In the journey of the aging process, poor appetite and unintentional weight loss often emerge as unwelcome companions for many elderly individuals.
While it is widely acknowledged that it is inevitable among older adults. I’m here to tell you that it is not a normal part of aging.
The decreased appetite and subsequent unintended weight loss experienced by elderly people warrants an investigation into the root cause. It can signify underlying medical problems that demand timely nutrition interventions.
Quality of life is negatively affected when older people are going through this and it’s important to ensure that the lack of appetite doesn’t lead to sudden weight loss and early mortality.
So if you have someone, an elderly with weight loss and no appetite, the first step is to find the real reason behind it.
Causes of Appetite Loss
Elderly appetite loss, medically known as anorexia of aging, is a common and multifaceted issue affecting a significant portion of the elderly population. More often than not there is an underlying cause that can be treated.
As someone ages, their nutritional needs and dietary habits can undergo various changes, often leading to appetite changes and subsequent challenges in maintaining proper nutrition.
This phenomenon is influenced by a complex interplay of physical, psychological, and social factors, making it crucial to understand the root causes in order to effectively address and manage this issue.
There are both physiological changes and external influences that play a pivotal role in shaping their nutritional well-being. Here’s the top ten causes of appetite loss to look at.
Effects of Appetite Loss
Appetite loss isn’t an isolated condition. Unexplained weight loss and sudden loss of appetite go hand in hand and both are detrimental to older peoples overall health.
When appetite loss is accompanied by rapid weight loss, it can lead to:
Mobility issues
Nutritional deficiencies
Social isolation
Increased side effects of chronic diseases
Emotional issues for family members
Higher mortality rate and early mortality
Loss of muscle mass
Body weight below health range
How to Start Evaluating Reasons for Appetite Loss
I will always recommend that a Dietitian is at the forefront of evaluating reasons behind appetite loss and weight loss.
A full nutrition assessment is needed in these scenarios, but using a mini nutritional assessment (MNA) or subjective global assessment (SGA) can be a useful pre-screening tool.
It is important that a Dietitian looks at all aspects of what could be contributing to the loss of appetite, come up with a formal nutrition diagnosis, and propose nutrition interventions that will tackle the root cause.
Here are some of the common areas that a Dietitian should look at:
Medical Conditions
An elderly person’s health is ever changing. Check over their list of diagnoses, they may have one or a combination of some that are progressively getting worse.
Perhaps they have a cancer diagnosis, maybe it was stable for a time but is now progressing.
Some chronic health conditions that can impact appetite and weight loss are:
Kidney failure
Thyroid disorders
Cancer diagnosis
Cardiovascular disease
Chronic pain
Parkinson’s disease
A patient may also have developed an infection (look at WBC lab levels). Infections may cause a temporary drop in appetite and overall condition. This can result in elderly weight loss.
Typically when the infection clears up, the patient stabilises back to their regular appetite.
Recent Surgery
Similar to infections, if a patient has a surgery, a hip fracture repair for example. Once they recover, their intake stabilises. Recovering from a surgery requires increased protein and calories to aid in repair.
Anticipating an individuals needs post surgery can really help to prevent issues down the road. Meaning put in place nutrition interventions such as protein powder, fortified foods, and higher calorie items to prevent weight loss before it starts.
Social And Family Issues
This is a tough one because the issues can’t always be dealt with. But there are some issues I have seen such as a recent death in the family, family isolation, family conflict that can contribute to decreased appetite.
Their food and fluid intake may be negatively impacted by social and family issues going on.
They feel social impacts just like the rest of us. So ensure you touch base with loved ones to see if something happened.
Dementia
Dementia is a progressive disease that will continue to get worse over time. The negative impact it has on nutrition is felt all throughout the diagnosis.
There are a few different forms of Dementia and each will have their own nutrition issues. Some common issues that can lead to appetite and weight loss are:
Increased pacing
Decreased focus at meals
Difficulty swallowing as it progresses
Decreased ability to manage eating
What we do know though is that we need to adapt a nutrition care plan to manage the symptoms associated with Dementia.
Mouth Issues
Mouth issues can include a variety of things to investigate such as:
- Dentures not being put in
- Dentures not fitting properly anymore
- Mouth sores from ill fitting dentures
- Mouth sores from medications/treatments
- Dry mouth from medications
All of these avenues need to be investigated. You can work with the Doctor and Nurses to get them to check if there are mouth issues with a patient. These will all contribute to weight loss in elderly patients.
Mental Health Issues
Mental health can severely impact and debilitate an individual’s ability and desire to eat.
Some mental health issues that may impact are:
Anxiety disorder
Depression
Schizophrenia
Bipolar disorder
If there is any serious health conditions such as these a Doctor should be involved in their care and addressing the issues.
Medication Side Effects
A variety of medications can impact the nutrition status of an elderly person. If you want a free list of common medications used in the elderly and a free resource on Food and Medication Interactions, click here.
Altered Taste Perception
Cancer treatments, dental treatments, and certain medications can cause severe changes to ones ability to taste. Check if there have been any new medications added or treatments, that may have changed their taste buds.
Meal Environment
A meal environment is almost as important as the food put on the table. If there is music, television on, loud people talking, they don’t enjoy who they’re sitting with, among other issues. Then the meal environment may need to be changed.
All of these contributing factors will reduce someone’s desire to eat.
Swallowing Difficulties and Dysphagia
While Dysphagia may not be a direct cause of appetite loss, the more difficulty someone has with eating. The less likely they are to want to eat if the problem is not dealt with.
If you are unsure of what exactly to look for to see if there is a swallowing difficulty, look at the meal time observation screen form here. If there are multiple checks during observation, then there is a swallowing difficulty.
Not Enough Activity
Any type of physical activity can work up someones appetite. Elderly individuals may not have the full capacity to do your standard exercises but there are still ways they can.
Working with a physiotherapist or rehabilitation aide can be a great way to come up with adaptive exercises.
Even a few bicep curls or leg lifts can help to work up an appetite.
Increasing Appetite
If you’re looking for my top 5 tips to increase appetite and prevent further weight loss. Check out the articles below!
Stimulating Appetite in Elderly: 5 Tricks to Help!
Beyond Restrictions: The Advantages of Liberalized Diets.
5 Tips for Managing Weight Loss in Long Term Care.
Here are some tips that can help to improve calorie intake:
1. Lifestyle changes including some physical activity.
2. Appetite stimulants, there are some prescription medications that can trigger hunger.
3. Ensuring high calorie healthy snacks are given between meals.
4. Oral nutritional supplement drinks between meals to increase calorie and protein intake.
5. Treating underlying mental health issues, see medical professionals for this.
6. Making sure all meals are high in calories, avoid large portions. Start with smaller portions and offer seconds after they finish.
7. Provide a distraction free eating environment.
8. Treat the underlying condition before expected improvements.
9. Be patient, appetite takes time to come back, it is a day by day journey.
10. If Alzheimer’s Disease or Dementia (generalized) is the cause, offer finger foods if they don’t want to sit.
11. If there are any chewing or swallowing issues have a speech therapist/speech language pathologist assess their needs.
Dietitian Takeaway Points
- Appetite loss and weight loss are not an inevitable part of aging
- There are 11 common reasons why an older adult may lose their appetite and weight. It’s important to evaluate all aspects to find out the root cause.
- Addressing appetite and weight loss means trying to prevent further weight loss. Weight gain may not always be possible, but weight maintenance may be the goal.
- Nutrition interventions should target the root cause of the appetite and weight loss.
- If you suspect appetite and weight loss are related to end of life, here are great articles for advice.
Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.
