Pushing The Plate Away: Why Loss Of Appetite In Elderly Is Common

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Loss of appetite in the elderly is a common problem. Older adults are often not hungry or complain of no desire to eat at all. Here’s an expert look at the problem and its solutions.

Anorexia of ageing can be defined as the loss of appetite or decreased food intake in elders. In medical terms, it serves as a prototype of a Geriatric Syndrome. It is an unavoidable side effect of ageing and several changes occurring with advancing age can facilitate its development. Age-related disease conditions, lifestyle habits, as well as social and environmental factors, may significantly impact dietary behaviours and nutritional status.

Risk Factors for Loss of Appetite

Physical Factors: In this case, loss of appetite can be related to physical impairment because mobility problems can interfere with cooking, procuring food and eating on one’s own. Loss of vision and hearing leads to the inability to shop and eat food. Mouth conditions, poor dentition, or ill-fitting dentures can make chewing difficult for many elders. Elderly people often have periodontal disease and many may be toothless, leading to difficulty in eating. Difficulty in swallowing may also occur due to gastrointestinal or neurologic disease, limiting food intake. Dry mouth and sores in the tongue/mouth can also cause decreased appetite. Also, a decreased sense of smell and taste in the elderly adds to it.

Medical Factors: Chronic medical problems may reduce the appetite or may interfere with eating. These include chest conditions like chronic obstructive pulmonary disease and heart failure. It also includes neurological problems like Parkinson’s Disease, Stroke any form of Dementia and psychological factors like depression. Those who have severe gastritis, nausea, vomiting and constipation will also have a loss of appetite. Infection and cancer can also be influencing factors. Arthritis which causes pain and leads to deformity may lead to difficulty in food consumption.

Medications may interfere with appetite too

Medications: The elderly could be taking many medications at one time leading to polypharmacy (concurrent use of multiple medications). Many of the drugs can cause loss of appetite like painkillers, antacids (Pantoprazole), etc.

Social and Functional factors: Some of these factors include living alone, social isolation and lack of social support. Poverty or incapacity to shop and inability to prepare and cook meals could also be the culprit. In many cases, the impairment to feed independently may cause a loss of appetite. Institutionalization could also lead to this.

Consequences of Loss of Appetite
1. Malnutrition
2. Frailty and Sarcopenia (loss of muscle mass)
3. Increased in the rate of death

How to Stimulate Appetite in the Elderly
It may seem like appetite just comes and goes mysteriously, but there are things you can do to help your elderly loved one increase their appetite. Try these tricks to stimulate appetite in the elderly:

• Create a routine. Encourage the elders at home to start eating at the same time every day. This can train the body and mind to expect and even look forward to an upcoming meal.

Make it healthy & yummy

• Pack in those nutrients. Seniors may find a big plate of food daunting, so instead of loading the plate and trying to get them to eat big portions, make sure that what they ARE eating is packed with good stuff, like vitamins, minerals, protein and complex carbohydrates. Even if the portion is small. Healthy fats like nuts, olive oil and whole milk dairy products can also raise the calorie count without adding a lot of extra mass to their plates.
• Eat with others. Depression and loneliness are associated with loss of appetite in seniors. Your loved one may enjoy mealtime more if they see it as an interesting social activity rather than a chore. If it is possible, offer to eat meals with them on a regular basis and encourage others at home to do so too.
• You can also encourage them to eat with friends who live close by, a few days in the week.
• Fight dry mouth. Dry mouth is a common side effect of medication and apart from being uncomfortable, it can also affect appetite. Ask older people facing this to use a mouth rinse, brush their teeth or chew sugarless gum before a meal to treat dry mouth and help their appetite return.
• Embrace finger foods. Shaky hands or loss of coordination, both of which make using utensils difficult, can cause seniors to reject their meals out of frustration or embarrassment. Try to cut their food into bite-sized portions that can be picked up and eaten by hand.
• Encourage healthy snacking. Sometimes, seniors may prefer snacking to eating full meals, and that’s OK. Help your loved one choose a variety of easy-to-eat, healthy snacks to keep handy.
• Drink meals instead. Many elderly people have trouble chewing. And others may prefer liquids and softer foods. Smoothies, whole-fat milk and soup work very well in this case. Bottled nutritional drinks like Ensure are also good options.
• Make it special. Create a lovely dinner or lunch setting for your older loved one. Use table linens in their favourite colours. Play some music if they like it. Creating a pleasant atmosphere may make eating more enjoyable for some people.
• Let them choose. People never want to be told what to do! To make a senior feel more empowered and make eating more appealing, get them involved in what they’re going to eat and how it’s going to be prepared.
• Suggest appetite stimulants. Some people have had luck with medications that stimulate appetite. These are available by prescription only and may not be compatible with other medication an elderly person already takes, so if they are interested in this option, encourage them to talk to their doctor and see if any options are available.


Drink your meal

Treating The Problem
Provision of palatable food with dietary variety and improved flavour may increase the food intake. A lot of our taste also depends on the look and aroma. Try to serve food that smells good like freshly made rotis, a steaming plate of rice or freshly baked bread.

Serve fresh food

Dietary restrictions must not be rigid in the elderly particularly in those who are under-nourished and losing weight.
Choose the right diet for an elderly with slowed gastric contractions — it should be low in fat and fibre, which delays the transit of food through the stomach. It should also contain soft foods in small portions.

Assistance During Eating

Some elderly might need assistance with eating. You can help by cutting food into bite-sized pieces, opening packets, dipping the idli in sambar, buttering bread and aiding with utensils. A feeding tube may be an option for some patients such as those with dementia or nearing the end of life, but the patient’s preference must be respected.

Adaptation to Environment

Older adults eat less when they are depressed. Hence depression must be treated to prevent anorexia of ageing. The elderly, particularly those living alone, can socialize. Family-style diners have increased appetite and they gained body weight with improved quality of life.

Medications
It may often be necessary to change, stop or reduce the doses of Medications associated with anorexia There are many medications which can cause anorexia, the doses of these might have to be reduced or changed. In some cases, the medication will have to be stopped. It may also be due to medical conditions and therefore, treating the medical causes of loss of appetite is important.

Nutritional Supplementation
Nutritional supplementation in the elderly improves calorie intake and reduces the risk of malnutrition.

Specific treatment of Loss of Appetite
There is no specific agent to improve the appetite in old persons. Most agents are of limited use.

Loss of appetite is an important problem and a specific care plan needs to be devised for it. The risk factors may range from medical to social so you need to get every aspect thoroughly looked at.


Liked this story? You may also like to read: Why Do You Need To Visit A Geriatrician

About Author

Dr Naganath Narasimhan Prem

Dr Naganath Narasimhan Prem is MBBS, MD Geriatric Medicine and Consultant Geriatrician, Elderly Care Specialist at Jaslok Hospital and Research Center, Mumbai. He also heads the dedicated one of its kind Geriatric Care department at Jaslok Hospital and is passionate about spreading the word on the importance of geriatric care management and services for senior citizens.