Angie Mezzetti looks at the factors affecting appetite in old age and at the various ways of fortifying body and soul in frail older people
Loss of appetite in an older person can often lead to a frail or weak condition, and causes upset to family members who see a loved one fading away.
Fortifying those medically termed as "frail elderly" is an important issue, according to Dr Dermot Power, a geriatrician at St Mary's Hospital in the Phoenix Park and Mater Hospital, Dublin.
"We need to change our attitude to older people," he says. "These are the strong survivors who have not died from cardiovascular disease and who have remained active for many years. If we take that perspective, we begin to see older people as a strong force in society."
Appetites decline for many reasons, Dr Power says. "Taste sensation often fades in older people and this is why they like tea a bit sweeter, food a little hotter or saltier. It's because they aren't getting as much pleasure from food as before."
Social reasons and general health problems can all be factors. "For people living alone, cooking for one is not much fun and, consequently, they tend to eat relatively small portions and intermittently," he says. "Sometimes medication can affect the taste sensation too."
The consequences of under-nutrition are that frail elderly are more vulnerable to falls and therefore hip fractures, he says, and this in turn creates further problems as people are more likely to go from managing at home to nursing home care. The mortality rate one year after a hip fracture has been estimated at 25-40 per cent depending on the population according to international studies, Dr Power says. "What we really need to do is increase their protein intake and focus on muscle building."
He and his team are looking to sports medicine techniques of exercise using weights and nutrition to improve the outlook for older people prone to falls.
"We are trying to train them to build up the big quad muscles in the legs which actually stop people from falling. We know that a protein burst taken within half an hour to two hours after exercise will help build up these muscles because growth factors are released during exercise and these use proteins to build up muscle."
The Mater Hospital is testing this programme of combined exercise and nutrition on a sample group of patients.
Bridie Bowe, a community general nurse based in Rathfarnham, Co Dublin, says she asks about all aspects of life when visiting an older person who is looking pale or thin. "Simple things like ill-fitting dentures or poor dental hygiene can make eating a problem," she says. "Deteriorating vision and not being able to see well enough to prepare food can be another factor."
On a first visit she asks what the daily diet is like and often suggests simple remedies like adding a little cream or honey to the porridge in the morning or taking jam with the toast. Small amounts more often will help and she recommends they eat a snack of cheese and crackers mid-morning and have ready-made or homemade soup rather than packets. "We often recommend they get meals on wheels if they are open to that or get someone to help prepare vegetables, especially if they have arthritis."
One of the more common reasons for a decrease in appetite, she says, is loneliness and depression. Often older people may be hungry for conversation over a meal. "If a person is recently bereaved or depressed, they may be off their food," says Bowe. "So we would often encourage family members to stay and eat with their frail elderly relatives or take them out for a meal."