What are the recommended strategies to increase appetite in an elderly patient?

Strategies to Increase Appetite in Elderly Patients

Pharmacologic appetite stimulants should NOT be used in elderly patients, as they lack consistent efficacy and carry significant risks of adverse effects that outweigh uncertain benefits. 1

Avoid Pharmacologic Appetite Stimulants

• Orexigenic drugs are not recommended for promoting food intake in older adults 1
• Cannabinoids show no significant effect on body weight, BMI, or energy intake in elderly patients with dementia 1
• Megestrol acetate and mirtazapine have conflicting evidence, with adverse events that are not benign; their use should only be considered after all underlying causes of weight loss are thoroughly assessed and treated 2
• Mirtazapine may have a role only when elderly patients with weight loss also have depression requiring antidepressant treatment, but cannot be recommended for weight loss alone 1

Effective Non-Pharmacologic Strategies

Optimize the Eating Environment and Food Quality

• Improve sensory quality of meals according to the preferences of elderly individuals, which increases both meal enjoyment and energy intake by approximately 5% 3
• Provide variety in main dishes and condiments throughout meals, which boosts food intake by approximately 7% 3
• Encourage older adults to eat in company rather than alone, as social dining is a simple strategy to increase food intake 4
• Allow older adults to participate in meal preparation when possible, as this increases appetite and subsequent food intake 4

Address Protein Intake

• Protein does not elicit as strong a satiating effect in older adults as it does in younger individuals, creating an opportunity to increase protein intake without reducing overall energy consumption 4
• Focus on increasing protein-rich foods since older adults have higher protein requirements and reduced satiety response to protein 4

Implement Exercise Programs

• Regular exercise significantly reduces fasting leptin and glucose levels, promoting improved satiety sensitivity and appetite control in adults aged 60 and older 5
• Exercise programs (resistance training, aerobic, or mixed modalities) help modulate resting hunger and satiety, providing a meaningful avenue for balanced energy intake 5

Maintain Oral Health

• Support oral care including tooth brushing once or twice daily, ideally performed by a specially trained person with regular dental visits 1
• Proper oral health serves as an important prerequisite for adequate dietary intake and may prevent pneumonia and other complications 1

Common Pitfalls to Avoid

• Do not reach for appetite-stimulating medications as a first-line approach; the evidence does not support their routine use and side effects can be harmful 1
• Do not overlook underlying reversible causes of poor appetite (depression, medication side effects, dental problems, swallowing difficulties) before considering any intervention 2
• Avoid focusing solely on increasing food volume; instead prioritize sensory quality and variety which are more effective 3

Practical Implementation

• Use packaging and food preparation methods that are easy for elderly patients to manage safely 4
• Educate older adults on safe food storage and preparation to reduce barriers to eating 4
• For patients with dysphagia, involve speech therapy and dietetics services for close monitoring and tailored strategies 6
• Ensure adequate hydration with approximately 30 mL per kilogram of body weight per day, as dehydration can worsen appetite 6