4 Things Caregivers Can Do to Improve an Older Person’s Appetite

I have a dear friend who is incredibly accomplished and independent. I’ve always loved visiting with and hearing about her adventures—including sailing around the world on a sailboat when she was well into her 70s! But on a recent visit, I became concerned.

Now 93, my friend was sleeping much of the day. She’d had some falls and was unable to reach her walker on the other side of the room. Most concerning, she’d lost weight. When I checked her kitchen, she had very little food. The leftovers in her fridge were clearly days old. I was worried. These were bad signs.

Many caregivers fear that weight loss is a sign of cancer or some other scary disease, but that’s usually not the case. As I’ve previously written, there are many reasons why seniors lose their appetite, from decreased sense of taste, to difficulty moving around the kitchen, to the irregular eating habits that develop when people eat alone.

How Appetite Loss Leads to Decline

But remember that even if the physician can’t find anything medically wrong, weight loss itself is a major concern. "Not eating" becomes the most important diagnosis. That’s because eating less and losing weight can kick off a downward spiral. The person declines much faster with low energy, decreasing strength, and loss of independence. This cycle can lead to a life that is shorter and of lower quality. Fortunately, by catching weight loss early and addressing the underlying causes, we can stop the cycle and turn things around.

Start by Checking the Basics

• Medications. Many medications can interfere with eating and appetite. Some decrease production of saliva. Work with the doctor to review prescriptions and look for alternatives.

• Dental issues. Does the person have tooth decay, gum disease, ill-fitting dentures, or dry mouth? Dental issues can make it hard or painful to chew and swallow. Schedule a dental visit to check.

• Mental health. Anxiety and depression can both affect appetite. Consult with a professional if you think this may be a factor.

4 Steps to Improve Appetite

Once you’ve addressed any underlying causes, follow these steps to help your loved one regain healthy eating habits:

1. Help seniors look forward to eating. Favorite foods, favorite people, and favorite places are a recipe for success. Offer foods they like and take some care with the presentation, so food looks appealing and tasty. Remember, taste sensation is decreased so extra flavoring is often needed. Comfort foods and desserts are fine—whatever they enjoy! Offer a few choices. "Mom, do you want to try the mashed potatoes or chicken nuggets?" Serve modest portions that aren’t intimidating. Remember: moderate physical activity boosts appetite. So, take a walk before dinner.

2. Make it easy. Serve foods that are easy to manage and eat. Provide utensils they can comfortably grasp and set food within reach. Try cream soups and smoothies for people who have difficulty chewing. Offer assistance when needed. However, avoid "feeding" a person if at all possible.

3. Make it enjoyable. Eating should be a time to relax and enjoy. Set aside plenty of time, and don’t rush. Make the environment comfortable. Sit with them and give yourself a snack so you can eat together. Don't just "watch" a person eat. Remember that meals are a social activity. Give your loved one some extra attention. A simple comment like, "Mom, would you like some coffee?" can make a person feel special.

4. Make it manageable. Never force a senior to eat. If it becomes a battle of wills, back off and try again later. Instead of pushing a large meal, offer five to six smaller portions throughout the day. Make eating a habit. Snack foods are great. Make them easy to reach for when the munchies strike. Old adages like "don't snack, you'll ruin your appetite" don't apply when caring for an underweight frail elder.

What about Medication?

People sometimes wonder if they should give elderly patients medication to improve their appetite. Medication may be a solution when it treats the underlying cause. For instance, the antidepressant mirtazepine is often prescribed when poor appetite is combined with depression. Used appropriately and at the right dose, this drug can improve appetite in elderly patients. Mirtazepine does have side effects including drowsiness. Other medications are sometimes prescribed to increase appetite. However, results are mixed. All drugs have potential side effects. So, talk with your doctor about the pros and cons.

The Good News About Appetite Loss

Caring for an elderly person who stops eating can be incredibly stressful. But the good news is, at this stage of life, you no longer need to follow strict rules about what’s “healthy.” Ice cream ? Go for it! Mashed potatoes with butter and lots of gravy? Sure! Some of these “bad” foods are now a major source of calories for your loved one. Remember that cholesterol levels tend to fall with weight loss, so limiting fat and cholesterol is no longer a priority. Favorite foods can help a person maintain weight, enjoy life, and live longer.

The other good news is that, as caregivers, we often have the power to turn things around. This is especially true when loss of appetite is due to aging related factors. As a geriatrician, I’ve seen many success stories where caregivers played a vital role in helping a frail elderly person enjoy eating again and regain strength. Caregivers are problem solvers who can make all the difference. It does take patience and it is a labor of love.

I’m pleased to say that’s what happened for my friend. After being hospitalized for a fall, she finally accepted that she couldn’t live by herself anymore. She reluctantly moved to a senior living community. At first, she complained, but within a few weeks she started making friends. She had people helping her with meal preparation, and friends to eat with. Now when I visit, I can see that she’s regained some weight and looks stronger.

Tips from a Nutritionist

• Fortify smoothies, milkshakes, and soups with protein powder. You can also use products such as Carnation Instant Breakfast.

• Mix supplements like Ensure Plus or Boost into regular foods.

• "Buttering up" foods adds calories. Olive oil is a great addition too.

• Products like Ensure are supplements -- not replacements for meals. It's best to use these supplements between meals, not as a food substitute. Also, avoid getting a person too full on supplements.

• Just try it and see if it works. If it doesn't, try something else. In some ways, it’s like caring for children who are picky eaters.

What a Difference Eating Can Make

Do you have a pearl of wisdom or piece of advice about helping an elderly person with their appetite? Drop your tips in the comments!

Warmest Aloha,

Dr. Warren Wong

PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.

Pattie’s Smoothie Recipe

Ingredients:

• 3 cups Motts Applesauce (Motts has the least acid level of all brands)

• 1 or 2 large bananas

• 2 Jello brand vanilla pudding cups (These are found in the refrigerator section of the grocery store in a 6 pack.) Because calories are so important to maintain weight, avoid low calorie pudding.

• 2 edible vanilla cookie dough “cookies” also found in the grocery store's refrigerator section (This cookie dough is ok to eat and adds flavor and calories to the smoothie)

• ½ cup or a bit more of smooth peanut butter. You may need to add more if the smoothie is too thin. Peanut butter provides protein and adds enough texture without irritating the mouth and throat.

• Apple pie filling – a third straight from the can to add more caloric value to the smoothie. 

• Add water or apple juice until the consistency is correct.

Blend all ingredients in a blender.

Serve with a spoon.