Appetite Loss in the Elderly

Appetite loss is common in the elderly. Anorexia of aging occurs in over 20% of the geriatric population (1). 

This article will explain why this occurs in the elderly and ways to combat this frequent problem. 

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What is Anorexia of Aging?

Anorexia of aging is the age-related decline in appetite and intake, even without the presence of illness. 

It is the decreased drive to eat (2). This can lead to weight loss and protein calorie malnutrition. 

Causes

Medical reasons, lifestyle, disease processes, psychological issues, and medications can all contribute to geriatric loss of appetite. 

Causes of anorexia of aging include (3, 4, 5): 

• Decreased sense of hunger
• Early satiety (fullness)
• Declined smell and taste
• Delayed stomach emptying
• Depression and/or anxiety
• Dementia
• Social isolation
• Hormonal changes
• Medications
• Swallowing problems
• Poor dentition
• Oral health issues 
• Diseases affecting activities of daily living (ADLs)
• Constipation
• Restrictive diets
• Poverty
• Malabsorption  
• Cancer
• Pulmonary disease such as COPD
• Cardiac issues 
• Gastrointestinal impairment 
• Alcoholism
• Grief
• Incontinence 
• Financial constraints 
• Decreased saliva secretion
• Digestive issues
• Inflammation

Risk Factors for Appetite Loss

Many risk factors for anorexia of aging exist. There are physical, medical, pharmacological, and social elements increasing the risk of appetite loss in the elderly (6). 

Physical

• Difficulty feeding self
• Inability to get groceries 
• Unable to cook or prepare food
• Hard of hearing
• Poor dentition 
• Visual impairment 
• Swallowing difficulties

Medical

• Gastrointestinal disorders
• Malabsorption syndromes
• Infections
• Thyroid disorders
• Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD)
• Dementia
• Parkinson’s disease 

Pharmacological

Many medications have side effects that impact digestion, absorptions, and appetite. 

Social

• Living alone
• Low socioeconomic status
• Being institutionalized

Consequences of Poor Appetite

Loss of appetite can lead to negative health consequences in the elderly (7).

Malnutrition

Anorexia of aging leads to inadequate nutritional intake. Over time this leads to malnutrition. Read Protein Calorie Malnutrition to learn more. 

Frailty

Prolonged loss of appetite and inadequate intake leads to reduced activity, muscle mass, and strength. This results in poor endurance and decreased mobility (8). 

Frailty leaves the elderly at increased risk for falls and fractures. More help with activities of daily living (ADLs) may be needed. 

Mortality

Poor appetite and therefore inadequate intake increases risk for death in the elderly. 

Pressure Ulcers

Poor appetite and inadequate intake can lead to impaired skin integrity. Pressure ulcers (bed sores) can lead to infections, pain, increased time in bed, and declined quality of life. 

Declined Quality of Life

All the consequences of anorexia of aging discussed above can negatively impact the quality of life of the elderly. This especially is true when independence is negatively affected. 

Anorexia of Aging Treatment

A combination of different interventions can be used to help stimulate appetite and combat the consequences of anorexia of aging (9). 

When decreased appetite is identified, early treatment can be more effective at preventing weight loss (10). 

Education

Discussing the importance of adequate nutrition with the elderly and their caregivers can help motivate them to eat more despite lack of appetite. 

Physical Activity

Encouraging physical activity can help reduce loss of muscle mass (11). It may also help “work up” an appetite.  

Feeding Assistance

Seniors may need assistance with eating and drinking, especially during appetite loss. Many disease processes impact feeding ability. 

When feeding ability starts to decline, adaptive eating equipment can be helpful to continue to promote self feeding. Occupational therapy (OT) can work on improving feeding ability as well. 

Shop Amazon for all your adaptive eating equipment needs.

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Cutting up meats, applying condiments, and offering finger foods are good places to start if self feeding is beginning to be an issue. 

Poor appetite may lead to lack of motivation to self feed. Providing encouragement, cueing, or even physical assistance with eating can promote intake. 

Flavor Enhancement 

Taste diminishes with age so food may need extra seasoning to even taste like anything. 

Using herbs, spices, sauces, and other flavor enhancers can make foods more appealing. Some ingredients and condiments may also add additional calories, such as cheese, gravy, and sour cream 

While salt does have some negative health consequences, if it improves oral intake then the benefits likely outweigh any potential risks.  

Food Variety

Try a variety of foods in small portions at meals. Different colors and textures at meals can visually stimulate appetite. 

Small, frequent meals and snacks may also increase intake. Keep foods and beverages accessible throughout the day. 

Offer a few meal options so they have some control over food choices. Incorporate favorite foods. 

Oral Nutrition Supplements

While oral nutrition supplements may not directly improve appetite, they can provide additional calories and protein during times of appetite loss. 

These nutrition drinks can help meet nutritional needs to reduce bed sores, malnutrition, and improve quality of life (12). 

Encourage supplements between meals to avoid filling up on liquids instead of foods at meals. Or offer after a meal if intake is poor. 

Try adding to coffee instead of creamer or make hot chocolate with it. Offer some when giving medications. 

Many brands of supplements are available and most are of comparable nutritional value. Make taste preference, acceptance, and affordability the priority over specific brand names. 

Mealtime Environment

Try family style dining. Seeing others eating can help increase food consumption. 

Play soft music. Turn off the television to avoid unnecessary distractions. 

Offer to cut up foods and apply condiments. Serve a variety of colors on contrasting plates. 

Fortified Foods

Add additional ingredients to enhance flavor and provide additional calories and/or protein.

Mix in cheese, sour cream, cream cheese, butter, powdered milk, cream, sugar, or gravy for added calories. These extra ingredients can also improve taste and therefore increase intake. 

Medications

There are medications that can stimulate appetite, however they are not without negative side effects. 

They are typically used as a last resort and are closely monitored by the healthcare team. 

Medications may need to be indirectly used to treat root cause of appetite loss, such as laxatives for constipation or antidepressants to treat mood disorders. 

Practical Takeaways

Appetite loss is common in the elderly. There are strategies that can be used to increase nutritional intake to prevent negative health consequences associated with anorexia of aging. 

Encourage, feed, season meals, offer favorite foods, provide supplements or fortified foods are among some of the things you can try. 

*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you.