This article follows on from our recent article on the “Food First Approach” to optimising nutrition for the aged care industry.

Some residents are not able to meet their nutritional requirements with food alone and require nutrition supplements. 

As the term suggests, nutritional supplements are used to ‘supplement’ the diet, not to replace it. Supplements are most effective when they are used in conjunction with a High Energy High Protein (HEHP) diet. 

For a Dietitian working in Aged Care, supplements are usually recommended when all options to achieve a nutritionally complete and calorically adequate diet from foods first, have been trialled. 

If supplements are prescribed, ideally by the Dietitian, consider the following tips to maximise their effectiveness:

• Provide small doses as part of the medication rounds. 
• Sometimes, supplements are more easily taken if they are viewed as a medicine rather than a drink.
• If possible, encourage residents to use them to take their medication instead of using water. 
• If supplements have been prescribed for mealtimes, it is best to give them at the end of the meals, so that they will not affect appetite for the meal.
• If supplements have been prescribed for mid meals, it is best not to serve tea/coffee/another drink at the same time. Residents may become overwhelmed with multiple drinks, or, forgo the supplement in favour of the more familiar drink. It is recommended that residents complete their supplement before offering them other drinks.
• A supplement is not a meal – if supplement drinks have been prescribed for morning tea/afternoon tea/supper time, residents should still be offered a food snack as well, just like everybody else.
• Monitoring – if supplements are left with a resident to complete, ensure that you check on them periodically, as they may need prompting. If supplement work logs are in place, ensure that staff record how much of each supplement dose has been completed each time, so that adjustments can be made as required when supplement reviews are conducted.
• Review Supplements regularly– it is recommended that residents on supplements be reviewed every 6-12 months to ensure that their prescription is appropriate. A referral to the Dietitian is also recommended if someone on regular supplements has reached their weight goal, or if they have consistently refused their supplement. 
• There are many supplement products available, in a number of forms. Sometimes it is a matter of “trial and error” to find one that the resident likes. If the resident dislikes a supplement because of its flavour, check to see what other flavours that particular supplement comes in and if unsure, refer to the Dietitian.
• Give supplements exactly as prescribed – the supplement and dose has been specifically selected by the Dietitian for each resident as charted – do not use supplements interchangeably. Supplements may look like different flavoured drinks but they each have different indications, contraindications, and different nutritional profiles. Treat supplements like medications – don’t swap the supplement or change the dose without advice from your Dietitian. 
• Audit supplements usage– If your facility’s spending on supplements is increasing, it may be worthwhile investigating use and dosage – are only those residents prescribed supplements receiving them or are other residents receiving them as well? Are staff measuring out the correct doses?  A 60 or 80mL dose is 1/3 of a bottle/tetrapack yet often residents are given half a bottle/tetrapack – this discrepancy adds up over time and can lead to escalating supplement costs. 

Supplements are expensive, so it is important to avoid wastage as much as possible. 

While it is ideal for residents to be able to meet all of their nutritional requirements with food, sometimes, they are unable to eat and drink adequately for this to occur. There is a place for nutritional supplements, however, care should be taken to ensure that they are used appropriately to maximise their effectiveness. 

For more information or assistance with implementing any of the recommendations listed, please contact Food Solutions Diet Consultants or your Food Solutions facility Dietitian.