Poor appetite is a common and serious problem in older people. Reduced appetite can lead to nutritional deficiencies and weight loss, which can lead to poor healthcare outcomes and even increased mortality. It is most commonly observed in elders living at home, in hospitals, or in elder care facilities.
In this article, we will discuss the causes of appetite loss in the elderly, its effects, and ways to combat it.
What can cause loss of appetite in the elderly?
The decrease in appetite is quite common amongst the elderly, and should not be considered shameful or unusual. In fact, between 15% and 30% of older people are estimated to experience it, with higher rates in women, nursing home residents, hospitalized people and with increasing age.
There are many changes that occur with aging that can be responsible for a decrease in appetite. Broadly, these include:
- Changes to the physiology of the older body
- Changes in psychological functioning, and/or social circumstances,
- Acute illness, chronic diseases and changes in the use of medication
Physiological Changes That Cause Reduced Appetite
Let us first look at some common physiological changes that can lead to a reduced appetite. Such physiological changes include changes to the digestive system, presence of disease, pain, decreases in need for energy with age, and changes to the sense of smell, taste and vision. Changes in the levels and responsiveness to some of the hormones involved in appetite control have also been found in older people.
Changes to the Digestive System That Can Contribute to Declining Appetite
Gastric emptying is slower in older people, so food remains in the stomach longer prolonging satiation and reducing appetite. Constipation can also cause reduced appetite, and is commonly reported by older people, with reported rates of between 30% and 40% of community-dwelling older people. Over 50% of nursing home residents complaining of chronic constipation.
Sensory Impairment and its relation to Appetite
Taste, smell, and vision are all involved with the enjoyment of food, and impairments of these senses that occur with aging can cause reduced appetite.
The smell of food stimulates appetite, and taste promotes the enjoyment of food and further stimulates appetite during eating. Many older people have impaired sense of smell and taste which will cause them to have a worse appetite.
Good eyesight helps to stimulate appetite and older adults with poor vision are more likely to report poor appetite.
Visual impairment is increasingly common with increasing age, with one in five aged over 75 years and one in two aged over 90 years are reported as having sight loss.
Oral and Dental Health
Our older family members are more likely to have poor dentition (condition and number of their teeth). Unfortunately, wearing dentures and chewing difficulties are both associated with loss of appetite.
Poor oral health is more common in frail older people, reducing the sense of taste and can contribute to poor appetite.
Additionally, an estimated one third of people over 65 years old have reduced saliva production, causing difficulties in eating that may impair appetite. Decreased saliva production is not a part of normal ageing, and is most often caused by medication side effects. 
Acute Illness and Chronic Pain
Appetite tends to decline acutely in response to acute illness especially acute infection which induces cytokine production that may substantially impair appetite.
Some chronic diseases which worsen appetite include cardiac failure, chronic obstructive pulmonary disease, renal failure, chronic liver disease, Parkinson’s disease, and cancer. Note that all of these conditions are more prevalent in older people.
Chronic disease can also impair appetite through impaired dexterity and pain. Impaired dexterity interferes with the eating process, food takes longer to eat and may go cold, reducing the appetite usually stimulated during eating.
Chronic pain is associated with poor appetite, and since as many as half of all community-dwelling older people suffer from chronic pain this may contribute significantly to the loss of appetite in older people. 
Low Energy needs
The energy needs of an individual are determined by 2 factors
- Their body composition, especially the fat-free mass (all the body components that are not fat, including muscle, bones, and organs)
- Their levels of physical activity.
Most older people are less physically active and they usually lose fat-free mass with increasing age, with skeletal muscle being lost at a rate of approximately 1% per year in the 70s. Hence older people have lower energy requirements which may contribute to a reduction in appetite. The energy needs of the elderly will vary between individuals reflecting differences in their body composition and levels of physical activity.
Effects of Low Eating
Reduced appetite can lead to reduced food and nutrient intake, increasing the risk of weight loss and nutritional deficiencies
Appetite may also decline acutely in response to acute illness. Detecting loss of appetite before weight loss and nutritional deficiencies occur will allow intervention at an early stage, preventing a decline in health.
Nutritional deficiencies and weight loss have serious consequences for older people such as a high risk of osteoporosis, osteomalacia, muscle weakness, frailty, being prone to fall, may sustain fracture that would take long to heal, etc. It weakens your immune system, leaving you more susceptible to infections, and it increases your risk of being deficient in important nutrients such as vitamins and minerals . Also, older people may find it hard to regain lost weight.
If you are underweight or have lost weight suddenly or for no obvious reason, see your GP to ensure there is no underlying medical cause for this weight loss.
Being underweight can be especially serious for older people. It increases your risk of health problems, including bone fracture if you fall and and impaired quality of life.
Ways to Combat Low Appetite
Older people usually lose appetite even if there is nothing wrong with their health. They may be underweight simply because they are not eating enough and their diet doesn’t give them sufficient energy or calories.
However, you can take certain measures to improve their diet and get the energy and essential nutrients they need.
How to eat if you’ve lost your appetite
The appetite generally decreases as we grow old and, normally, an older person may not even feel like eating. But still, it is important to get all the energy and nutrients that your body needs especially if you are underweight and your appetite has decreased.
There are 3 ways to do this:
- Have smaller meals and frequent snacks instead of struggling to eat 3 large meals a day.
- Increase your calorie intake
- Limit consumption of trans fats or foods that are high in saturated fat or sugars, such as sugary fizzy drinks, cakes, and biscuits 
Tips to boost your calorie intake
1. Try these following healthy yet still high-energy meal and snack ideas:
- Porridge made with whole (full-fat) milk, with fruit or dried fruit on top
- Sardines on toast
- Peanut butter on toast or healthy beans on toast with sprinkled cheese on top
- Smoothies or shakes with nuts
- Soups with pulses, pasta or meats
- Cottage/shepherd’s pie
- Milky drinks as a bedtime snack
- Unsalted nuts
2. Add more calories from healthier foods to your diet to help you gain weight:
- Sprinkle grated cheese on savoury dishes
- Add cheese or milk to soups
- Spread avocado on toast for a high-energy and healthy snack
- Pour white sauce (made with butter, flour and milk) on fish or vegetables
- Replace 1 cup of tea or coffee each day with a cup of warm full-fat milk
- Put milk or butter into mashed potato
3. Eat with friends and family
If you’ve lost the motivation to eat or fighting hard to find interest in food, eat with friends or family. Eating together with friends or family helps to reconnect, socialize, and promote healthy eating. Lunch clubs are also a great way to make mealtimes more social.
If you find it difficult to prepare foods, try the following tips:
- Choose ready meals with less salt. It can be hard to find a ready meal that is nutritionally balanced. To find out how to choose a healthy meal, read about food labels.
- Keep some tinned and dried fruit at home. It’s an alternative to fresh fruit, needs no preparation and can count towards your 5 A Day . Tinned fruit is also easy to eat if you have dental problems.
- Keep some frozen and tinned vegetables at home. They’re easy to prepare and can count towards your 5 A Day.
- Buy puddings and snacks that come in individual pots, such as yogurt and rice puddings.
- Replace or supplement a meal with a high-calorie drink.
- Improve your appetite with exercise: Physical activity is particularly important for older people. It can help you stay healthy, mobile and independent. Being active helps keep your heart healthy and lowers your risk of heart disease and stroke – even if you’re underweight. You may also feel hungrier the more active you are.
- Have your meals delivered, if you struggle to cook for yourself or to shop for food, consider getting outside help.