From the Guidelines
To help an elderly person with appetite, prioritize a cause-oriented approach by identifying and managing underlying factors contributing to reduced appetite, such as dental issues, medication side effects, or depression, as recommended by the most recent ESPEN guideline on nutrition and hydration in dementia - update 2024 1.
Key Strategies
- Offer smaller, more frequent meals throughout the day to accommodate decreased stomach capacity and altered hormonal signals associated with aging.
- Enhance flavors with herbs and spices to compensate for decreased taste sensitivity.
- Ensure meals are nutrient-dense and include protein sources like eggs, yogurt, or fish to support overall health.
- Consider nutritional supplements such as Ensure, Boost, or Carnation Instant Breakfast between meals if food intake remains low.
- Encourage light physical activity before meals to stimulate appetite.
- Address any medication side effects that might be suppressing appetite by consulting with their doctor.
- Create a pleasant social environment for meals, as eating with others often improves intake.
Importance of Individualized Approach
Given the varied and person-specific causes of reduced appetite in elderly individuals, an individualized approach is essential, as emphasized by the ESPEN guideline on clinical nutrition and hydration in geriatrics 1 and further supported by the practical guideline from 2022 1.
Evidence-Based Recommendations
The ESPEN guidelines 1 provide evidence-based recommendations for clinical nutrition and hydration in older persons, including the importance of routine screening for malnutrition, support of oral nutrition, and consideration of enteral or parenteral nutrition when necessary.
Conclusion Not Required
Instead, focusing on the practical application of these guidelines, healthcare providers can work with elderly individuals and their caregivers to implement tailored strategies that address the complex factors influencing appetite and nutritional status, ultimately aiming to improve morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
In U. S. controlled clinical studies, appetite increase was reported in 17% of patients treated with mirtazapine tablets, compared to 2% for placebo. In these same trials, weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo.
Mirtazapine may be suggested to help an elderly person with appetite, as it has been reported to increase appetite in 17% of patients treated with the medication, compared to 2% for placebo 2. However, it is essential to weigh the potential benefits against the risks, including weight gain, which was reported in 7.5% of patients treated with mirtazapine 2.
- Key considerations:
- Monitor for increased appetite and weight gain
- Weigh the potential benefits against the risks
- Consider alternative treatments if necessary
- Main idea: Mirtazapine may help increase appetite in elderly patients, but caution is advised due to potential side effects.
From the Research
Appetite Stimulation in the Elderly
- Several studies have investigated the use of medications to stimulate appetite in elderly individuals, including megestrol acetate and mirtazapine 3, 4, 5.
- These medications have been shown to be effective in some settings, but their applicability to elderly individuals is unclear, and adverse events have been reported 3, 4.
- A study comparing megestrol acetate and mirtazapine found that both medications improved appetite, but the improvement was not statistically significant when compared to each other 5.
Combination Therapy
- Combining megestrol acetate with oral nutrition supplements has been shown to be effective in improving body mass index, Eastern Cooperative Oncology Group score, and other nutritional parameters in malnourished lung cancer patients 6.
- However, a study comparing an eicosapentaenoic acid supplement to megestrol acetate found that megestrol acetate was more effective in stimulating appetite and improving weight gain 7.
Safety and Efficacy
- The safety and efficacy of appetite-stimulating medications in elderly individuals need to be thoroughly evaluated on an individual basis, taking into account underlying causes of weight loss and potential adverse events 3, 4.
- Higher quality evidence is needed to determine the efficacy of these medications in the inpatient setting and to establish standardized treatment guidelines 4.