A gradual reduction in appetite with advancing age is not usually a cause for concern. Most seniors will eat less because of lower energy requirements with advancing age. In fact this is considered as a relatively normal part of health aging. However, there comes a point where this reduction in appetite should be considered as a warning sign of an underlying problem. A drastic reduction in appetite along with weight loss, fatigue and other symptoms needs to attended to by a medical professional.
Why do older people eat less?
This is a common question among concerned friends, family and relatives. There is no simple answer because the factors affecting appetite in one older person may not apply to another. This is particularly the case when it comes to pathological causes (diseases causing appetite loss) and psychosocial factors. Appetite control is a complex short-term and long-term process involving multiple factors from the feeding centers in the brain to hormones, blood glucose levels and nerve impulses between the digestive tract and central nervous system.
It is generally accepted that a moderate reduction in appetite among the elderly is related to normal aging processes. Firstly the resting metabolic rate decreases with age due to dwindling levels of certain hormones, like growth hormone, and reduced levels of physical activity that is common in the retirement years. Second is the impact of food preparation, taste, chewing, swallowing and digestive changes that are also considered part and parcel of growing old.
Tea and Toast Diet
Some elderly people will experience a significant reduction of appetite that may affect their body weight, health and wellbeing. Studies have shown that a loss of more than 10% of body weight in the elderly is linked to a higher mortality rate within 6 months after weight loss. The problem of a loss of appetite among the elderly is recognized as a significant geriatric problem. It is known as the ‘anorexia of aging’ and is often associated with poor dietary habits like the ‘tea and toast diet’ that is common among seniors across the globe.
The tea and toast diet is where the elderly tend to eat toast and drink tea as a means of replacing more conventional meals. It may apply to one or two meals, or it may even be for every meal. The inadequate nutrition can lead to weight loss and nutritional deficiencies. Sometimes there are physical and psychological reasons for opting for this type of diet. However, it is now also known that financial and social factors may also be a consideration in why the elderly may choose the tea and toast diet for sustenance.
Causes of Appetite Loss In Elderly People
The causes of appetite loss in older people can be due to a myriad of conditions. Some of these conditions have been discussed below but it is not uncommon for there to be no clearly identifiable cause of the appetite loss. As mentioned, the reduction of appetite is not considered to be an issue if it is severely affecting body weight or compromising health. It is therefore important for family members and caregivers to identify appetite problems in the elderly and seek medical assistance if there is associated weight loss.
A diminished sense of taste and smell which occurs with advancing age can impact on appetite. Even the sense of sight plays a role in appetite control. Similarly other disturbances in taste and smell may reduce appetite. This includes abnormalities in taste known as dysgeusia or more specifically a bad taste in the mouth (cacogeusia). Dysosmia and cacosmia are similar disturbances with the sense of smell.
A number of different mouth and tooth problems can affect chewing. This is one of the common causes of reduced appetite among seniors. It includes insufficient teeth, poorly fitting dentures, weakness and poor coordination of the muscles of mastication (chewing), mouth ulcers, burning mouth syndrome, dry mouth and temporomandibular (TMJ) problems.
A number of gastrointestinal conditions may present with a loss of appetite. Sometimes these conditions are undiagnosed in seniors. It can include problems with swallowing and gastrointestinal motility as well as digestion of food and absorption of nutrients. Associated gastrointestinal symptoms like heartburn, abdominal pain, nausea, vomiting, bloating and diarrhea may detract from eating.
The endocrine system involves the glands and hormones. Diabetes mellitus is a common endocrine disorder among the elderly and loss of appetite may be one of the symptoms. It is also more likely to arise with diabetic complications like gastroparesis or the use of diabetic medication such as metformin. There are other endocrine diseases which may also present with loss of appetite.
Another factor that has to be considered is the physical limitation of seniors to shop for and prepare food. It may be associated with frailty of advancing age or musculoskeletal disorders that limit dexterity. The elderly with very restricted mobility may opt to forgo meals purposely or experience a loss of appetite possibly due to the difficulty in sourcing and preparing food.
Depression is considered as one of the leading causes of loss of appetite among the elderly. The depression in seniors may arise for a number of reasons which may overlap with physical and socioeconomic factors where a loss of appetite is present. Dementia, addiction and eating disorders are other mental health conditions in seniors that may affect normal appetite.
Socioeconomic factors are not always taken into account with anorexia of aging. The implications of living longer or having inadequate financial support during retirement may force seniors to eat less. Social isolation and living alone with physical limitations can also play a role in appetite among the elderly.
Loss of appetite is one of the common side effects of several drugs. With the elderly being prone to chronic diseases and requiring long term treatment with one or more drugs, the loss of appetite may be due to medication. These drugs may not directly impact on appetite control but rather contribute to other conditions such as gastrointestinal problems which may in turn affect normal appetite.