As we age it is normal for our appetites to become decreased. Aging results in a decrease in physical activity and metabolic rate. However, residents in long term care facilities who continue to lose weight can be at a higher mortality rate. According to the Annals of Long-Term Care, physiologic, pathologic, psychologic, and sociologic factors (ex: depression, loss of social networks, chronic illness, medications) increase the risk of anorexia of aging and resultant malnutrition.
Proper nutrition plays a huge role especially during the aging process. Many residents eat smaller meals and eat slowly. Some may snack less frequently and therefore consume fewer calories.
Some physical ailments such as chronic obstructive pulmonary disease (COPD) or Parkinson’s disease can cause a decrease in appetite. Those affected by Alzheimer’s or dementia may experience loss of appetite or totally forget to eat. As we age, the desire or enjoyment of food can be diminished and our sense of smell and taste changes significantly. Those with a decrease in smell and taste tend to experience a decreased interest in eating.
Residents with ill-fitting dentures can experience difficulty chewing. Make sure that a resident receives a dental consult for issues with dentition. If a resident’s dentures are too loose or uncomfortable, eating can become difficult or unpleasant. Make sure a texture modified diet is provided to aid with any dentition problems.
Loss of appetite can also occur from certain medications. There are some anti-depressants which can adversely affect the appetite. Make sure the physician is made aware of any loss of appetite and its possible relationship to medications. Considering the average elderly person takes 15 pills a day there is a strong chance one of them can affect the appetite. There may be alternative medications that could be prescribed that would not have a negative effect on the appetite.
It is up to food service supervisors, dietary managers or dietitians to find out how a resident has been eating prior to admission. Has the resident experienced any weight loss or change in their appetite? Has there been a recent death of a loved one that could affect their appetite? Be aware that when a resident is first admitted to a long-term care facility that it may take a few days to get accustomed to their surroundings. The initial shock of being in a new place can often adversely affect their appetite. It is common for a new resident who is having a hard time adjusting to experience a decrease in appetite only to have it improve once they have become acclimated.
How can we help those residents who find eating to be a chore? First off, as was mentioned earlier, the older we become the less we need to eat. Some elderly persons are overwhelmed by large amounts of food. Be sensitive to the fact that some people may want smaller portions. An elderly person requires fewer calories than a younger or middle aged person. Getting an order for small portions is usually all that is needed if a facility is worried about what a state surveyor may say about providing less food on the plate.
Ask family members to help if the resident’s appetite is down. Are they some special comfort or ethnic foods that could be brought in to stimulate some interest? Is the resident a fan of junk food? While eating a bacon cheeseburger may not be what a cardiologist orders, when a resident eats very little, sometimes anything is better than nothing at all.
We need to liberalize diets whenever possible to improve the appetite. If someone is on a strict dialysis diet but is not eating, perhaps changing the diet to a regular diet with no restrictions is the answer. Maybe someone on a diabetic diet should be allowed whatever cookies, cakes, etc. that they want. The risk and benefit needs to be weighed when considering liberalizing. If a resident is not eating much at all, it is better for them to be consuming some type of calories rather than very little or none.
Supplements are certainly a solution that most long-term care facilities use for their residents. These must be offered between meals and not as a replacement for a meal. These can help to increase or stabilize weight status. Our number one goal is to have the resident consume their meal first and then take supplements.
There are also nutrient dense solutions like power pudding, fortified cereals, muffins, mashed potatoes etc. These are items the resident normally eats but contain a boost of calories and protein.
Just as with many of us, meal time is a very social time. Make the environment calm and inviting. Give the resident plenty of time to eat. Serve the food restaurant style, rather than on institutional trays. As with young children, some residents can become distracted at meal time and stop eating. Pipe in some calming music and try to eliminate distractions.
Work together with all departments to identify those residents who are experiencing a decrease in their appetite. The sooner they are identified the quicker the plan of action to improve their appetite can be implemented.