Choosing supplements for the elderly.

Elderly Eat food with nutrition
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One of the most common problems in the elderly is the consumption of food less, not enough to meet the needs of energy and nutrients per day. This increases the risk of malnutrition. Using medical food is one of the ways to help older people get more essential energy and nutrients.

What is medical food?
Medical food is a type of food developed for oral consumption or nasogastric tube feeding under the guidance and care of the doctor. These foods have the right proportion of nutrients and are fully vitamin and mineralized. It can be used as a substitute for common foods for those who cannot consume oral food (or nasogastric tube feeding) or insufficient oral food consumption.

When the elderly should take medical supplements?
In the elderly, anorexia or food consumption has decreased insufficiently, but there is still a normal digestive system and can swallow food normally. Your doctor may consider recommending medical supplements. The number of supplements should be supplemented per day, depending on the ability to consume a common diet, energy requirements and nutrients per day and should consult a nutritionist or dietitian to calculate the energy needs of the elderly and assess the amount of energy take from the diet per day to determine the amount of medical food that should be given per day.

Types of medical food.
Medical food can be divided into two types: general medical food, formula, and medical food formulated with specific diseases (suitable for specific patients with diseases such as diabetes, chronic kidney disease, cancer, etc.). In this article, it will only mention general medical food recipes. Most of the nutrients are carbohydrates, about 40 to 60% of total energy, Protein about 15– 25% of total energy, and Fat 15 to 35% of total energy, which is in line with the normal dietary guidelines. In addition, medical foods are fully mixed with vitamins and minerals. This causes when older people to consume medical foods that receive energy 1000 – 1500 kcal or more to receive enough vitamins and minerals to meet daily needs.

The general characteristics of medical food are powder-like milk powders, mixed with water in proportions indicated beside the packaging (which vary by brand). However, almost all medical foods are lactose-free. Therefore, it does not cause diarrhea in elderly people who can not digest the lactose sugar in milk.

Consideration of choosing general medical food for the elderly.
Medical food in each brand, even though it is a general formula, but there are a few differences. The selection, therefore, depends on the characteristics of the elderly, existing disease, requirements for different nutrients, prices, etc. However, what needs to be considered is the taste acceptance. Because each elderly has a different taste. The appropriate recipes should be recipes that the elderly can accept the taste as well.

In practice, medical food can be considered as follows:

  • General elderly people which do not have an increased protein demand. The elderly can choose a generic recipe where any older person can accept the taste.
  • Elderly people with constipation problems may consider choosing a recipe with fiber mix (either FOS or Inulin) to help the elderly get more fiber and helps to excretion better.
  • Elderly people with diarrhea may temporarily consider choosing a formula that does not contain dietary fiber until diarrhea gone, then gradually adjust to the formulas that are mixed with dietary fiber.

This is because medical food generally has a milk-flavored vanilla flavor. (except for some medical foods with other flavorings, such as chocolate Strawberry, for example), if the elderly are not used to drinking milk, there may be a problem with taste acceptance. In general practice, it can be mixed with other food ingredients such as cocoa powder, green tea powder, concentrated nectar (with a little bit ), or other beverages to adjust the taste to be more acceptable. However, be careful with mixing with fruit juice or other beverages with acidic conditions due to precipitation.

Elderly people with health problems, especially chronic non-communicable diseases such as chronic kidney disease. It tends to be less prone to food consumption compared to older people with no health problems. The use of medical food is an important way to increase energy and nutrient intake for the elderly in this group. However, due to different conditions of the disease, which can result in different dietary requirements and restrictions in each elderly person. It is important to choose a medical diet to suit the condition and disease.

This article will only discuss the general details of a medical diet specific to the disease. Consideration for each elderly person should consult your doctor and nutritionist/dietitian to choose the type and dosage that should be taken per day appropriately.

Medical diet for diabetes.
A group of these medical foods has developed the most formulated recipes. The general characteristics of medical diets for diabetes are that the proportion of carbohydrates is a lower source of energy than conventional medical foods, and carbohydrates with a low glycemic index (e.g. Maltodextrin, Isomaltulose, and sucromolt) are used to slow blood sugar levels higher after consuming, as well as more fiber than conventional formulations.

When comparing nutrients, “Glucerna SR Triple Care” and “Once Pro” has the highest protein content: 20% of total energy, so they may consider using it in elderly people with diabetes and having a low protein intake or need consuming foods that are high in protein. But if the elderly often have high sugar levels May consider choosing a formula with the lowest carbohydrate content “Once Pro” but should be aware of hypoglycemia that often occurs in the elderly as well.

If the elderly have frequent hypoglycemia, they may be affected, in addition to taking care of the consumption of the main meal, it is possible to consider a diabetic medical diet with a higher proportion of carbohydrates, such as “Nutren Balance” (46% of total energy) or “Gen DM” (53% of total energy). It may allow older people to experiment with the taste test, and then choose the product that tastes most acceptable.

Medical diet for chronic kidney disease.
At present, only one product is “Nepro HP” (Abbott Company), it is a medical food product for patients with late-stage chronic kidney disease that was treated with renal replacement therapy. In this case, there is a limit to the number of minerals such as sodium, potassium, phosphorus, magnesium that may be concentrated in patients with chronic kidney disease and a little bit high amount of protein (17% of total energy) because patients treated with kidney replacement therapy will have increased protein requirements and a high protein and high energy concentration of 1.8 kcal per 1 ml. (general medical diet usually provides 1 kcal per 1 ml) energy, Therefore suitable for the elderly who do peritoneal dialysis or dialysis that has little to eat.

However, Nepro HP is usually not suitable for patients with chronic kidney disease who have not yet undergone renal replacement therapy due to excessive protein content. Therefore, if considering using Must always calculate the amount of protein that the patient received first, otherwise, the patient will get too much protein.

This can result in the kidneys working harder and deteriorating faster. For patients in this group, it is possible to consider a general medical diet or another formula that has a very high mineral and protein content. However, laboratory monitoring and evaluation (especially electrolyte levels in the body, especially potassium and phosphorus levels) are required regularly.

Medical diet for liver disease.
Currently, there is only one product, “Aminoleban Oral”, characterized by a fat limit (15% of total energy) because liver disease patients often have disorders in the digestion of fats in the food, and a high protein content (25% of total energy) that is part of the protein branched-chain Amino Acids that can be applied by muscles without having to go through the liver process like other amino acids, thus reducing the risk of hepaticence lyphapathy (HE), therefore it has been used in patients with liver disease who are at low risk of HE consumed a normal diet.

Since Aminoleban Oral has a different proportion of amino acids from other formulations, it has a relatively unacceptable taste of the patient. Therefore, the orange flavor is added to make them taste better. However, the taste acceptance of Aminoleban is still less than other medical foods. If the patient is unable to drink and is not at high risk of HE, they may consider choosing other medical foods that do not have a high-fat content but a high protein content, allowing the elderly to drink to increase energy and nutrients first. Only during the patient has HE or very high risk (high blood ammonia levels) may consider using Aminoleban for a short period of time, possibly mixed with a general medical diet to make the taste more acceptable.

Medical foods for those who need high protein or increased immunity.
It has a much higher protein content than conventional formulations and contains nutrients that increase immunity. This is suitable for older people with higher protein demands such as cancer, the patient recovers from major surgery, burns patients severe acute injury, etc. When considering the nutrients “Neomune” which have the highest protein content (25% of total energy), the secondary “Impact” (22% of total energy) and “Prosure” (21% of total energy), Therefore, in patients who require very high energy and protein, such as patients with severe burns May consider choosing “Neomune” to get the highest protein.

But in summary, in general practice, as with diabetic formulations, The general characteristics of this group of medical food are not very different. However, each brand’s product has a different flavor (“Neomune” tastes like soy milk, “Impact” fruit flavor added and “Prosure” are vanilla.) Therefore, it is important to take a look at the patient’s taste acceptance. Especially in cancer patients, the taste may change.

This reduces taste accept and consumption. This group of medical foods can adjust the taste by adding juice or cocoa powder, coffee powder, etc. to change the taste, it may help the patient to accept the taste more. However, it is important to be aware that adding juices may precipitate proteins in the medical diet and makes it unappetizing.

A medical food for those who have difficulty digesting and absorbing nutrients.
At present, only one major brand, “Peptamen” (Nestle), has a characteristic effect: the use of some of the whey hydrolysate proteins, as well as the medium-length fatty acids (MCT) that the body absorbs more easily than conventional long-term fatty acids (LCT), making it easier to digest and absorb proteins and fats for older people. Suitable for patients with digestive and absorption problems, such as patients who undergo surgery, short bowel syndrome, or patients with liver or pancreatic disorders. This causes the digestion and absorption of nutrients (especially fat) abnormally. However, the effect of “Peptamen” contains some of the proteins that have been digested, Resulting in a taste that is not very acceptable, It is more suitable for food than oral drinking, but there are some elderly people who can accept it as well.

In the event that the elderly are unable to accept the taste of “Peptamen” and have no trouble absorbing the protein, it may be considered to opt for “Pan-enteral”. “Pan-enteral” is developed as a medical food for children who have difficulty digesting and absorbing fat, so they have about 50% of all fat. However, due to its relatively small protein content (12% of total energy), it is necessary to consider supplementing proteins from other sources so that older people get enough protein as well.

In summary, It can be seen that medical food products are specific to the disease. There are a variety of recipes. Various brands The choice is suitable for the elderly with the disease need to be considered individually, for example, elderly people with diabetics with kidney degeneration, nutrition assessment is required before the appropriate formula can be recommended. Therefore, before considering any medical diet, always consult your doctor and nutritionist/dietitian for the safety and efficacy that the elderly will receive.

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