As people age, they can experience a decline in appetite. Among seniors living in a community (versus an institutional setting), the prevalence of poor appetite ranges from 15% to 30% .
This can be worrisome for caregivers or family members for a few reasons. A loss of appetite in elderly people can lead to malnutrition. This, in turn, can lead to a weakened immune system and decreased bone mass, which can increase the risk of injury from falls and fractures.
A lack of hunger can also cause unintentional weight loss in older people, which is associated with increased illness and mortality.
Despite its impact on health outcomes, however, loss of appetite in elderly people is not routinely assessed, and the causes remain insufficiently understood. It can help to have a wide perspective on potential causes and nutritional impacts so you know what kind of care you may need to seek to protect your loved one.
Common Causes of Appetite Loss in Elderly People
Appetite can wane for several reasons. Natural age-related changes, including sensory functions, can lead to a diminished appetite. Psychosocial factors such as depression, grief, loneliness and isolation can also lead to loss of appetite in older adults.
Other times, appetite loss is associated with a medical issue. Here are a few conditions that can reduce appetite:
- Frailty
- Cancer
- Diabetes
- Dementia
- Chronic kidney disease
- Chronic obstructive pulmonary disease
- Heart disease and heart failure
- Hepatitis
- HIV
- Underactive thyroid
Some medications may suppress appetite or interfere with nutrient absorption. Others may cause nausea or affect the sense of taste.
Sometimes a disinterest in eating isn’t due to appetite loss but a physical challenge:
- Chewing and Swallowing Difficulties: These not only include dental issues but having trouble swallowing, known as dysphagia, which affects 10% to 33% of older adults. It usually occurs in those who have had a stroke or have a neurodegenerative condition such as Parkinson’s disease.
- Mobility Issues: Limited movement, whether a result of injury, arthritis or another issue, can make meal preparation challenging and decrease interest in regular eating, leading to a decline in necessary nutrients.
Regardless of what may be the root cause, it may be a good idea to mention appetite changes to your loved one’s medical provider so they can assess and treat potential causes.
Loss of Appetite in the Elderly: Special Dementia Issues
Memory loss, decreased verbal ability and confusion can have a significant effect on appetite and hunger. It may be a problem simply to remember to eat.
Some people with Alzheimer’s disease may not be able to ask for the foods they’d like to eat. They also may not be able to describe to their physician the symptoms impairing their appetite. It’s little surprise, then, that weight loss is common in the intermediate and later stages of Alzheimer’s.
Nutritional Impact of Loss of Appetite in the Elderly
The nutritional consequences of the loss of appetite in elderly people include:
- Protein-Energy Malnutrition (PEM): Loss of appetite often leads to insufficient protein and calorie intake. PEM causes muscle wasting, weakness, and compromised immune function.
- Micronutrient Deficiencies: Diminished appetite can decrease the intake of vitamins and minerals, leading to deficiencies (especially in vitamin D, varieties of vitamin B and zinc). These deficiencies can adversely impact various aspects of health, including bone health, immune response and cognitive function.
- Dehydration: Poor fluid intake because of appetite loss increases the risk of dehydration. Dehydration affects cognition, kidney function and overall well-being.
You can often avoid these consequences by enlisting the help of a health care professional. They can assess individual needs, recommend personalized dietary modifications and address specific deficiencies.
Addressing Loss of Appetite in Elderly Loved Ones: Tips for Caregivers
You may be able to improve your loved one’s appetite by changing how you prepare and serve meals and snacks. Often, interest in eating is just as much about the atmosphere as the food.
General Mealtime Strategies
- Keep It Calm: Make mealtimes comfortable and stress-free, avoiding digital distractions like smartphones, tablets or TV.
- Keep It Simple: Use basic table settings — unless your loved one genuinely prefers formal table service.
- Pay Attention to the Preparation: The texture and appearance of food can influence how appetizing it is.
- Cook and Bake When You Can: Often the smell of something being made fresh, such as baked bread or stir-fried vegetables, can stimulate an appetite.
- Personalize the Experience: Pay attention to your loved one’s unique needs, routines, likes and dislikes at mealtimes. Keep in mind these preferences may change with age or with certain medical conditions.
- Offer a Few Different Choices: Create something like a tapas plate or dim sum, and let your loved one pick and choose.
- Cook Together: Involve your loved one in preparing the meal to keep them engaged. This can give you an opportunity to assess how able they are to prepare their own meals.
- Show Respect: Honor their decisions, such as preferring dessert first. Refrain from nagging and instead encourage eating when they’re feeling good.
- Make It Fun: Food is a powerful memory cue, and memory can trigger appetite. It may help to bring up mealtime experiences you and your loved one shared.
Practical Tips for Eating
Sometimes, the problem isn’t loss of appetite in elderly loved ones but that the act of eating is too challenging. You can try overcoming this with several tactics:
- Modify Food Consistency: Consider softer options such as milkshakes, smoothies or warm soups if chewing or swallowing is difficult. Many foods can be minced, mashed or pureed without affecting flavor.
- Serve Smaller Portions: Less food presented all at once can make eating feel less daunting. Also consider serving finger foods like falafel or a fruit and veggie plate that are good for snacking without a time pressure.
- Take Bites Before Drinks: It can help to encourage eating foods before filling up on liquids. But do make sure water or preferred liquids are available to help with swallowing and encourage hydration.
- Be Patient: Observe social and behavioral cues and offer more food when they’re ready for it. Don’t rush your loved one to clear their plate.
- Communicate Clearly: Talk with your loved one in a way they understand and welcome. For those with cognitive issues, consider using visual aids for clarity about what’s being served or what they’d prefer.
- Adjust as Needed: Meal frequency doesn’t have to be scheduled or at traditional times of the day. Consider smaller but more frequent meals.
Also consider stocking up on healthy basics. For example, you may want to keep fresh fruit and cereal on hand. These are easy to prepare and can help your loved one get the fundamental nutrition they need. Eggs are another solid staple and a good source of protein that can be readily eaten or added to other foods.
Medications and Interventions for Appetite Management
Sometimes the loss of appetite in elderly people requires a medical intervention recommended by and under the supervision of a health care provider. These prescription medications can be used to stimulate appetite, but always consult with a medical provider first to learn more about how these medicines work and if they are appropriate:
- Megestrol Acetate (Megace ES): This is used to stimulate appetite and manage muscle and fat wasting in adults with AIDS and is sometimes provided to people with cancer.
- Dronabinol (Marinol, Syndros): This drug contains synthetic THC, an active ingredient found in medical marijuana. It’s officially approved for AIDS-related anorexia and chemotherapy-induced nausea.
- Oxandrolone: This is an anabolic steroid used to treat muscle-wasting conditions.
- Mirtazapine (Remeron): This is an antidepressant sometimes taken off-label to boost appetite.
Over-the-counter nutritional supplements used for appetite stimulation include Omega-3 fatty acids, zinc supplements and ginger. Some supplements include ghrelin, a natural hormone that signals hunger in the brain and stimulates appetite. Nutritional supplement drinks may also help with sufficient calorie and protein intake. While prescriptions for these commercial products aren’t needed, you should consult with your physician about any potential medication interactions or contraindications.
Always work closely with your loved one’s health care professionals, even if you’re just using supplements. They will tailor treatment based on your loved one’s health history and are knowledgeable about potential drug interactions. Regular check-ups are essential to assess effectiveness, adjust dosages and manage side effects.
If your loved one still doesn’t eat enough, a feeding tube can help them get the calories, nutrients and hydration they need. This will not prevent them from eating or drinking by mouth when they feel like it. If this feels like the right decision, you and your loved one should talk to a health care provider who can assess medical needs, comfort and quality-of-life considerations
Loss of Appetite in Elderly Loved Ones: Complex but Manageable
From implementing practical mealtime strategies to seeking pharmaceutical interventions to considering medical interventions, the approach to managing loss of appetite in elderly people must be holistic and tailored to individual needs. It’s deeply personal, and it can be challenging.
But you are not alone on this journey. From caregiver support groups to health care professionals, resources abound. You can reach out to a registered dietitian, a geriatric specialist, a family doctor or other professional. Ask them how they mitigate loss of appetite in elderly patients and discuss several potential strategies.
You can also stay informed by reviewing the list of resources for caregivers.
The more you know, the more perspective you have to identify appetite loss in your loved one and the more ideas you have to enhance their health and quality of life.
Resources for Caregivers on Loss of Appetite in Older Adults
- AARP: Meal Planning for an Older Adult at Home
- Administration for Community Living, part of the U.S. Department of Health and Human Services: Caregiver Nutrition Education Toolkit
- Alzheimer’s Association: Food and Eating
- Alzheimer's Society: Improving the Eating Experience
- American Heart Association: Cooking Tips for Caregivers
- Mayo Clinic: Consumer Health: Nutrition Challenges for Seniors
- Mount Sinai: Appetite-decreased
- National Council on Aging: Healthy Eating for Caregivers
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