What causes decreased appetite in the elderly and how is it managed?

Management of Decreased Appetite in the Elderly

Decreased appetite in the elderly should be addressed through a comprehensive approach that identifies and manages underlying causes while implementing supportive nutritional strategies.

Causes of Decreased Appetite in the Elderly

Appetite loss in older adults is multifactorial and can be attributed to:

Physiological Factors

• Age-related changes in appetite regulation 1
  • Decreased adaptive relaxation of the stomach fundus
  • Increased cholecystokinin levels and effectiveness
  • Decline in central feeding drive (opioid and neuropeptide Y effects)
• Sensory changes (taste and smell deterioration) 1

Medical Factors

• Acute and chronic diseases 2
• Chronic pain 2, 3
• Swallowing difficulties (dysphagia) 2
• Chewing problems and poor dentition 2, 1
• Medication side effects 2, 3, 1
• Depression 3, 1

Social and Environmental Factors

• Loneliness and social isolation 1
• Poverty 1
• Inadequate meal environment 3
• Loss of social networks 1

Assessment Approach

1. Nutritional Screening:

   • Use validated screening tools to identify malnutrition risk 2
   • Assess weight history and recent changes 3

2. Comprehensive Assessment:

   • Evaluate eating patterns and behaviors 3
   • Assess individual habits, preferences and abilities around eating 2
   • Screen for depression and psychological factors 3
   • Review medication regimen for appetite-affecting drugs 2
   • Physical examination and laboratory assessment 3

Management Strategy

1. Address Underlying Causes

• Identify and manage probable causes of malnutrition and dehydration 2
• Treat acute diseases and chronic pain 2, 3
• Address oral health issues and swallowing problems 2
• Manage depression if present 3
• Review and modify medications with adverse effects on appetite 2, 3

2. Dietary Modifications

• Eliminate dietary restrictions that may limit food intake 2
• Offer small, frequent meals and high-calorie snacks 3
• Tailor meals to personal preferences 2, 3
• Provide protein-enriched familiar foods and drinks 3

3. Environmental and Social Interventions

• Encourage eating with others/shared meals 2, 3
• Create a pleasant meal ambience 2
• Provide adequate meal assistance (verbal prompting, help with eating) 2
• Consider shopping/cooking aid or meals on wheels services 2

4. Pharmacological Interventions (if appropriate)

• Routine use of appetite stimulating agents is not recommended in dementia patients 2
• For patients with depression and appetite loss, consider mirtazapine (15-30mg daily) 3
• For cancer patients with appetite loss, megestrol acetate (400-800mg daily) has strongest evidence 3
• Monitor effectiveness after 2-4 weeks and discontinue if no improvement 3
• Be cautious of risks with appetite stimulants, including thromboembolic events (RR 1.84) and increased mortality risk (RR 1.42) 3

Common Pitfalls to Avoid

1. Implementing restrictive diets that worsen nutritional status 3
2. Overlooking the impact of polypharmacy on appetite 3
3. Using appetite stimulants indiscriminately where evidence is limited 2, 3
4. Continuing ineffective treatments without reassessment 3
5. Failing to consider individual preferences and abilities 2

Monitoring

• Regular weight monitoring 2
• Reassessment of nutritional status 2
• Evaluation of intervention effectiveness 3
• Adjustment of care plan as needed 2

By systematically addressing the complex factors contributing to decreased appetite in the elderly, healthcare providers can improve nutritional status, prevent malnutrition, and enhance quality of life in this vulnerable population.