From the Guidelines
To improve appetite in the elderly, creating enjoyable eating experiences and addressing underlying causes is crucial, as evidenced by the most recent and highest quality study 1.
Key Recommendations
- Serve smaller, more frequent meals with favorite foods that are visually appealing and flavorful, as aging can diminish taste and smell.
- Encourage social eating, as meals shared with others tend to increase food intake.
- Regular physical activity, even gentle walking for 15-20 minutes daily, can naturally stimulate hunger.
- Ensure adequate hydration by offering water throughout the day, but limit fluids right before meals to prevent feeling full.
Medication Options
- Appetite stimulants like mirtazapine (starting at 7.5-15mg at bedtime) may be prescribed by a physician when appropriate, especially if a concomitant depressive syndrome is to be treated pharmacologically 1.
- However, the systematic use of appetite stimulants is not recommended due to limited evidence and potential harmful side effects 1.
Additional Strategies
- Addressing underlying issues such as depression, dental problems, medication side effects, or chronic conditions is essential.
- Supplements like high-calorie nutritional drinks between meals can provide additional nutrition without filling the stomach before regular meals.
Rationale
These approaches work because they target both the physiological changes in aging (decreased taste sensitivity, slower digestion) and psychological factors (reduced enjoyment, loneliness) that contribute to poor appetite in older adults, as supported by the ESPEN guideline on clinical nutrition and hydration in geriatrics 1.
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. Mirtazapine may be used to improve appetite in the elderly, as it has been shown to increase appetite in 17% of patients treated with the medication, compared to 2% for placebo 2.
- Key points:
- Appetite increase was reported in 17% of patients treated with mirtazapine tablets.
- Weight gain of ≥7% of body weight was reported in 7.5% of patients treated with mirtazapine, compared to 0% for placebo.
From the Research
Improving Appetite in the Elderly
To improve appetite in the elderly, several strategies can be considered:
- The use of appetite-stimulating medications such as megestrol acetate and mirtazapine has been studied in various settings 3, 4, 5, 6.
- Megestrol acetate and mirtazapine appear to be effective for appetite stimulation and weight gain in some settings, but their applicability to elderly individuals is unclear, and adverse events have been reported 3.
- Dronabinol is another medication that can be used to stimulate appetite, and it may be particularly useful for persons with anorexia who are at the end of life 6.
- Mirtazapine may be the antidepressant of choice for persons with depression and anorexia 6.
- The use of taste enhancers can also be considered for persons who complain that food does not taste good 6.
- Testosterone replacement therapy may be beneficial for older men who are losing weight and have low bioavailable testosterone levels 6.
- Anabolic agents such as oxandrolone should be reserved for those who have profound cachexia 6.
Dietary Interventions
In addition to medication, dietary interventions can also play a role in improving appetite in the elderly:
- Recommending small, frequent meals (SFMs) may promote higher energy and fluid intakes, reduce gastrointestinal-related symptoms, and prevent postprandial hypotension in patients with primary autonomic failure 7.
- However, potential health complications related to SFMs include unwarranted weight gain, suboptimal nutrition quality, later meal times, sleep disturbances, limited intermittent fasting, and disordered eating 7.
- It is prudent for health professionals to supplement SFM recommendations with additional guidance on meal size, frequency, and timing, with a strong emphasis on healthy meal quality 7.