Loss of Appetite in the Elderly: Causes and Treatment

Your elderly loved one complains about loss of appetite and you wonder what may cause it. Is it a taste or digestion problem? Can you solve the problem at home by making food more appetising? Is there medication to increase appetite?

In this guide to loss of appetite, we will help you understand the various causes that could interfere with appetite, what to do at home and when to visit a doctor. We also introduce a few tips to revive the joy of eating for your elderly loved one or for yourself as a senior. 

1. What is Loss of Appetite?

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, prolonged loss of appetite is not a normal part of aging. It may signal underlying conditions that require medical attention, especially when it causes nutritional deficiency and affects our overall health. 

Medically known as anorexia, loss of appetite 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. Unmanaged appetite loss can lead to malnutrition, which 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 the older adults who are at risk of malnutrition have low muscle mass, medically known as sarcopenia. They also suffer from frailty, reduced immunity, longer recovery from illnesses, and increased risk of hospitalisation and overall poor health. The risks of malnutrition and complications are higher when the elderly has one or more existing health conditions.  

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

Almost everyone experiences temporary poor appetite at times - when we have a flu, go through a stressful time, or feel overwhelmed with anxiety. In most cases, 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, it may indicate a medical condition that needs to be examined by a doctor. 

3. Causes of Appetite Loss

A variety of medical and non-medical conditions can lead to a decreased appetite, ranging from dental issue to depression. Recognising them is the first step towards finding solutions. The common causes of poor appetite include chewing or swallowing difficulty, an oral problem, a digestive issue, an infection, a mental health condition, a side effect of medications, or another underlying condition with loss of appetite as a symptom. We go through each of the causes below.  

3.1. Oral Conditions and Swallowing Difficulty

Digestion starts the moment food touches our tongue, not just in our stomach. As we chew food and savour its taste, we trigger the release of saliva and digestive hormones. However, several factors can interfere with this initial phase of digestion, directly affecting our ability to eat and enjoy food:

  • Dry mouth: Often a side effect of medications, chronic conditions, or aging itself, reduced saliva production can make swallowing tough and eating uncomfortable. 
  • Chewing difficulty: Dental issues, jaw problems, or weakened muscles can turn eating into a frustrating and time-consuming task.
  • Reduced taste: Ageing can dull our taste buds, stripping away the ability to relish different flavours of food.
  • Swallowing difficulty (Dysphagia): This can occur as a complication of gastroesophageal reflux disease (GERD) or Chronic Obstructive Pulmonary Diseases (COPD). Impaired nerves or muscles after a stroke or in the late stage of dementia can also be the cause. Besides loss of appetite and nutritional deficiency, dysphagia can cause food to enter the airway, leading to an infection known as aspiration pneumonia. 

A senior may experience one or more of these conditions at the same time, as these issues are often interlinked. Check out our article on oral conditions and swallowing difficulties in the elderly for details of what cause them, possible treatments, and complications to watch out for. 

3.2. Poor Digestion

Poor digestion refers to an impaired ability to absorb nutrients. It may result in discomforts such as bloating, gas, heartburn, cramping in the stomach area, constipation or diarrhoea. The negative experience associated with eating can lead to a psychological aversion to food. People with poor digestion often find eating a chore, and they may avoid certain foods or meals altogether. 

If you experience poor appetite and other digestive symptoms concurrently, it is advisable to visit a doctor to have your gastrointestinal tract examined. Common digestive disorders may include acid reflux, constipation, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Crohn’s disease, ulcerative colitis, and Celiac disease. Learn more about them in our article discussing the most common stomach and digestive conditions among seniors here.

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 trigger loss of appetite. Common infections that can affect appetite include flu, upper respiratory infections, pneumonia, gastroenteritis, colitis, meningitis, or even skin infections.

In these cases, you will notice that your appetite improves and gradually comes back to normal a few days after you have recovered from the infection. 

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. When stress becomes chronic, so does loss of appetite. The same goes for diagnosable mental health conditions such as generalised anxiety disorder and depression. When this is the case, addressing the stressor and treating the mental health issue can improve your appetite. 

3.5. Other medical conditions

Alzheimer's and other types of dementia are known 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 deteriorate as Alzheimer's progresses. At late stage of Alzheimer's, swallowing difficulty is common in addition to other eating disturbances. 

People suffering from chronic liver disease, kidney failure, heart failure, hepatitis, HIV, hypothyroidism, or stroke as well as a number of cancer types may also experience decreased appetite. Improving appetite and/or ensuring adequate nutrition is crucial to protect the immunity function for these individuals.  

3.6. Medications

Certain pharmacological drugs may affect your appetite. Prescription medications that are known to reduce appetite include antibiotics, chemotherapy drugs, drugs for blood pressure, certain antidepressants, and strong painkillers such as codeine and morphine.

Ninkatec Infographic_Causes of poor appetite

 

4. Treatment for Loss of Appetite

Treatment for poor appetite focuses on addressing the underlying condition. Once the root cause is resolved, your appetite will return to normal. However, it may take some time for your doctor to figure out what the cause is, as there is a diverse range of reasons ranging from digestive to mental health, as we discuss above.

Your doctor may ask you questions about your eating pattern, lifestyle habits, general health, medications you are taking and other symptoms you experience. Depending on his/her assessment, additional tests such as blood work, ultrasound of the abdomen, or stool test may be necessary before a diagnosis can be made. 

Treatment plan will follow the diagnosis. For example, to tackle swallowing difficulty, your doctor may recommend speech therapy to improve how you swallow. To counter nausea due to a medication, you may be prescribed anti-nausea and vomiting drugs. If loss of appetite is the side effect of a medicine, adjustments in dosage or switching to a different medication may help to alleviate the issue. 

As appetite has psychological and social aspects to it, your doctor may recommend measures to improve your overall well-being, in addition to medical interventions. Reducing stress and engaging in enjoyable daily activities, such as sharing meals with a companion, staying socially connected can enhance your mood and contribute to an improved appetite. Regular physical activity can stimulate appetite by increasing metabolic rate and promoting a healthy appetite. Improving sleep quality can also be helpful.

For people with mental health-related appetite issues, therapy or counselling can help address the underlying emotional or psychological factors contributing to the loss of appetite. 

5. Potential Complications of Appetite Loss

Prolonged period of poor appetite without intervention can develop into nutritional deficiencies, or malnutrition in severe cases. Among the elderly, inadequate nutrition can result 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. The senior may also experience: 

  • Fatigue
  • Weight loss
  • Rapid heart rate (tachycardia)
  • Frequent bouts of cold, flu and infection
  • Irritability
  • A general feeling of illness and malaise

Certain nutritional deficiencies may also trigger specific health problems. For example, inadequate intake of protein can lead to sarcopenia or loss of muscle mass and function. Deficiency of calcium and vitamin D is known to aggravate elderly’s risk for age-related bone issues such as osteoporosis and osteopenia.  A lack of vitamin A can exacerbate vision problems in the elderly – an issue that is already prevalent in this age group. Vitamin C deficiency can lead to scurvy (i.e., loose skin), bleeding, and joint problems. 

For this reason, it is crucial to seek medical attention if loss of appetite persists or doesn't improve with non-medical measures you have tried at home. 

Treatment for loss of appetite focuses on addressing the underlying condition while helping to stimulate appetite through exercises, psychological and social factors.

6. Ensuring Adequate Nutrition when you Struggle with Appetite

If you are facing debilitating nutritional deficiency due to loss of appetite, you may be referred to dieticians for nutritional counselling. These experts can guide you on choosing the right foods and planning your meals to meet your nutritional needs, thereby improve your appetite and overall health.

For instance, incorporating nutrient-dense foods that are not only nutritious but also appealing to the senses with their flavours, textures, and aromas can help to stimulate your appetite and meet your nutritional need. A dietician can also help you create meal and snack schedules to keep up with your calorie and nutrient needs. Instead of three large meals, eating smaller portions spread throughout the day can help maintain consistent nutritional intake without feeling overwhelmed. 

People diagnosed with malnutrition or a medical condition that interfere with oral intake and digestion may need parenteral nutrition. This method of delivering nutrients directly into the bloodstream through the vein aims to improve the patient's nutritional status while the underlying medical issue is being addressed. It is often used for a short period of time during acute illnesses and under careful medical supervision.

As nutritional knowledge and healthy diet habits are beneficial for everyone, it is important to equip yourself with sufficient awareness. We published an essential guide to nutrition as we age on our blog. Discover how elderly's nutritional needs differ from those of younger adults, how to choose nutrient-dense, low-calorie foods and other practical tips to eat well from our guide. 

Takeaway Message

Loss of appetite is an under-discussed topic, especially among elderly people. To some extent, aging affects appetite, sense of taste, and preference for food. However, reduced appetite that compromises your well-being is not a part of the normal aging process. Make sure you seek medical advice if you experience persistent loss of appetite accompanied by other concerning symptoms. However, for those experiencing a few days of poor appetite, rest assured that it can often resolve on its own.

Bringing back the joy of eating is essential for good nutrition, which helps you maintain immunity and well-being. There are practical steps you can take at home to boost your appetite and overall health, such as exercising, staying hydrated, and making mealtime enjoyable. When in doubt, consult your GP or family doctor who can accurately assess your concerns and provide appropriate guidance to solve your nutritional or health issue safely and effectively.

 

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