How to Improve Appetite in Seniors

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These resources were made possible due to an unrestricted educational grant from Ensure.

How to Improve Appetite in Seniors was written by Rosanna Lee, RD | May 2022

Approximately 1 in 3 seniors in Canada has difficulty meeting nutritional needs.  Declining appetite may be one of the most common characteristics of aging. This phenomenon was first coined in the 1980s by researchers as the “anorexia of aging.” Changes to the body’s physiology, psychological functioning, social environment, presence of acute or chronic illnesses, and medication use are all known to impact appetite. Long term poor appetite can lead to lower energy and nutrient intake, increasing the risk for unintentional weight loss and malnutrition. Consequently, this increases one’s risk for frailty, falls, hip fractures, muscle weakness, bone decline (osteoporosis, osteomalacia), skin breakdown, pressure sores, longer length of hospital stay, and mortality. There could also be impaired wound healing, poor immune function, and reduced quality of life.

Physiological Factors

Digestive system

  • Reduced saliva production may be a side effect of some medications. Lack of saliva may affect food bolus formation and make swallowing uncomfortable and thus impair appetite. Adding moisteners (sauces, gravies, dressings) and drinking fluids can help with swallowing ease. Artificial saliva may also be considered.
  • Poor dentition and use of ill-fitting dentures may cause difficulties with chewing due to pain or discomfort, which impacts appetite. Progressive muscle loss with aging can sometimes cause changes to the shape of your face, including your jaw. With frequent use, dentures can also be worn out so regular check-ups with the dentist/ denturist are key to good oral health and hygiene.
  • Dysphagia can challenge swallowing and impair one’s appetite and motivation to eat. If you have dysphagia, it is best to speak with you Speech Language Pathologist for individualized guidance. You may be recommended to go on a texture-modified diet or a different fluid consistency to support swallowing safety. Appetite/ intake may decline with these changes so think about enticing the other senses (i.e., food colours, shape, aroma, plating, food pairings, ambiance – music) to stimulate appetite.
  • Slowed digestion also happens. Food remains in the stomach longer, resulting in prolonged satiety. Meals may need to be spaced further apart.
  • Constipation may reduce appetite. It may be exacerbated by medications, lack of dietary fiber and fluid intake, and inactivity. Increase vegetables, fruits, whole grains, plant-based proteins or include dietary fiber supplements to support bowel regularity.

Hormones

  • Hunger hormones known as “ghrelin” may be lower among seniors, while leptin, the “satiety hormone,” are higher at baseline.
  • Fasting and post-meal levels of cholecystokinin (a hormone made in the small intestine that controls appetite, reduces the rate that food empties from the stomach, and increases sensation of short-term fullness) is increased.

Disease activity or progression

  • Acute infections/ illnesses may impair appetite (i.e., heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, chronic liver disease, cancer, dementia, and Parkinson’s disease. Chronic disease can further impair one’s dexterity and cause pain, which can associate with poor appetite. Good disease and symptom management are key to supporting quality of life and good intake.

Altered or blunted sense perceptions (taste, smell, vision, touch, hearing)

  • These senses help us enjoy food and the meal experience. When senses are impaired, it can change the way we respond to food, particularly with smell and taste. As vision changes, it may reduce the visual appeal of food. Try to utilize the remaining intact senses (i.e., if vision is lost, consider using various spices/ herbs/ seasonings to entice smell and taste).

Reduced energy needs

  • Physiological changes to the aging body results in changes to body composition, particularly in muscle. Reduction in physical activity means that energy needs may be lower, leading to reduced appetite. Consider physical activities that are enjoyable to motivate movement (i.e., walking the dog, gardening, tinkering in the garage, yoga).

Psychosocial Factors

Our environment and mood can affect appetite just as much as the physiological changes.

Depression

  • According to the Centre for Addiction and Mental Health (CAMH), depression is a biological illness caused by chemical imbalances in the brain, affecting one’s thoughts, feelings, behaviours, and physical health. It can be triggered by sadness (i.e., a loss of a loved one, loss of vision or hearing), but it can also be caused by medical conditions (i.e., cancer, stroke, or Alzheimer’s disease) or symptoms of pain. Medication and alcohol use can likewise cause depression. It may also develop for no apparent reason. Depression requires both medical and social interventions. Ways to combat depression may involve family/peer support, counselling, staying connected to community and support resources (i.e., seniors day programs), preparing food and eating together/ congregate dining, creating an environment of enjoyment/ comfort like including favorite foods/ treats, improving ambiance (i.e., music, setting) and customizing meals to cultural/ religious food preferences.

Dementia

According to the Alzheimer’s Society, a person with dementia may lose interest in eating. Many causes are like the physiological factors mentioned earlier. They may have physical limitations like difficulty with picking up food, chewing or swallowing. It may also be related to depression, difficulty communicating with care providers (i.e., they may dislike a particular food, or they may be unsure what to do with the food), pain (discomfort of the body or in the oral cavity), fatigue and concentration (tiredness can reduce appetite to eat or impair mealtime concentration). Persons with dementia may consider behavioural strategies by working with an occupational therapist. This may include use of shortened instructions, visual and verbal cueing, or using support tools to optimize function and independence for eating.

Loneliness and Social Isolation

  • Living and eating alone can cause appetite reduction. This may be driven by a lack of social support to shop, prepare, and cook meals, resulting in less motivation to eat. The experience is not as enjoyable and there are fewer cues to encourage appetite and intake. Thus, community social groups, having personal support workers or home care supports, and using community meal delivery services may help.

Portion sizes

  • Larger portions may be unappetizing for some. Considering the physiological process of aging impacting appetite and the changes to seniors’ daily routine, the schedule of eating may need to adapt to new meal patterns and changing food preferences over time. Smaller, more frequent meals and snacks with greater nutrient density can be used to support needs and accommodate early satiety. Oral nutrition supplements may need to be added or mixed into homemade recipes to support nutritional needs, particularly protein and calories. Registered dietitians can review intake patterns and provide individualized goals and strategies to support weight and healthy aging.

Medications

Some medications are known to cause changes to taste and smell and may also cause nausea and impair appetite. Notable ones include antibiotics, antivirals, Parkinson’s medications, muscle relaxants, antihypertensives, diuretics, heart failure medications, cholesterol medications, antipsychotics, anti-inflammatories. It is best to have medications reviewed regularly by the pharmacist or doctor to lessen the side effects of appetite suppression.


About the Author:

Rosanna Lee is a geriatric dietitian specializing in the areas of chronic disease prevention and management. She works primarily with the elderly at the Centre for Seniors and Neuro Rehabilitation at Peel Memorial Centre (William Osler Health System). Rosanna works closely with seniors that are part of the Memory, Parkinson’s, Falls and Frailty, Osteoporosis, Continence, Behavioural and Psychological Symptoms of Dementia (BPSD), Neurological Rehabilitation, and Geriatric Outreach clinics. Follow her on LinkedInFacebook, or Instagram. If you would like to be in touch, send her an email at rosannaleerd@gmail.com.    

References:

  1. Bareuther, C.M. (2010, Summer). Dwindling Appetites. Today’s Geriatric Medicine: News and Insights for Professionals in Elder Care. https://www.todaysgeriatricmedicine.com/archive/082510p32.shtml
  2. Government of Canada. (2021, July 21). Canada’s food guide: Healthy eating for seniors. Government of Canada. https://food-guide.canada.ca/en/tips-for-healthy-eating/seniors/
  3. McManus, K.D. (2019, June 20). Healthy eating for older adults. Harvard Health Publishing: Harvard Medical School. https://www.health.harvard.edu/blog/healthy-eating-for-older-adults-2019062016868
  4. Pilgrim, A., & Sayer, A.A. (2015). An overview of appetite decline in older people. Nursing Older People 27(5), 29-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589891/
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