As we age, our appetites change greatly. This is due to a number of causes, but this also puts us at risk for malnutrition and anorexia of ageing. Anorexia describes the act of not eating or having a poor appetite.

Anorexia nervosa is the psychiatric disorder that consists of avoiding food and severely reducing intake, normally due to body dysmorphic disorder or some other comorbidity that affects the way one perceives their weight. This is more likely to affect teens, young adults, and those whose careers are based on their appearance than elderly individuals.

Anorexia itself is a symptom that describes a lack of food intake, normally due to illness or reduced appetite. Occasional anorexia is not cause for concern, but the older we get, the more likely we are to start significantly reducing food intake for one reason or another, also known as anorexia of aging. It’s important that elderly individuals and their family members take note of what they are eating to ensure they are getting the proper nutrients.

Why elderly lose their appetite

Although roughly 40% of elderly are obese in the US, 15-30% of older people are estimated to have anorexia of aging, with higher populations being women, nursing home residents, hospitalized patients and increasing age. It’s important to remember, that not all causes of anorexia are due to voluntary decreased food intake. Some causes are due to other health concerns, including Alzheimer’s and Dementia, thyroid disorders, cancer, mouth and throat infections or gum disease or salivary gland problems. Also, some medications can have a side effect of dry mouth or a metallic taste that can change how food or water tastes. If you or your parent/patient has any of these disorders, then it’s important to address those before addressing anorexia.

If you or your patient/parent does not have any of those disorders, then there may be other reasons they’re eating alone, including:

• Lack of exercise – regular exercise boosts appetite. Sometimes seniors need to workout before a meal so they can build their appetite. Without, their body may not be giving them the signals that they are hungry.
• Dehydration – a lack of water can reduce one’s appetite. Many older adults don’t get enough fluids and can become dehydrated more quickly due to age-related changes or the medications they’re taking.
• Lack of a routine – most seniors are retired, and this unstructured time can lead to a loss of meal times. Eating meals at the same time everyday can help the body feel hungry and ready to eat at those times.
• Inability to prepare meals – seniors who live alone or live in assisted living may not be able to prepare meals for themselves.
• Loss of taste – age-related changes of the tongue can cause many people’s taste buds to become less able to detect flavors. Normal food may be bland and unappetizing to them. This can be exacerbated in those who have smoked, consumed alcohol, or participated in other behaviors that damaged taste receptors in the mouth.
• Difficulty chewing, swallowing or eating independently – if eating is too difficult, then seniors may not want to eat. These problems can be caused by normal aging, dental problems, medication, treatments like surgery, and neurodegenerative disorders like a stroke, dementia, multiple sclerosis, and Parkinson’s.
• Sensitivity to smells – sometimes people develop a sensitivity to the smell of certain foods that can make them feel nauseated or unable to eat.
• Depression or loneliness – Depression affects 1 in 10 seniors and often causes loss of appetite. Many older adults may also dislike mealtime because they have no one to eat with and their loneliness gets intensified.
• Loss of control – When older adults are dependent on others for everything, they’ve lost control over how they want to live their lives. Sometimes, not being able to choose what they eat makes someone not want to eat all there, which is an example of them exercising the little bit of autonomy they have.

Malnutrition in Older Age

Malnutrition is a frequent and serious problem in the elderly. The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status, undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. Malnutrition is considered an “ominous sign” and without intervention, can be the beginning to a treacherous road to the end of life. Malnutrition does not just consist of not eating, but there is also a psychological component that can be precipitated by loss, dependency, loneliness and chronic illness.

Malnutrition can often be overlooked in the elderly because it is just attributed to a normal event in older age. However, at all stages in life, it’s important to maintain a healthy diet, and although energy expenditure may be less in older age, that does not mean that they don’t still need to hit their recommended daily intake for their body composition and gender.

Consequences of Malnutrition

The consequences of malnutrition are so serious, which is why it’s important that malnutrition is addressed quickly and prevented when possible. Malnutrition can be fatal in elderly adults due to a variety of reasons.

Malnutrition can weaken immune systems, therefore making if difficult to fight of disease. Older adults already may have weakened or waning immune systems already, so adding to this by reducing the presence of essential nutrients can be very dangerous. Also, malnutrition can lead to slower sound healing, a processes that also is already slowed in seniors. Slow wound healing increases the risk of that wound getting infected, which the body will have a hard time fighting off due to the fact that immune system is weakened.

Malnutrition can also have physical consequences with muscle wasting and weaker bones making falls more likely. Falls in older age are hard to recovery from already, and being deficient in key micronutrients like Vitamin D and calcium exacerbate that process. Last, but certainly not least, malnutrition can contribute to disease complications and hospitalizations.

Preventing Malnutrition

Malnutrition can be difficult to recognize because it’s not based on body size or weight. The signs and symptoms may be more subtle and dismissed as a normal party of aging. However, unexpected weight loss and a noticeable loss of appetite or food intake can be a clue.

There are a few ways to prevent malnutrition, including:

• monitoring weight
• observing habits
• keeping track of medications, and which ones may contribute to weight loss or decreased appetite
• assistance with meal plans
• use local services for meal preparation (like Diverse Health Services!)
• make meals social events

These tips are a a few easy ways that seniors citizens and their families/caretakers can work together to make meal time an enjoyable experience. With these preventative measures, hopefully elderly individuals can avoid malnourishment through the rest of their lives.