"Doctor, can you tell my mom that she needs to eat? We tell her it's important, but she won't listen to us."
Article by Jill Powers, DO, FACP, Internal Medicine Physician at Grand River Medical Group
Some normal things happen with advanced age that decreases one's appetite. Taste buds aren't as plentiful, the ability to smell decreases, and even the look of food may not be as appealing to aging eyes. With diminishing levels of activity, the need for food energy also decreases.
A newly decreased appetite may require some further investigation. Some prescriptions lead to dry mouth, which further contributes to the loss of taste. Other side effects of medications can cause changes in digestion, and eliminating them when the side effects outweigh the benefits should be considered.
Depression is recognized as the number one cause of appetite suppression. This can develop following a recent hospitalization, change in living arrangements, or during the grieving process. Loneliness may also contribute to this, as food is frequently the center of social events.
Family can address some of these concerns in several ways to add appeal to mealtime: adding flavorful spices to meals, serving a rainbow of foods on contrasting colored plates, trying sugarless gum for dry mouth, and adding citrus to water. Keeping meals a family and friends social event with greater frequency will lessen the loneliness. If their loved one is not able to eat a big volume of food, increasing the nutritional density of foods with avocados and nut butters is helpful. Also, it has never been proven that supplementing calories with nutritional shakes has ever made anyone live longer. They are to be used as a temporary aid during a recognized reversible problem as mentioned above and never forced on someone who doesn't want them.
When the above issues have been addressed or no clear cause is found, the loss of appetite situation I then find is the failure by family to recognize and respect the dying process. Most people know when pets are nearing the end of life that they stop eating. However, this is difficult to recognize when thinking about your human loved ones. To best address this, I tell the patient that they are now captain of the ship and they get to set the eating rules. I educate families to stop asking about the patient's hunger and simply provide meals when the patient asks. When the body is shutting down, it can actually be painful to eat due to fluid shifts that occur, decreased blood supply to organs, and weakening of the digestive tract just like in all their other muscles. Too often, I see the patient wanting to please the family and try to eat despite it making them more uncomfortable.
As nutritional needs shift later life, it's important to recognize the changes that occur, including the loss of feeling of hunger or thirst. Knowing this can give peace to those trying to help. When it's time, all they'll need is love.
Article was originally published in the Telegraph Herald- Healthy Living Section, 03-15-2020.