Experiencing a loss in appetite is considered a normal part of aging. Naturally, as we age, the metabolism decreases and the need for energy(calories) decreases as well. Due to many physical limitations as we age, activity also declines which means the body requires less calories. Many elderly also experience a decrease in the sense of hunger which results in the consumption of less calories. Due to many of these changes causing decreased intake, poor nutrition contributes to a progressive decline in health and unintentional weight loss, which is an area of great concern in the elderly population.
According to the National Health and Nutrition Examination Survey (NHANES) 16% of community-dwelling Americans older than 65 years consumed fewer than 1000 calories per day. This is obviously below daily requirements. Elderly residents tend to reach satiety faster and may push a plate away before adequate calories are consumed.
It is important for older adults to continue healthy dietary patterns and to maintain their body weight. Unplanned weight loss can lead to muscle loss increasing the risk of falls, illness, or other health conditions. The following are causes residents may suffer from appetite loss.
- Many commonly prescribed medications can suppress the appetite or cause nausea. These include diuretics, antihypertensive, antidepressants, antibiotics, antihistamines, or dopamine agonists (Parkinson’s or restless leg treatment)
- Dental issues – dentures that do not fit, mouth pain, etc.
- Physical limitations- difficulty eating
- Chronic diseases such as cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, end stage renal disease (ESRD), thyroid disorders, hepatitis, or chronic liver disease have been known to decrease appetite or make eating difficult.
- Dementia or Alzheimer’s disease
- Depression- Feelings of depression, anxiety and loneliness can all lead to a decrease in appetite
- Chronic pain- Chronic pain and fatigue can reduce one’s desire to eat.
Finding ways to improve intake for residents and ensuring adequate calorie intake is essential in maintaining residents’ health. Below is a list of ideas to correspond with the limitations listed above on how to improve intake when a resident does not want to eat.
- Reevaluate medications (especially the ones listed above) and speak with the doctor about any medication changes and changes in appetite and intake.
- Residents should have regular dental visits to monitor and address any mouth pain, gum disease and other conditions of the mouth that can make eating difficult.
- Residents may require feeding assistance. Take time with feeding residents and assisting with meals as needed. Do not rush mealtimes and allow adequate time for residents to eat.
- Consult a speech pathologist to work with the resident is they are displaying signs of Dysphagia.
- Chronic diseases can cause changes in taste, smell, and eyesight. Experiment with adding flavor enhancers such as different herbs and seasonings to spice foods up a bit. Be intentional about making food flavorful and look appealing. Plate presentation matters.
- Offer supplementation or snacks throughout the day if a resident does not eat well during mealtime.
- Address depression and make mealtime social- studies show that seniors who eat alone, are not only more likely to experience depression, anxiety, and loss of appetite, but they make less healthy food choices than those who dine with others. Encourage residents to go to the dining room for meals and discourage eating alone in their room.
- Consult the dietitian to work with the resident on ways to improve intake.
It is crucial to pay attention when you notice a change in a resident’s eating pattern. The earlier an issue is addressed, the more likely health complications can be avoided. Consult the dietitian to work with the resident as soon an intake decline is noticed.
Malnutrition in the Elderly: A Multifactorial Failure to Thrive. The Permanente Journal. 2005. Volume 9 No. 3 http://www.thepermanentejournal.org/files/Summer2005/elderly.pdf
National Health and Nutrition Examination Survey (NHANES) https://www.cdc.gov/nchs/nhanes/index.htm