Getting a senior to eat can be a difficult task when you don’t understand the underlying cause.  Appetite loss can result in unintentional weight loss, malnutrition, decreased quality of life, health complications, and early mortality if not dealt with.  We can focus on stimulating appetite in elderly through the tips in this article! Keep reading to find out more.

5 Tricks to Stimulating Appetite in Elderly

Sometimes appetite loss in the elderly can be an acute problem that will resolve itself.  Other times we need to look a little deeper at why appetite loss has happened in the elderly.  Nutrition interventions in appetite loss in the elderly can require more than one approach. 

Let’s take a deeper dive into causes of appetite loss in the elderly.

Causes of Appetite Loss in Elderly

Change in Medical Status

Appetite loss can be a natural result of ageing in the elderly.  But change in medical status can impair appetite.  

Look at the following changes in medical status as a cause of appetite loss in the elderly:

– Recent surgery (hip fracture repair, hernia repair, invasive explorations (colonoscopy), dental surgery)
– New diagnoses (may have been a long-standing issue) such as cancer, tumour impacting nutritional status
– Pneumonia, recent bout with Aspiration
– COPD, CKD, CHF, etc, that are now progressing closer to end stages.
– Urinary Tract Infection

Advancing medical conditions can have an impact on nutritional status in the elderly.  You will try to manage their nutrition with the tips below.

Infections can cause a sudden appetite loss in the elderly.  The team should be aware of sudden changes in medical status and will likely check for an infection if suspected.  

Sensory Changes

You cannot avoid sensory changes with ageing.  

With ageing the elderly have a decrease in vision, taste, hearing, and smell, all impact their nutrition.

Much of these are managed with inventions of our age (hearing aids, glasses).  But taste and smell need to be managed with quality food for elderly with no appetite.

Cognitive Decline

Dementia affects up to 69% of elderly patients¹.  Dementia can affect an elderly person’s ability to focus at meal times, stay seated, use utensils, eat independently, as well chewing/focusing.

Obviously we cannot manage the rate or effect of Dementia on an elderly person.  But we can manage a nutrition care plan to reduce the effects.  

Dentition

Dental status is another big area that needs to be monitored in the elderly.  Whether an elderly person has their own teeth, dentures, partials, or no teeth at all.  It is a constant area to be monitored.  

I have seen too frequently an elderly person seemingly having a decreased appetite and no one knowing why.  Then upon further examination, they have a severe dental impaction or infection.  Teeth infections can cause severe pain, and is a reason for appetite loss in the elderly.  

Make sure that you are having this checked by someone on the team!

Change in dental status in general needs to be monitored.  Look at:

Ill fitting dentures
Dental infections
Dentures not being put in
Teeth falling out

These all impact food intake in the elderly.

Depression

As a nutrition professional, I cannot speak to this area too in depth.  I would consult the Medical Doctor if you suspect this may be affecting intake. 

Up to 29% of elderly persons in long term care are confirmed to have a diagnosis of depression².  Research does show that elderly depression can affect nutritional behaviour and dietary intake, and it is highly affected.

Depression does create appetite loss in the elderly, and it needs to be checked.

Pharmacological

Many, many, many medications affect nutrition in the elderly!

They can alter taste, smell, create nausea, constipation, and diarrhoea in the elderly³.  There is some research that suggests increasing medications is associated with decreased fibre intake in the elderly⁴.  If fibre intake is decreased this can lead to constipation and resultant increased medications to manage. 

If you want a free list of food and medication interactions, click here, to see a free resource.  This free resource is a list of frequently used medications in the elderly, as well the nutrition effects that should be monitored.

Stimulating Appetite in Elderly

Stimulating appetite in elderly can be a complex topic, so let me break it down for you.

First of all, you need to investigate the reason that their appetite is low.  Investigate the underlying cause.  The starting point is always to discuss with the elderly person, or their loved ones.  

You can uncover a lot by having a discussion.  From the list above of causes of appetite loss in elderly, we can address many of those!

Depression, Pharmacological, Infections, if noted, will be dealt with by the attending Doctor.  Dentition, depending on the cause (is it loose dentures? Loose teeth?).  Perhaps the team needs to look at either getting dentures fitted again, or a dental visit.

Sensory issues are an individual thing.  You need to ensure that built into the care plan are certain things regarding their sensory aids.  For example: Is a patient independent if they have their glasses on?  Staff need to ensure that the patient has their glasses at meals!  

But let’s take a look at the 5 tricks to stimulating appetite in elderly, outside of the above.  

High Calorie Food for Elderly

If an elderly person has appetite loss, you want to, get the most bang for your buck.  The times that they do eat, you want the foods to be very high in calories.

To increase calories in meals you can add:
Butter (add to whipped potatoes, oatmeal, bread)
High fat creams to soups
Ice cream to smoothies (create your own in house recipes! – you don’t just have to provide supplements)
Cheeses (Can be whipped into potatoes, soups, grated on top of foods)
Ground Nuts (Can be added as a coating to meats, in baked goods)
Whole milk to drink
Add protein powders to various meals
Adding skim milk powder to cereals (oatmeals, cream of wheat)
Add brown sugar to cereals

Fortifying foods in the elderly can help to increase the amount of calories in each bite.  You can also look at increasing the protein if they aren’t meeting their needs there either.  I find the easiest way to add protein is through non-meat sources.  I find they tend to be accepted more than simply trying to add in more chicken throughout the day.

Drink Supplements for Elderly

Nutritional supplement drinks are an obvious addition to the list of stimulating appetite in elderly. 

There is a wide variety available from juices, two calories per mL, high protein, chronic disease adjusted drinks, and much more.

If you are finding availability difficult and your supplier is constantly shorting you, I suggest finding a new supplier.  There are enough companies out there that can provide products on time and in sufficient quantity.  

Shop around with suppliers and products.  Most companies will allow you to acquire samples.  Test them out with the elderly to find what suits your patients and facility best.

For delivery of nutritional drink supplements, I suggest avoiding them being delivered with meals, or around meal times.  Evidence suggests that nutritional supplement drinks for the elderly should be given between meals to increase intake.  If delivered at meals, it will decrease the intake of food, which defeats the purpose of implementing.

Finger Foods for Dementia Patients

At times patients with dementia can have a difficult time staying seated at meals.  The extended time it requires to focus at meals can be taken for granted by those who don’t have dementia.  

We need to remind ourselves that dementia is a progressive disease.  Their nutrition care plan will be ever evolving with time.  If they continue to be mobile and do not have difficulty chewing/swallowing, finger foods can be a great alternative.

Finger foods for dementia patients can be a great way for them to take food ‘on the go.’  Foods such as:

Sandwiches
Cheese slices
Breaded meats/fishes
Crackers
Soups served in a mug with a lid (Cooled down)
Smoothies
Sausage patties
French toast

Think about foods that won’t need a utensil to be a non-messy food.  We want to present food in a manner that respects their dignity while also allowing for their cues to lead the way.  

With dementia, it may not be that they necessarily lost their appetite, their disease may just be altering the focus.  We can provide gentle cues and reminders to eat.  We can also hand them food as they walk around, granted that it is safe to do so.

Healthy Snacks for Elderly

With appetite loss in elderly we need to look at instituting smaller, more frequent meals and snacks in the day.  

Outside of regular meals (and tips discussed above), snacks between lunch and supper, and between supper and bedtime, can be implemented.

Some great snacks to include are:

Egg & Tuna salad sandwiches
Cheese and crackers
High calorie cookies (In house recipes!)
Smoothies (Again, a great thing to implement!)
Cottage cheese & fruit
Pudding (Can add in skim milk powder to increase protein)
Cheese sticks

You want to individualise the snacks, ask patients what they want.  You’re more likely to have compliance and intake if they choose.  You can also ask family members/loved ones what the elderly person enjoys.  If the facility cannot provide, the family can bring it in!  Get them involved in the appetite issue as well.  

Increased Frequency

We’ve talked about this above, but we really need to be flexible in this area.  Dietary patterns change as we age, some research suggests this is related to quality of life, but evidence isn’t concrete yet.

Providing food frequently through regular meals, and snacks, may help to increase caloric intake daily.  If intake is insufficient at meals, snacks can help to compensate for that.  It also provides flexibility in timing of foods provided.

Conclusions

We all need to be flexible in the food and timing that is provided to elderly persons.  There are many factors that are working against us with appetite loss in elderly persons.  

I get asked frequently about medications to combat appetite loss in elderly persons, and I purposely left it out.  I haven’t been able to find concrete research suggesting that these work.  There is anecdotal evidence, and some RD’s have found they work.  

That being said, I try to stick with evidence based research here.  The Food and Drug Administration, as far as I can see, hasn’t prescribed medications as an appetite stimulant in elderly persons.  Some are used to treat depression, and a side effect may be increased appetite.  But in that case, a patient would need to be diagnosed with depression to take the medication.  It shouldn’t be prescribed just for appetite increase.

As medications aren’t my area of expertise, because I’m a Dietitian, I’ll leave that area for now.  I recommend if you think that it may help, speak with the patient and their Doctor to evaluate the option.

Tackling appetite loss in elderly persons is of the utmost importance due to the negative health effects of not!