Reducing Elder Pedestrian Fatalities And the Alex and Ronni Show
INTERESTING STUFF – 14 July 2018

Anorexia of Ageing: How Growing Old Affects Appetite

Some medical professionals call the loss of appetite in old people the “anorexia of ageing.”

Up until a year ago, if anyone had told me I would one day need to work at maintaining or gaining weight, I would have collapsed laughing. The opposite had always been my problem and I've always loved to eat - just about anything.

Then, even after recovering from the extensive Whipple surgery 13 months ago, I wasn't hungry much of the time.

As happened to with me, serious diseases and conditions can reduce appetite in elders but it is not uncommon for a remarkably long list of other reasons too. Here are some of both kinds:

Any acute illness such as:
Cardiac disease
COPD
Renal failure
Liver disease
Parkinson's disease
Cancer
Alzheimer's disease

Other difficulties such as:
Dental conditions or denture problems
Reduced saliva production
Swallowing problems
Constipation
Impaired senses of smell and taste
Medication side effects
Depression
Loneliness
Lack of energy to cook

And that's just a partial list from which, I suppose, it can be extrapolated that pretty much every old person has an appetite problem at one time or another.

The BBC website tell us that changes to appetite happen throughout our lives but become more common in old age:

“After the age of 50, we begin to suffer a gradual loss of muscle mass, at between 0.5-1% per year. This is called sarcopenia, and lessened physical activity, consuming too little protein, and menopause in women will accelerate the decline in muscle mass.”
At age 60 and beyond, the BBC continues, old age and lack of hunger can lead “to unintentional weight loss and greater frailty,” and frailty is nothing to fool around with. The opening paragraph of Wikipedia's entry about it is worth quoting if just for the literary reference that amuses me:

”Frailty is a condition associated with ageing, and it has been recognized for centuries. As described by Shakespeare in As You Like It, 'the sixth age shifts into the lean and slipper’d pantaloon, with spectacles on nose and pouch on side, his youthful hose well sav’d, a world too wide, for his shrunk shank…'

“The shrunk shank is a result of loss of muscle with aging. It is also a marker of a more widespread syndrome of frailty, with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss.”

Unintended weight loss is serious business that is difficult to reverse in elders. A good-sized 2017 study about appetite in elders discovered that

”...older adults with poor appetites ate much less protein and dietary fiber. They also ate fewer solid foods, protein-rich foods, whole grains, fruits, and vegetables.

“However, people with poor appetite did eat/drink more dairy foods, fats, oils, sweets, and sodas compared to older adults who reported having very good appetites...

“The team concluded that identifying the specific food preferences of older adults with poor appetites could be helpful for learning how to help improve their appetite and the quality of their diets.”

Directly following my surgery, I was told to eat six small meals a day. I was lucky to be able to get down four before anything more that day threatened to cause me to vomit. But the nurses were terrific in helping me figure out how to increase the high daily calorie count I needed to prevent more weight loss.

Little things, they said, like adding grated cheese to scrambled eggs, switching to whole milk for cereal, eating as much of my two favorite foods – ice cream and cheese – as I wanted, also peanut butter, lots of high protein foods including red meat.

They also recommended that old folks' staple, protein drinks. I won't mention brand names because I dislike all the supermarket brands – it's like trying to drink glue to get them down.

(I go out of my way to not mention product names here and I tell you this one for information purposes: I finally discovered a brand of protein drink that actually tastes good: Odwalla. They make other kinds of drinks so if more protein is your goal, be sure to use the bottles labeled “Protein.” on the front. Of course, everyone's tastes differ.)

For the first three or four months, I wasn't allowed most vegetables and no fresh fruit with small seeds. When I said I was concerned about my health with such a high fat, high protein diet, one nurse said, “Ronni, cancer will kill you long before this diet will,” so I stopped complaining and followed instructions.

As much as the point was to keep up my weight, it was also to accommodate the radical surgery that removed quite a few pieces of my digestive system – something that would not apply to the diet of those who haven't had this kind of surgery.

Nowadays, just over a year since the surgery, I eat a normal three meals a day, am back on lots of salads, fish and fruit but I've hung on to red meat once or twice a week and I drink Odwalla (average 300 calories per 15 ounce container) several times a week.

Plus, I weigh myself every morning and keep a chart. Mostly my weight is stable but if it drops more two pounds within a week, I up the calorie intake for awhile.

And now, after nearly a year off, I am back to my workout four times a week. I've lost a lot of muscle mass and doubt I'll get much of it back, but I can work at strengthning the muscles I've got.

The point is to fight back against loss of appetite – it will go a long way to keeping us healthy and active. WebMD has a good list of strategies to help overcome lack of hunger.

What's your experience with anexoria of ageing?



Comments

I’m 70 and still love my chow.

I'm 75 and could use a goodly amount of unintentional weight loss. I lost 20-25 lbs during my chemo three years ago, but it came right back afterwards. Can't say I recommend the method, but I sure would like to have kept that weight off.

As for the protein drinks, one particular brand started as supplement in hospitals and is what they were trying to get my mom to drink before she died. I'll never be able to think of them any other way. There are plenty of high protein foods I'd rather binge on.

Good information Ronni thanks. I've noticed this last year (my 76th) that food is losing its charm and I forget to eat. I'm losing about a pound a month but I've been about 20 pounds over for years. But I can see I'm losing muscle so I'm working on eating a healthier diet.

I remember feeding those protein drinks to my Dad after his two separate by several years colon cancer surgeries. He was never a big eater and it turned into a problem when he aged and became ill. He really disliked the drinks but he persisted and recovered both times. He always had gobs more discipline than I. He was a lifelong tall string bean and it was hard to get his weight back up for quite awhile. He did recover after a year or so but he did just get thinner and smaller and he still added those drinks in and a little ice cream.

This is a timely subject for me. My appetite has been decreasing for several weeks now and the only thing that tastes good to me is ice cream. Some nights that's all I can tolerate and I am beginning to worry about it.

I could certainly stand to lose 20 pounds and it would be better for my knees, but all I crave are pastries and rich ice cream. For many years I have been unable to stand long enough to do more that fix oatmeal and fruit for breakfast so cooked foods are out of he question. Even fresh vegetables that can be microwaved require more preparation than I am prepared to accomplish.

For a couple of years I forced myself to eat "meals on wheels" and, even though some of them were very unappetizing, I knew they were good for me and forced them down. After my last bad fall I could no longer face another one and Lean Cuisine and Stouffers have become my dinner staples.

I realize that I am no longer eating a healthy diet, but sometimes doing so made me feel like a martyr. Good food is one of the few pleasures left to me. and I hate being reduced to food for fuel and not pleasure.

Unfortunately, lack of appetite and low energy go hand-in-hand and I now have trouble staying upright long enough to fix oatmeal and it's too easy to pop a frozen waffle in the toaster and settle for an orange or a banana as the fruit of the day.

There are meal deliveries that I investigated, but most of them still require some preparation. Right now I am assessing my options and know I must get back to a healthier diet. This is an elder problem that many face and perhaps more thought should be given to a solution. While the studies can tell you what to eat, how to increase your appetite, and so on they don't offer a solution on how to get the already prepared food to you. Unless you have more funds to spend on food than I do, it's a problem. I can't order take-out every night and most of it is not healthy anyhow.

I do drink one protein drink a day and I don't mind the chocolate or strawberry flavored ones. Sometimes they taste better at room temperature instead of straight from the refrigerator. I will try Odwalla and see if it's more palatable. Thanks for the tip.

This is for me
Last winter my daughter wanted me to come to a facility, near her home and very upscale.
I planned on 2 to 3 months. What a mistake, making my large room seem like my home a number
of trips taken back and forth by a helper to bring items. It was a beautiful facility, 5 minuets
from my daughter - but - she is so busy with her writing really did not see her much more.
My car still at my country cottage and I felt so isolated.
The worst part was the food was horrible and I lost 10 lbs. Also, a dental procedure at one of the best in Nashville turned into a horrible situation. Tooth crumbled while being pulled and now have Shingles since March.
I am back home and learned a lot. I am better off in my home with some help that is less expensive and I still
love to cook. Trying to gain weight, drink 2 protein drinks a day with ice cream:)
A gain of 2 lbs so far puts me at 100 lbs from my normal 110.
I learned a big lesson that was very expensive with much being brought to another location and brought home in March.
But now I know
I stay in my home and this one is 83

As you once did, Ronnie, I am laughing at the idea of needing to gain weight. I'm probably 50 pounds overweight now. I was very thin as a child and into my early 20s, and was always forced to clean my plate, so eating even when I didn't want to became a sort of unconscious habit. BUT - I also eat because I love good food and want to eat! In the last year or 2 of my husband's illness I was so exhausted and depressed that I didn't do the little exercise I did before, and began gaining weight pretty rapidly. And after he died I just didn't care, and allowed myself ice cream and candy, things I don't normally eat.

Last summer I lost 20 pounds. Then over the holidays I indulged myself and I'm sure I've
gained some of that back. I've decided not to worry about it. My various arthritic issues keep me from doing lots of exercise, and I still have days or weeks when I'm too sad to do much but read. And I've noticed that some things don't taste that good any more. Wine, for instance. I had some ice-cream the other day that was just ok. So we'll see what happens. I do know that I have tripped and fallen a few times in the last year and have been glad of extra padding on my hip!

Add chronic pain and fatigue to the list of reasons for not always eating right. I like stuff that isn't good for me, like ice cream, cake and sandwiches, but I try to eat salads, whole grains, fruit and some protein. I'm 5' 1-1/2" tall and usually weigh between 93-97#. My doc wants me to gain a few lbs., but I'm O.K. with where I am.

If I stop eating eventually (in the absence of major illness), it will likely be because I'm ready to do so. I have no desire to live many more years if pain becomes unmanageable and I'm not at least marginally functional physically and mentally.


After 5, or is it 6 years living alone, I have just noticed a bit of cooking- for- just- me fatigue. But often, trying something new, like those Japanese little peppers from the farmers' market, will perk up the interest. Or something as small as adding blueberries to tonight's salad. Asking a friend to join me is good.
And like Elizabeth, I've thought of not eating as a possible way out if the need should arise.

At nearly 78, my appetite is still good and I indulge it whenever possible. I also drink a protein drink now and then. It was suggested by my cardiologist. I like Boost; rich chocolate.

I could stand to lose 20 lbs. but I’m not worried about it.

Have not had appetite issue but am very aware of issues I could encounter as older person. Often when I was assessing individuals for swallowing problems people complained the food didn’t taste right was why they didn’t eat.. For some it had to do with food having to be prepared with reduced salt due to medical problems. For some others their taste and smell just weren’t as keen so more seasoning sometimes helped. I recall reading of a large east coast facility that having determined certain of their residents were attracted primarily to sweet foods began adding sugar to all sorts of food where it wouldn’t usually have been added. Some individuals responded to this stimulation, but others did not.

FWIW deciding to stop eating and drinking as a way of ending it all is not as easy as it sounds. For one thing without fluids/water the mind soon becomes disoriented, other cognitive issues, so the person may not be capable of following plan made previously. Had only one person who was able to successfully achieve her intent and she amazed staff by surviving a week or so longer than was medically expected.

I take exercise classes 5X a week. I use light weights. My arms and legs have more muscle definition. I am on a GERD food plan due to burning mouth syndrome. It's low sugar and low carb. My body shape is changing and clothes are getting looser around the waist. It's a nice feeling. I just wish my energy level was higher! I really feel like a nap after lunch.

I found the best way to handle the protein drinks are to:
- drink it cold (keep a mug in the freezer for the refrigerated drinks)
- drink it fast (before it warms up to the texture of raw eggs)
- drink it while thinking of something else. Reading at the table may not be polite, but it is distracting.

My favourite protein drink has both Plus Calorie and High Protein options.

After recent dental work I learned to like cottage cheese because it is soft, easy to swallow, and contains 15 grams of protein per half cup. It can also be mixed with other foods or used in smoothies.

At 74, keeping my weight up is a brand new problem for me, so these tips are very timely.

Of course I don't want to go overboard, either. It's only a marginal thing at the moment, and I suppose I could easily overshoot. Mostly, so far, I'm just very slightly shifting the balance of what I eat.

Easy protein: I stock a variety of individual-serving packages of cheeses and yogurt in the fridge. They're more expensive that way, and you don't get all the lovely fancy varieties, but cheaper when you consider that they won't go mouldy before you get to eat them. And they make great snacks. You can just grab one on impulse, no cooking required.

I have raw unsalted almonds on the shelf, and a good trail mix (unsalted sunflower seeds, pumpkin seeds, peanuts, currants, and a few cashews and almonds). Peanut butter, of course. Milk on my morning cereal. Hummus, which comes in a variety of flavors. Granola bars. A spoonful of Nutella is a delicious indulgence.

Is it just my failing sense of smell, or do today's bananas really not taste as fragrant as they used to?

As usual, this blog tells me tons more than I learn from any of my doctors or from any of the so-called self help articles on line. Darlene is so right about the various food options, and about the dificulty of preparing anything. If certain foods make you gag or are too difficult to deal with, they are useless.

Like many on TGB, my sense of taste has left me, but unfortunately I compulsively compensate by eating more sweets like ice cream and marmalade on my toast. Although I don't overeat, I am very overweight, mostly because I am almost completely sedentary due to the pain of arthitis and neuropathy. If you eat fewer than 900 calories a day, but use even less, you aren't going to lose weight.

Having gone round and round with the issue of staying in my not very convenient upside-down home or moving to a facility, Earnestine's comment resonated with me. What she experienced is much as I imagined it would be, so for now at least I will follow her example and stay put. Maybe I'll try Ronni's Odwalla, or some of the other good suggestions here.

At nearly 45, my appetite is very good and I indulge it whenever possible. I drink a protein drink now and then. It was suggested by my cardiologist. I like complain; rich chocolate. I also read many articles on different healthcare websites.

Hi Ronni, I was just re-reading this post to recommend Odwalla to a friend who is experiencing weight loss. I Googled this product and saw this link FYI https://www.fox13news.com/consumer/voluntary-recall-of-odwalla-superfood-bottles

I have definitely lost the appetite I once had. Some of it is because of CKD - chronic kidney disease, and some of it is because I do not have much of a sense of taste or smell anymore.

The bad thing about losing sense of taste/smell is that cooking has become difficult. If I am cooking for others I have to have a "taster" before I serve most things to see if there is too little salt (I'm so afraid of oversalting things, because then you're stuck with it) or if it needs something else. I hate that. I have always prided myself on my cooking skills, but I don't have as much confidence as I used to.

I have shrunk in height and in weight also, but that doesn't really bother me. I prefer being smaller, for some reason. Like you, I weigh myself every day and just take it from there. I'm not overly concerned about this phase of my deconstruction!

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