Causes of Appetite Loss in Seniors

It’s no revelation that not getting enough food leads to many different health issues. This makes appetite loss a very serious concern as not eating increases the risk of malnutrition. When our bodies can’t get the nutrients they need, our health suffers.

Particularly at risk are those who have underlying health issues or conditions as can sometimes be the case with older populations. There are many different causes and factors of appetite loss. We will be focusing on a form of appetite loss that affects older people in particular: anorexia of aging.

With connections to Harvard Medical School, Hebrew SeniorLife specializes in geriatric care, and we work with seniors every day who have nutritional concerns. As a dietetic intern at Hebrew Rehabilitation Center in Boston, I help older adults in both the inpatient and outpatient settings create individualized nutrition plans that help manage or prevent serious illness.

What is anorexia of aging?

Alarmingly, it’s estimated that between 15% - 30% of older people have anorexia of aging—an ongoing period of low appetite caused by age-based changes to our bodies. As we age, the digestive system slows down, energy needs decrease, and sense of smell, taste, and vision change. These factors can all contribute to loss of appetite.

Appetite is closely connected to health. Not eating enough leads to weight loss and malnutrition, which accelerates frailty. A lack of nutrients weakens overall health, decreases mobility, and brings down the general quality of life. Not getting enough protein can lead to a loss of skin integrity, and increase the risk for infection. A lack of calcium can cause osteoporosis, increasing the likelihood of bone fractures. Research has shown that anorexia of aging increases the overall risk of morbidity and mortality.

What are the causes?

Appetite loss in seniors is a complex issue with many causes and contributing factors. Physical changes in the body, shifts in mental health, and certain medications all contribute to anorexia of aging.

Physiological:

Physical changes of aging can cause appetite loss or difficulty getting enough nutrition. Biological processes can be a direct cause, or sometimes the effect of other chronic conditions that lead to anorexia of aging, and might include:

• Slower food processing: when food takes longer to digest it might be harder to eat consistently.
• Changes to taste: a reduced number of taste buds or reduced saliva affects the capacity to taste.
• Difficulty chewing or swallowing.
• Physical limitations that may restrain cooking options.
• Medical conditions, such as:
  • Gastrointestinal diseases:
  • Malabsorption syndromes, which impair the body’s ability to absorb nutrients in food
  • Acute and chronic infections
  • Hypermetabolism (e.g., hyperthyroidism, which is when your thyroid makes more thyroid hormones than your body needs)

Psychological:

Mental health can be affected by the aging process. Changes to the living environment, coping with the loss of a spouse or other loved one, adapting to a loss of independence, or side effects of a chronic medical condition can all negatively impact mental health or cause depression, which in turn can affect appetite.

Another factor is social isolation, which can be a risk for older adults who may have trouble with transportation or mobility. Eating alone can result in eating less, and a lack of stimulation decreases wanting to eat. One thing we see at Hebrew SeniorLife is that older adults with dementia are often cued to eat by seeing others around them eating - making communal meals an essential part of ensuring proper nutrition, in addition to the socialization that eating with friends provides.

Pharmacological:

Many side effects of medications contribute to appetite reduction. Some prescriptions affect the GI tract making eating unpleasant, or blocking nutrients from being properly absorbed. One of the most direct side effects of some medications is changes to or loss of taste. This risk is exacerbated by the fact that many seniors take a variety of medications that can interact with each other and have unanticipated side effects. 

Research shows that these types of medications can contribute to anorexia of aging:

• Antibiotics 
  • Ampicillin
  • Macrolides
  • Quinolones
  • Trimethoprim 
  • Tetracycline 
  • Metronidazole
• Antivirals
  • Ganciclovir 
  • Foscarnet sodium
  • Valganciclovir 
  • Telbivudine
  • Boceprevir 
  • Ribavariptan
• Muscle relaxants
  • Baclofen
  • Dantrolene sodium
• Migraine medications
  • Eletriptan 
  • Frovatriptan 
  • Rizatriptan
• Diuretics
  • Amiloride hydrochloride
• Heart failure medication
  • Angiotensin Converting Enzyme inhibitors
• Thyroid medication
  • Carbamiazole 
  • Propylthiouracil
• Psychiatric medications
  • Trifluoperazine
  • Aripiprazole
  • Risperidone
  • Lithium carbonate
  • Lithium citrate
  • Zaleplon
  • Zopiclone
• A more comprehensive list can be found here.

Should I be concerned about all changes in appetite? 

It is normal to have a short-term or situational loss of appetite due to something like an illness or traumatic event. While aging will cause a mild loss of appetite, a loss of appetite that results in the inability to meet your body’s needs is concerning. Loss of appetite becomes a serious concern when it is associated with weight loss, loss of energy, loss of interest in all foods, or increased frequencies of illness. That’s when it’s time to consult your primary care physician to rule out serious illness, then consider working with a dietitian. 

Recommendations for appetite loss

Fortunately, anorexia of aging is not as inevitable as aging itself. Here are some things you can do to prevent or address appetite loss. Please talk with your doctor for specific advice or diagnosis.

• Smaller portions – studies show that large portions can be distressing to older people and result in less intake rather than more. 
• Light meals such as enriched drinks or soups are less satiating than solid meals and will encourage eating more.
• Instead of three large meals, try snacking throughout the day or having five smaller meals.
• Consider moving to a community where meals are provided and enjoyed with other residents. Improvements to the dining environment such as using tablecloths, nice crockery, and dedicated mealtimes encourage eating more.
• Include “dips” like ranch dressing with vegetables.
• Try offering finger foods if there are physical limitations to using utensils.
• Add flavor: Make the food more interesting with pepper, herbs, and spices. Stay away from adding salt and sugar. 
• Eat nutritionally dense foods: 
  • Whole milk instead of reduced-fat or skim milk.
  • Adding milk powder to milk for more nutrients.
  • Fairlife or other modified milk can add a little extra protein without any additional effort.
  • Nutrient-dense spreads such as mayonnaise, peanut butter, hummus, or butter.
  • Eggs, dressing, cheese, croutons, and meat are great additions to salads.
  • Fatty fish, like salmon.
  • Full-fat Greek yogurt is high in protein and comes in a variety of different flavors.
  • Most importantly: add avocado wherever appropriate.
• Medications can help with saliva production and appetite stimulation.

In addition to appetite loss, seniors can face other challenges in getting adequate nutrition. In Massachusetts, about one in 10 adults age 60 and older experiences food insecurity, or a lack of consistent access to healthy food - and that number has likely gone up during the pandemic. Sometimes this is because of physical limitations in getting and preparing food, while other times it’s due to financial hardship. Some resources include:

• Meal services such as Meals on Wheels or Community Servings deliver nutritionally-balanced prepared meals. 
• Grocery delivery is a convenient way to get food when going out is difficult. 
• If you don’t like eating alone, many churches, schools, or senior centers host regularly scheduled community meals, either for free or low cost. 

One-on-one nutrition counseling for seniors in Boston

As a part of Hebrew SeniorLife’s multidisciplinary approach to health care, we consider nutrition as a key component of managing or preventing serious health issues. If you or a loved one are suffering from appetite loss or other nutritional concerns, Hebrew Rehabilitation Center in Boston offers an outpatient medical nutrition therapy program for older adults, including one-on-one individualized education and treatment plans developed by our Registered Dietitians. To learn more, contact us online or call our outpatient therapy program at 617-363-8539.