Introduction
Appetite is the natural desire to satisfy bodily needs, which gives a sense of hunger and an increased desire to eat food items. Unfortunately, poor appetite is a common problem in older adults, including hospitalized patients increasing the risk of malnutrition and unhealthy weight loss. The poor healthcare outcomes generated by the problem may also include increased mortality risk. However, a set of strategies can be implemented to promote healthy appetite in the elderly.
What Is Meant by Anorexia of Aging?
Appetite is a bodily need divided into three components: hunger, satiation, and satiety. The sensation that promotes the intake of food is called hunger. The feeling of fullness that forces the individual to terminate the meal intake in between is called satiation. Satiety is the feeling of fullness persisting between eating periods.
Loss of appetite is medically known as anorexia. Seniority is related to the persistence of low appetite, called anorexia of aging, which is proportional to the severity of malnutrition-related health issues. Lack of adequate nutrition can bring down the quality of life by decreasing overall health. A decline in appetite will also arise due to acute illness.
What Causes Reduced Appetite in Older People?
Many factors are responsible for anorexia of aging. Some of them are:
Physiological Causes:
These include age-related changes in the hormonal level and function, digestive changes, altered smell, taste, and vision, pain, diseases, and decreased need for energy.
Changes occurring within the digestive system are the main factor responsible for decreased appetite in old age. Saliva eases the eating process by wetting the food and initiating the digestive procedure. Aging and medications consumed for illness may decrease the amount of saliva produced, thus making food consumption difficult. Senescence (getting old) is also related to tooth loss and chewing difficulty, which may be another critical cause for not eating. Frail seniors may find it challenging to maintain oral hygiene by brushing and cleaning their mouths frequently. Poor oral hygiene can alter the taste and reduces appetite. The process of emptying the gastric contents slows down with age, thus creating a sensation of fullness. Constipation in old age can also reduce appetite.
Ghrelin, also known as the hunger hormone, is a gut hormone that increases the drive to eat. Its level decreases with age, causing a lack of hunger. Likewise, levels of cholecystokinin (the gut hormone that stimulates digestion and reduces appetite) will decrease with age, causing a lack of appetite. The levels of another hormone, leptin, an appetite suppressant, will increase in older adults.
Acute infections and chronic diseases like heart failure, kidney failure, chronic liver disease, chronic obstructive pulmonary disease (inflammatory lung disease causing obstructed airflow), and cancer are more prevalent in old age. The inflammatory and sensory changes related to these disorders and the side effects of medications taken can cause anorexia of aging. In addition, diseases in old age may show the symptom of increased pain, which impairs dexterity, prolongs the time taken to eat meals, and gradually reduces appetite.
Food becomes a joy when plated well, smells good, and tastes heavenly. Vision, smell, and taste are essential senses that make the experience of eating magical. In addition, the smell of the food stimulates appetite, and its taste increases the craving for eating more. Unfortunately, these senses get impaired with age, decreasing the affection towards eating.
Older individuals tend to spend less time doing physical activities. The fat and muscle mass also get reduced with senescence. These changes contribute to a lesser need for energy. Energy is primarily generated through foods, and reduced requirement implies decreased food intake.
Psychosocial Causes:
The psychological and social changes occurring with age can highly influence appetite. Depression, dementia (disorder affecting thinking, memory, and social abilities), and delirium (severe change in mental abilities) are associated with a lack of appetite and poor nutritional intake. In addition, the art of having food will be more pleasurable when done together, and being alone can create a sense of neglect towards food. Poor access to pleasant meals and the inability to prepare food are other factors responsible for the condition.
Pharmacological Causes:
Older adults are likely to take more medications which may have side effects that alter appetite. Some medicines may indirectly decrease the appetite by changing taste, digestive process, or smell. Some examples include antibiotics like Ampicillin, antifungals like Fluconazole, muscle relaxants like Baclofen, and bronchodilators like Triotropium.
How to Manage Appetite Loss in Older Adults?
Anorexia of aging can be managed or prevented by the following measures based on the underlying cause.
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Oral Issues- If the individual has a dry mouth, frequent sips of water, salivary replacement products, and avoiding dry and hard foods may help. Providing prostheses for a lost tooth or undergoing adequate treatments to cure tooth-related issues can solve the problem to an extent. Visiting a dental hygienist in timely intervals and getting help maintaining oral hygiene can prevent anorexia caused due to oral hygiene issues.
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Digestive Tract-Related Causes- Treating digestive problems, including constipation and nausea, can be considered.
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Sensory Problems- If the individual has an impaired smell or taste, enhancing the flavors of cooked food may improve appetite. Managing visual impairment by providing apt spectacles or other treatments is also essential. Using contrast-colored crockery and improving the plating of the food will also make the meals visually satisfying. Management of pain in case of diseases or infections should also be considered.
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Psychological Factors- Management of mental health issues like depression and dementia is essential. Serving finger foods, serving food in colored crockery, and giving required physical assistance may also help.
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Social Issues- Encouraging isolated individuals to have meals with friends or family may increase their interest in having food.
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Physical Activities- Increasing physical activities can improve appetite.
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Portion Size- Minimising the portion size and adding more nutrients to the plate will be beneficial. Instead of having large meals, having intermittent, small, and healthy snacks will be more healthy.
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Pharmacological Causes- In case of severe symptoms due to loss of appetite, asking the doctor to replace the medication will be the best choice.
Implementing certain acts at home may also help to improve appetite in the elderly.
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Take Liquids- Taking liquid meals like soup broths, fruit juices, and sports drinks containing electrolytes can be considered.
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Small Meals- Eating small portions for breakfast, lunch, and dinner may increase appetite.
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Snacking Intermittently- Having small and healthy intermittent snacks will provide more nutrients.
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Nutrient-Rich Food- Food rich in protein, vitamins, and minerals is essential.
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Eat Together- Eating with family or friends will make the whole episode of having food joyful and exciting.
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Finger Foods- Serving finger foods for individuals with limitations in using utensils will be helpful.
Conclusion
Poor appetite is not an inevitable issue with aging but can lead to severe malnutrition and irreversible and unhealthy weight loss. Safe and straightforward nutritional interventions can help manage the condition, not worsen it. Dietitians, doctors, nurses, and family members can help the individual overcome or manage the problem.
