Loss of Appetite in the Elderly: Causes and Treatment

July 22, 2021

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Ninkatec

Appetite tends to dwindle with age, due to physiological changes in the body and lifestyle, such as reduced metabolism, less sensitive taste buds and lower activity levels. However, long term loss of appetite – medically known as anorexia – is not a normal part of aging. It may signal underlying conditions that require medical attention. 

The general complication associated with unmanaged anorexia is malnutrition. This occurs when your body experiences a deficiency in one or more nutrients. According to a study, 1 in 3 seniors in Singapore is malnourished or at risk of malnutrition. 80% of these older adults who are at risk of malnutrition have low muscle mass – an indicator of poor health and immunity. As a result, the risk of severe complications among these seniors can dramatically increase, especially when they have existing underlying health conditions.  

If you are caring for an elderly with a loss of appetite, you may have asked yourself what causes loss of appetite? Is it a taste or digestion problem? Is there medication to increase appetite? Can you solve the problem at home by making food more appetizing for elderlies? In this comprehensive guideline, we will cover the various causes that could interfere with seniors’ appetite, including a few tips to revive the joy of eating for your senior loved one. 

1. What is Loss of Appetite (Anorexia)

Loss of appetite, or anorexia, is an umbrella term that encompasses a variety of health problems that lead to a lack of desire to eat and as a result, poor dietary intake. It can range from not feeling hungry, feeling hungry but not wanting to eat, to being afraid of food and eating. 

2. When to See a Doctor for Loss of Appetite?

Almost everyone experiences temporary poor appetite at times – when we have the flu, when we go through a stressful time, or feel overwhelmed with anxiety. Often, appetite comes back when we recover from the flu or feel more relaxed. However, when poor appetite persists and manifests with other symptoms, such as prolonged fatigue, loss of weight, loss of smell or taste, feeling of nausea, vomiting, or digestive issues like abdominal pain, diarrhoea or constipation, may indicate a medical condition that needs to be examined by a doctor. 

3. Causes and Risk Factors of Appetite Loss

A variety of medical and non-medical conditions can lead to a decreased appetite. In most cases, it is a symptom of another underlying condition; your appetite will return to normal once the primary condition is treated. Therefore, it is important to identify the underlying causes and address it. In the following sections, we will discuss the common medical conditions that are known to cause anorexia and in subsequent parts, we will address in detail the 5 medical conditions that are closely related to eating behaviours.

3.1. Oral Conditions and Swallowing Difficulty

You may have noticed that food tastes less appetizing when you are thirsty or dehydrated. This happens as a result of a medical condition called ‘dry mouth’. As such, eating can become a chore and an extended period of dry mouth may lead to long term loss of appetite. 

Below are 4 common oral problems that directly affect the ability to eat and enjoy food:

  • Dry mouth (Xerostomia) 
  • Chewing difficulty
  • Reduced taste 
  • Swallowing difficulty (Dysphagia) 

You may experience one, or more of these conditions at the same time, as they are sometimes related. If you or your elderly loved one experience any of the above, check out our blog article in which we address oral conditions and swallowing difficulties in detail, including causes, treatment, and possible complications. 

3.2. Poor Digestion

Poor digestion refers to impaired ability to absorb nutrients due to a variety of gastrointestinal causes such as acid reflux, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, Celiac disease, etc. These conditions interfere with the normal function of your digestive tract, causing unpleasant symptoms such as loss of appetite, bloating, gas, cramping in the stomach area, constipation or diarrhoea after each meal. Read our past article on top common digestive disorders in elderlies to learn more about these conditions if you suspect your elderly loved one is suffering from any of them.  

Poor digestion could also refer to malabsorption, which occurs when the intestinal walls are unable to absorb the nutrients due to a disease of the intestine, such as Celiac disease. 

3.3. Bacteria and viruses

Bacterial and viral infections can result in lack of appetite. Scientists believe a lack of desire to eat is part of systemic body response to fight infection, possibly to save energy for the purpose of healing. Infection does not have to be in the mouth or tongue to cause anorexia. Other common infection types known to trigger loss of appetite include flu, upper respiratory infections, pneumonia, gastroenteritis, colitis, meningitis, or even skin infections. 

3.4. Mental illnesses

You may have witnessed friends or family members losing their appetite and refusing to eat when they go through stressful experiences such as a grieving period. When it gets serious and is diagnosed as a medical condition, mental health issues such as depression, grief, or anxiety disorder tend to precipitate decreased appetite. 

3.5. Other medical conditions

Patients suffering from chronic liver disease, kidney failure, heart failure, hepatitis, HIV, hypothyroidism, or stroke as well as a number of cancer types are also reported to experience appetite loss. Dementia is also know to cause loss of appetite. A study showed that nearly half of Alzheimer’s disease patients suffer from loss of appetite even at mild stage of the disease. Their eating habits change further and affecting an increasing percentage of patients as Alzheimer’s progress. At late stage of Alzheimer’s, swallowing difficulty is common in addition to other eating disturbances.

3.6. Medications

Certain pharmacological drugs may affect your appetite, including illicit drugs (e.g., cocaine, heroin, amphetamines). Prescription medications that are known to reduce appetite include antibiotics, chemotherapy drugs, drugs for blood pressure, certain antidepressants, strong painkiller types such as codeine and morphine.

4. Treatment for Loss of Appetite

The treatment of anorexia focuses on addressing the root cause. For instance, if food feels less appetizing to you due to a bacterial infection, a short course of antibiotics is sufficient to clear out the infection. A few days after the infection, you will notice that your appetite improves and comes back to normal. 

For patients suffering from chronic diseases or conditions that take a long time to treat, parenteral feeding might be necessary to ensure sufficient nutrition is supplied until the main issue is addressed.

5. Potential Complications of Appetite Loss

The complications of anorexia depend on the underlying cause. If the cause of decreased appetite is a short-term condition, you are likely to recover once the primary condition is treated. However, if the underlying condition is a chronic medical condition, anorexia may turn chronic and leave irreversible complications.

Chronic anorexia may lead to the following signs and symptoms:

  • Extreme fatigue
  • Rapid weight loss
  • Rapid heart rate (tachycardia)
  • Fever
  • Irritability
  • A general feeling of illness and malaise

If left untreated, chronic anorexia could develop into malnutrition, where you experience one or more nutritional deficiencies. Among the elderly, this complication can be life-threatening, resulting in issues such as bone loss, muscle weakness, lowered immunity, and general frailty, making them more prone to sickness or injuries as well as having more challenges in recovering. For this reason, it is crucial to seek medical attention if you experience loss of appetite and weight loss for a few weeks despite treating the underlying medical condition. 

Besides these general complications, specific deficiencies can trigger specific health problems. For example, a lack of vitamin A can exacerbate vision problems in the elderly – an issue that is already prevalent in this age group. Another complication is vitamin C deficiency, which could lead to scurvy – loose skin, bleeding, and joint problems. Deficiency of calcium and vitamin D is known to aggravate elderly’s risk for age-related bone issues such as osteoporosis, osteopenia, and others

Takeaway message

Loss of appetite is often an under-discussed topic, especially in elderly people. To some extent, aging affects appetite, sense of taste, and preference for food. However, loss of appetite is not a part of the normal aging process. Neither is stimulating appetite in elderly purely a matter of cooking skill. More often, appetite loss signals underlying conditions that need medical attention. Left untreated, the underlying cause can turn severe and loss of appetite can become chronic, leading to devastating complications. 

We hope that this article highlights the major aspects of loss of appetite in elderly people, the causes that trigger this symptom, when to visit doctors for diagnosis and treatment, as well as general guidance towards how to increase appetite for your elderly loved one or for yourself as a senior.

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