional shake made from milk proteins may cause flatulence, nausea, constipation or diarrhea. Look for formulas that comply with any existing dietary concerns and food sensitivities.
Meal replacement drinks often contain high (sometimes even excessive) amounts of vitamins and minerals that can cause dangerous drug interactions with a senior’s 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 complex 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 eight-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).
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 bag up and 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 enrolled 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, and Medicare Part B covers nutrition therapy services for seniors with diabetes and kidney disease. CVS even offers a drug interaction checker tool on its website.
Drinks that are fortified with minerals, vitamins and supplements still won’t contain all the micronutrients, dietary fiber and antioxidants 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 probably 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.
Benefits of Nutritional Supplement Drinks for Seniors
Prevention of Unintentional 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 Very High Calorie product boasts 530 calories in an 8-ounce serving. Seniors who need to stop unintended weight loss or 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.
Increased Protein Intake
Loss of appetite and/or trouble preparing healthy meals may lead to malnourishment in older adults. Nutritional drinks that balance fats, carbohydrates and protein should also contain calcium, vitamins, nutrients and fiber. It’s important to look for a formula that addresses a senior’s unique 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. Sarcopenia (loss of skeletal muscle mass) is common in older adults—even those who appear to be maintaining a healthy weight—and associated with physical disability, poor quality of life and even death. Protein also acts within the body to carry oxygen, repair damaged tissues and create antibodies to fight infection.
Convenience and Effectiveness
Ensuring that seniors who have swallowing difficulties or no longer find eating pleasurable are getting enough calories and vitamins is no small feat. Nutrition drinks and shake are easy to find in grocery stores and designed to meet the goals of boosting calories and nutrition with rich, appetizing flavors. A ready-made product that helps get a senior 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 a 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 registered dietitian.
The bottom line is that nutrition drinks are not a magic bullet for loss of appetite or undernutrition in seniors. However, these products can certainly play a helpful role in an older adult’s diet when used correctly. Consult with your loved one’s doctor 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)