Elderly Not Eating: Aging and Appetite
“ Elderly Not Eating: Aging and Appetite” was written by Charlotte Fisher, a dietetic intern at Oregon Health Sciences University. Reviewed/edited by Reviewed/edited by Janina Phillips, RD, LD and Katie Dodd, MS, RDN, CSG, LD, FAND.
Aging is an inevitable part of life that brings with it many changes. One such change that is not discussed often is loss of appetite, particularly in the elderly.
Many of us may have experienced this with a loved one or friend, noticing a dinner plate that has barely been touched, a lack of food in the home or weight loss in the individual.
Whether you are a caregiver, a family member, a friend, or an older adult yourself… here are some important things you need to know about the elderly not eating. From possible causes to how you can help and when it may be time to take more serious interventions.
Elderly Not Eating: Why it Matters
Believe it or not, being underweight is a greater risk factor for death than being overweight in the elderly population (2). The Health and Nutrition Examination Survey found that around 16 percent of Americans over the age of 65 are consuming less than 1,000 calories per day (3). This can quickly lead to weight loss and poor nutritional status.
Unintended weight loss can usher in numerous complications including a decrease in cognitive and physical functions, malnutrition and can contribute to an overall more rapid decline in health (3).
Factors Affecting the Eating Habits of the Elderly
There are many factors that affect eating habits of the elderly.
Medication
Many elderly individuals are prescribed a regime of medications. This may be for various medical conditions. Or to improve quality of life. Some of the most common medications prescribed include antibiotics, diuretics, anticoagulants and anti-inflammatory drugs (1).
Some medications can bring side effects with them. Side effects can include lack of appetite, upset stomach ,and changes in taste. These types of side effects can be a lead to the elderly not eating enough or eating at all.
Metabolic Function
Metabolic rate (how many calories our body needs to function) decreases progressively as individuals age. This is often due to the fact that as we get older, we tend to lose muscle mass and gain fat mass (see Fat Loss vs. Weight Loss).
Muscle is the most metabolically active organ in the body. With less of it, metabolic rate will slow. Compounded with limited physical activity, this can lead to a lack of hunger. And, ultimately, the elderly not eating.
Sensory Changes
Loss of smell, taste and sight are all common with advancing age. With the loss of these senses, it’s understandable that eating may not be as enjoyable or appealing as it once was.
Dental Issues
The Health and Nutrition Examination Survey found that older adults often have much fewer of their own teeth, particularly after the age of 75. This can make it extremely difficult to chew foods and can often limit the variety of foods an elderly individual can consume (6).
The survey also found that calorie intake was lower in elderly individuals who had fewer of their own teeth. Additionally, their levels of the micronutrients like calcium, iron, vitamins A, C and E, and several of the B vitamins were lower.
Related to dental health, saliva production naturally declines as a part of aging. Certain medications may make this worse. Dry mouth can make it hard to chew and swallow foods, leading to less food intake (7).
Depression
Depression can affect anyone at any age. But certain factors can put the elderly at risk. Some older individuals are more socially isolated. This can wreak havoc on mental wellbeing.
Later life can also be a time of more loss, including the death of friends and family members which can be mentally taxing on anyone.
Add on being diagnosed with a chronic illness, which is common in elderly individuals, and you have the perfect storm for a decline in mental wellbeing. The CDC estimates that around 85.6 percent of older adults have a chronic health condition. (6)
While often treatable, depression can manifest itself in many ways including fatigue, irritability, difficulty sleeping and, oftentimes, lack of appetite.
Physical Limitations
The elderly often experience a progressive decline in physical functions. This can make basic tasks like grocery shopping and food preparation very difficult, particularly if they live alone.
Research has found that energy intake is significantly lower in individuals who live alone than those that live with others (5).
Illnesses
Illnesses that affect breathing such as Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) can make eating difficult and exhausting.
Those with advancing dementia may forget to eat. Or they may think they have already eaten, have difficulty maintaining interest during mealtime, and eventually forget how to swallow.
Additionally, urinary tract infections in the elderly can lead to extreme confusion which can decrease eating.
Elderly Not Eating: Interventions
While a decrease in appetite and eating less may seem like just a normal part of the aging process, at some point it can truly become detrimental to health. Taking steps early to support healthy appetite is important to prevent further decline.
If you notice that someone elderly is no longer eating much, consider getting a healthcare professional involved. A thorough general assessment can be an important tool. This can help in combating the effects of the elderly not eating. And oftentimes, the sooner the issue is addressed, the better the outcome.
A team approach is often most effective in these situations. Combining the knowledge of a dietitian, a speech therapist, physical therapist, and supervising physician can lead to better outcomes (3). Continued follow-up is important.
How to Stimulate Appetite
There are many things that can be done at home to encourage adequate consumption of calories.
Flavor Enhancement
As previously mentioned, elderly individuals may to lose their sense of taste, smell and eyesight, all important factors in appetite. Try adding flavor enhancers like different herbs and seasonings to spice things up a bit. Being intentional in making food flavorful.
Plate meals in an attractive manner as well. Try adding garnishes, neatly arranging food items, and purchasing attractive dishes. We eat with our eyes, right? All of these factors can make eating much more appealing.
Supplementation
If an individual is having trouble consuming enough or getting tired before finishing their meal, calorie supplements can be an excellent way to ensure nutrient needs are being met.
Consider whipping up a high calorie smoothie for them to sip on between meals or add calorie-boosters to main meals to increase the calorie and nutrient density.
Reevaluate Medications
While medications can be a critical tool in maintaining health and quality of life, certain medications can interfere with appetite.
Work with a health care provider to evaluate current medications to see if any could be changed together to improve appetite.
Address Depression
Depression can be a real hunger suppressor. So addressing the issue can be pertinent in getting the elderly to eat more.
Consider involving a mental health specialist if you notice symptoms of depression to help address the root issues that may be contributing to this.
Make Mealtime Social
As much as you can, help make mealtime a social experience! Rather than leaving an elderly individual to eat alone, join them for a meal. Or consider hiring in-home care to provide companionship during mealtime.
Don’t rush meals and allow elderly individuals as long as they need to eat their meals and enjoy their company.
Establish A Routine
Make meals a regular part of their daily routine. This way, eating becomes a habit. And they will be less likely to skip meals and miss out on important opportunities to get calories in. Simply establishing a time for breakfast, lunch and dinner can be a great start.
Conclusion
It’s normal for appetite to decrease with age. There are often multiple factors at play when this change occurs. It’s important to pay attention when we notice the elderly not eating. The earlier we address the issue, the more likely we can help them to avoid health complications.
Do your best to support healthy eating habits in the home and bring in the professionals, like a dietitian and primary care doctor, when needed.
References
- Brahma, D. K., Wahlang, J. B., Marak, M. D., & Ch Sangma, M. (2013). Adverse drug reactions in the elderly. Journal of pharmacology & pharmacotherapeutics, 4(2), 91–94. https://doi.org/10.4103/0976-500X.110872
- Dodd, K, Fischer, C. February 14, 2021. Fat Loss VS Weight Loss in the Elderly: Understanding the Difference. The Geriatric Dietitian. https://thegeriatricdietitian.com/fat-loss-vs-weight-loss/
- Evans C. (2005). Malnutrition in the elderly: a multifactorial failure to thrive. The Permanente journal, 9(3), 38–41. https://doi.org/10.7812/tpp/05-056
- Ponti, F., Santoro, A., Mercatelli, D., Gasperini, C., Conte, M., Martucci, M., Sangiorgi, L., Franceschi, C., & Bazzocchi, A. (2020). Aging and Imaging Assessment of Body Composition: From Fat to Facts. Frontiers in endocrinology, 10, 861. https://doi.org/10.3389/fendo.2019.00861
- Hickson M. (2006). Malnutrition and ageing. Postgraduate medical journal, 82(963), 2–8. https://doi.org/10.1136/pgmj.2005.037564
- Percent of US Adults 55 and over with Chronic Health Conditions. National Health Interview Survey. National Center for Health Statistics. November 6, 2015. Available from: https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm
- Mangels, Ann Reed PhD, RD, FADA CE: Malnutrition in Older Adults, AJN, American Journal of Nursing: March 2018 – Volume 118 – Issue 3 – p 34-41