Overuse of commercial supplements in Aged Care
- OSCAR Care Group
- 2 days ago
- 7 min read
Supplement drinks: the liquid solution or liquid pollution to aging?
Residents are often faced with inadequate nutrition due to poor dentition, lack of taste, swallowing issues, polypharmacy, low appetite, cognitive impairment, disabilities, and increased nutrient needs due to diseases and infections.
Consequently, may lead to an increased risk of malnutrition which then is associated with poorer health outcomes. Often, residents may be prescribed with commercial supplement drinks to assist in targeting the nutrient requirements. However, these supplement drinks are often misused and may cause other challenges.
We face a lot of challenges with overuse of supplements in aged care.
In the Aged Care homes, commercial supplements are seen as a convenient quick fix to address nutrition concerns or tick a box that something is being done if a resident is losing weight. However, the overuse of commercial supplements may be doing more harm than good.
Commercial supplements are not a quick fix - they should not be used to tick a box.
So, why are the resident being prescribed commercial supplement drinks as a go-to then? Often, it could be due to lack of education, understanding and clinical oversight where healthcare providers rely on commercial supplements without an experienced aged care Dietitian’s thorough review.
The Challenges
Doctors
Though with good intentions, residents may be prescribed commercial supplement drinks by a Doctor without a Dietitian’s awareness. Some Doctors do in fact chart any commercial supplement, often inappropriately, and the aged care staff comply.
While Doctors are respected, it is important that anything diet related, included supplement usage, a Dietitian should be involved in the commencement of any commercial supplement.
Hospitals
Residents who go to hospital are often prescribed commercial supplements and return to aged care homes on these commercial supplements. The aged care staff comply as this is a hospital Dietitian request. The challenge here is that the hospital setting is an acute setting, suitable for commercial supplement usage for a short time during the hospital stay.
However, our Aged Care Dietitians often see residents still unnecessarily on supplements months or years after a short hospital trip. Refer to a Dietitian in aged care to assess if the supplement is necessary after a resident returns from hospital. Aged care is a long-term setting, where commercial supplements should not be at the forefront of nutrition.
Family or NOK (next of Kins)
Another factor may be due to self-medication by family members or the resident themselves who may turn to commercial supplement drinks due to advertisements or popular health trends without Dietitian consultation. Always involve an Aged Care Dietitian to support the resident with a personalised approach, and not necessarily with a supplement, if not required.
Old school approach
Also, some old-school ways were going to commercial supplements straight away as the solution or quick fix. Things need to change. Commercial supplements should be a last resort, with the priority being a Food First Approach for enhancing residents’ enjoyment of food, beverages, taste and quality of life.
If there is an overuse of commercial supplements, what does that mean for the home and the residents?
The Residents
Overuse of commercial supplements can shift the focus away from whole foods that provide proper nutrients. Other factors that may impact on the resident’s quality of life include:
Reduced enjoyment for whole food
Reduced appetite
Reduced social engagement during the dining experience
Nutrient toxicity, especially for those who have clinical conditions such as kidney damage, gastrointestinal disturbances and diabetes
The above may lead to nutrient deficiencies or increase the risk of malnutrition.
The Aged Care Home
Not only does overuse of commercial supplements impact on the residents, but it can also have significant implications to the aged care home too.
Increased healthcare costs – the high reliance of supplement drinks may lead to nutrient toxicity, unintentional weight gain or other issues which can cause further medical complications
Supplement drink waste – not all supplements are properly consumed by the resident residents for several reasons, which can then lead to wastage or the supplements being ineffective
Lack of individualised care - if most residents are receiving the same supplement drinks, there is less of an effect of the home addressing the resident’s specific dietary needs
Negative perception of the home’s care – when families are trying to find the ‘right’ home for their family member, having good quality meals are important for families. If there is a high reliance on supplement drinks to address dietary needs rather than through food, this may deter families.
What are the disadvantages of supplements?
As with anything in life, there are pros and cons. Let’s explore the cons:
Taste
As the commercial supplement drinks are designed to provide high levels of nutrients in a small volume, often it is accompanied by a concentrated or very sweet taste due to the concentrated sugar levels. Our Dietitians in aged care often hear of residents not enjoying the taste of commercial supplements.
When prescribing commercial supplement drinks, residents may receive them at least once a day or even up to five times a day, depending on the clinical concerns from the Doctor and Dietitian. A major concern on daily commercial supplements is residents becoming tired of these, lack of variety of flavours in the day, even if a resident does enjoy the taste to start. It leads to taste fatigue and refusal of supplement drinks.
Early satiety
Due to the high concentration of energy and protein (and for some supplements, high fibre content), this may cause early satiety and especially for those who already have a low appetite. By promoting high usage of supplement drinks, this may displace regular food and drinks during mealtimes. Many staff also provide supplement drinks prior to a meal being served, so residents may feel full when a meal is served, and not eat their meals, becoming a poor cycle on repeat.
False sense of security
When prescribing medication and supplement drinks, some people may see it as a simple fix to assist with nutrient adequacy. Therefore, there is a higher reliance on these drinks rather than determining the underlying issues to inadequate oral intake.
Supplier issues
There may be issues with the supplier or having certain supplement drinks out of stock, which seems to still happen frequently. There are then delays to the delivery of nutrients to the residents. Aged Care homes may also have a contract with certain supplement companies which limits the variety of supplement drinks to choose from.
Financial cost
Commercial supplements are expensive, with one bottle already costing around $3-6 AUD. Some residents may require three bottles per day to assist their energy and nutrient needs, which means it can cost into the thousands per year.
What are the benefits of supplements?
Firstly, there is a place for commercial supplements when required. Commercial supplements are recommended to be used as a last resort when all other options are exhausted.
However, commercial supplements can be beneficial when prescribed by the Doctor or an Accredited Practising Dietitian. The key is this should only be done after a thorough evaluation and assessment of the resident has been conducted by a Dietitian.
Supplement drinks may assist those with:
very poor oral adequate where supplement drinks provide energy and protein in a smaller volume
chewing difficulties
increased energy and protein needs on top of their diet
cognitive impairment who may recognise supplement drinks as ‘special drinks’ or completely refuse all meals
Additionally, the small pact bottle with high energy and protein is convenient for nursing staff and carers to provide nutrients easily during medication rounds and is portable when required.
The ‘Food First’ Approach
The ‘Food First’ Approach is a strategy that prioritises obtaining nutrients through food rather than the reliance of commercial supplemented food and drinks.
The main goal of the ‘food first’ approach aims to provide a balanced diet that allows the residents to receive sufficient nutritional needs in the form vitamins, minerals, proteins and fibre naturally. In doing so, this promotes better digestive health, addresses nutritional deficiencies, promotes quality of life and mealtime experience.
The ‘food first approach’ is individualised by consulting with the resident as to what they prefer to eat according to their preferences, likes and dislikes. This strategy is sustainable and a more cost-effective method which can be maintained long-term as opposed to supplement drinks. Food fortification and HEHP foods are the best food first approach solutions to address the risk of weight loss and malnutrition in aged care.
How can working with an experienced team of Aged Care Dietitians benefit an aged care home?
There are a several ways for an experienced Accredited Practising Dietitian to help in an aged care home and improve the quality of life for the residents:
Provision of education for clinical and care staff and chefs to encourage the movement towards the food first approach.
Provision of resources and recipes for chefs to assist in food fortification, HEHP foods and other ideas as required to provide personalised support to residents.
Regular supplement reviews to assess if any are necessary.
Addressing clinical concerns through an individualised approach and targeting specific nutrient needs.
Ensuring regulatory compliance and evidenced-based practice is applied in nutrition.
Food first approach and oral intake tips
There are quick and easy ways to encourage the food first approach and oral intake.
Organise regular educations for staff on Malnutrition, Food Fortification, HEHP foods and the Food First Approach. Find out more about educations here
Build rapport with the residents to understand their eating behaviours, preferences, likes and dislikes.
Offer HEHP (high energy and protein) snacks first such as yoghurt, custard, cheese and biscuits, eggs etc. Find out more about HEHP Diets.
Optimise all mealtimes, from breakfast, morning tea, lunch, afternoon tea, dinner to supper with extra high energy and high protein snacks, and food fortification where possible.
Reach out to an Accredited Practising Dietitian at OSCAR Care Group who can help and provide the support you need!
Get your Foundation right
OSCAR Care Group can assist your home with a fantastic foundation on training the Food First Approach, reviewing your Nutrition and Hydration policy, supplement reviews and reducing or ceasing unnecessary commercial supplements, to focus on the Food First Approach.
Email dietitian@oscarcaregroup.com.au for assistance with this today.
