Understanding “resistance” to using oral nutritional supplements in older adults

Malnutrition in older adults is increasingly common, linked in part to loss of appetite. Treatment typically involves “food-first” approaches (adding energy-dense ingredients to food), followed by oral nutritional supplements (ONS: liquids/semi-solids supporting energy intake with macro- and micro-nutrients) if food-first is not successful. These strategies, however, are often resisted by older adults. Therefore, this study examined healthy adults' (n = 454, Mage = 47, female = 230) views on using food-first and ONS to prevent and treat malnutrition. Willingness to consume was assessed using visual analogue scales. Participants reported their preferences for personal use and for others, for prevention and treatment of malnutrition. Fear of eating novel foods, food choice motives and attitudes towards taking both methods were also assessed, along with open-ended responses to scenarios in which the participant made treatment suggestions for a relative with loss of appetite. Participants were more willing to consume food-first than ONS both to prevent and treat malnutrition, with older adults much less willing to consume either method to prevent malnutrition than to treat it. This was supported by content analysis illustrating that food-first is perceived as “natural”, with ONS as “medicinal”. Specific attitudes relating to “not seeing the point” or “valuing the benefits” of each method were the strongest predictors of willingness to consume, decreasing and increasing willingness respectively. Food choice motives and food neophobia were not significant predictors. These findings indicate a preference for food-first over ONS and clear age differences in attitudes towards taking each nutrition method. This suggests that ONS could be framed as supporting health and nutrition, rather than solely as a medicine for treating malnutrition.