Best Treatment for Appetite Loss in Elderly People
The best treatment for appetite loss in elderly individuals is a multimodal approach that identifies and addresses underlying causes, with medication review being the most important first-line intervention to minimize adverse drug effects on food intake. 1
Identifying and Addressing Underlying Causes
Step 1: Medication Review
- Have a qualified practitioner review all medications to identify those affecting appetite 1
- Common appetite-suppressing medications include:
- Consider reducing doses, replacing, or discontinuing medications with appetite-suppressing effects 1
Step 2: Address Medical Causes
- Treat underlying conditions that may cause appetite loss:
Step 3: Modify Dietary Restrictions
- Liberalize dietary restrictions that limit food choice and eating pleasure 1
- Avoid restrictive diets in older persons as they increase risk of malnutrition 1
Social and Environmental Interventions
Shared Meals and Social Interaction
- Encourage eating with others to improve quality of life and stimulate intake 1
- Implement family-style meals in care settings with staff participation 1
- Address social isolation and loneliness through group activities 1
Mealtime Environment
- Create pleasant meal ambience and eating environment 1
- Provide adequate meal assistance (verbal prompting, help with eating) 1
- Consider occupational therapy for functional impairments affecting food intake 1
Nutritional Support
Dietary Modifications
- Provide high-protein, calorie-dense supplementation 2
- Consider protein-enriched familiar foods and drinks 1
- Offer small, frequent meals and high-calorie snacks 1
- Tailor meals to personal culture and preferences 1
Feeding Assistance
- Provide appropriate eating and drinking aids 1
- Consider finger foods for those with impaired upper extremity function 1
- For institutional settings, consider meals-on-wheels or shopping/cooking aid 1
Pharmacological Interventions
When non-pharmacological approaches are insufficient, consider medication:
First-line option:
- Megestrol acetate (160-480 mg/day): Most extensively studied appetite stimulant with strongest evidence 2
- Benefits: Increases appetite and produces weight gain
- Risks: Thromboembolic events (RR 1.84), edema (RR 1.36), increased mortality (RR 1.42)
Alternative options:
Mirtazapine (15-30 mg/day): Particularly effective when depression contributes to anorexia 2, 3, 4
- Benefits: Increases appetite, weight gain, may improve depression
- Side effects: Somnolence (54%), increased appetite (17%), weight gain (7.5%)
Dexamethasone (2-8 mg/day): For short-term (1-3 weeks) appetite stimulation 2
Olanzapine (5 mg/day): Particularly when depression contributes to anorexia; also helps with nausea control 2
Monitoring and Follow-up
- Assess appetite improvement and weight gain within 2-4 weeks of starting therapy 2
- Monitor for specific adverse effects based on medication choice 2
- Discontinue treatment if no benefit is observed after an adequate trial 2
Common Pitfalls to Avoid
- Failing to identify and address reversible causes of appetite loss 2
- Using appetite stimulants indiscriminately without considering risk-benefit ratio 2
- Continuing ineffective treatments beyond 4 weeks without reassessment 2
- Overlooking the impact of polypharmacy on appetite 1
- Implementing restrictive diets that may worsen nutritional status 1
By systematically addressing the multifactorial causes of appetite loss in elderly individuals and implementing appropriate interventions, clinicians can effectively improve nutritional status and quality of life in this vulnerable population.