Loss of appetite among elderly often a sign of problems

ST. LOUIS -- Madeline Thompson was a home economist who cooked three square meals a day for her family in Springfield, Ill.

But as she and her husband aged, they began losing their appetites. Denture problems made it hard for John Thompson to chew his food. Depression, dementia and other health problems followed.

The couple, now 89 and 90, didn't complain but their daughter noticed.

"They started out with a great breakfast, but as the day wore on, they'd eat very little, half a sandwich, half a banana, a glass of milk. They were not eating healthy," said Jan Winter, who eventually moved her parents to a nursing home near her in St. Louis.

They are better nourished now with round-the-clock care, and are more interested in eating when Winter brings them to her house for Sunday dinners or takes them out to an ice cream parlor.

But proper nutrition and hydration continue to be a challenge.

The Thompsons are typical of elderly people who curtail eating for reasons as varied as poor-fitting dentures to pain to loneliness. Depression is the leading cause of poor nutrition, experts say, and should be treated.

Loss of appetite is often an early warning sign of something gone wrong.

"There's a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you'll have a higher chance of dying," said Dr. John Morley, geriatrics director at Saint Louis University Hospital, and a professor of medicine.

Despite conventional wisdom, weight loss is not a normal part of aging.

"They're not supposed to wither before they die," said Dr. Margaret-Mary Wilson, who teaches and researches geriatric medicine at Saint Louis University, and has a practice.

Older adults are more susceptible to malnutrition because the stomach empties more slowly in later years, and the sight, smell and taste that used to make eating so enjoyable are diminished.

"The battle to maintain nutritional status is uphill," Wilson said. "And restrictive diets only make the problem worse."

Registered dietitian Ann Gallagher, a Fort Wayne, Ind., dietary consultant to nursing homes, estimated that half of new admissions to long-term-care facilities are malnourished and it's difficult to recover from that.

"They're living at home with no food in the refrigerator," she said. "They're managing with a nephew who looks in on them once a week. It's horrible."

People with dementia may simply forget how to shop and prepare meals, or how to eat, chew or pick up utensils.

"We presume people are finding food and are able to unwrap meals from Meals on Wheels," said Dr. Eric Tangalos of the aging program at Mayo Clinic in Rochester, Minn. "But it's beyond their capacity. It's too difficult."

He says the chief concern is getting them to eat enough calories.

Wilson added, "When you're older, 70 or 80, there's no such thing as bad food when you're losing weight."

But while calories are important, those packed with nutrition are important for health, stamina, the immune system and repair of thin, less-resilient skin that breaks down easily, said Sue Moores, a nutrition consultant in St. Paul, Minn.

She recommends fortified, ready-to-eat cereals and powdered instant breakfast drinks mixed with milk. Liquid supplements are nutritionally comparable, she said, but often have an unpleasant medicinal taste.

Because many older adults are deficient in calcium and Vitamin D, she recommends adding a tablespoon or two of nonfat dry milk powder to yogurt, cottage cheese, creamed soup, hot cereals, and even a glass of milk. It adds protein and makes food creamier and easier to swallow. The trick is to blend it well to prevent graininess.

She also suggests baked or microwaved potatoes and colorful treats like cut-up watermelon, mandarins, apples, oranges, mangos, strawberries or other berries -- the brighter in color the better.

Many older adults limit themselves to the easily unwrapped, eaten and digested banana, but it lacks the nutrition of other fruits, Moores said. In place of hard-to-digest broccoli, offer spinach, green beans and tender lettuce. Also high on her list are beans, which are stuffed with vitamins and fiber. Casseroles are good too because they can be easily stored and require less chewing.

Some older adults live on toast, cereal and other foods that require minimal preparation, but such a simple diet puts them at risk of anemia. Moores recommends regular blood workups by a visiting nurse.

The bottom line, says Tangalos, is calories. "It's all about calories."