When your elderly parent has stopped eating

You notice the fridge is full of food you bought last week. Her clothes are looser. She says she is not hungry, or that she ate earlier, or that she is fine. Appetite loss in an older adult is easy to explain away and dangerous to ignore, because weight loss in later life predicts falls, hospital stays, and decline, and because most of its causes can be fixed.

Older adults have less reserve. Losing muscle means weaker legs, more falls, slower recovery from illness and a weaker immune system. Doctors treat unintentional loss of about 5 percent of body weight in six months, or 10 percent in a year, as significant. For a 150-pound woman, that is seven or eight pounds. If you have noticed it, it has probably already reached that threshold.

• Medications. Dozens of common drugs suppress appetite, alter taste, cause nausea or dry mouth: some antidepressants, metformin, digoxin, opioids, many antibiotics, some blood pressure drugs, and cholinesterase inhibitors for dementia. Polypharmacy itself is a cause. This is the first thing to review.
• Mouth and teeth. Painful teeth, gum disease, ill-fitting dentures, dry mouth and thrush make eating unpleasant. Medicare does not cover routine dental care, so it is often neglected. A dental visit is one of the highest-yield steps.
• Swallowing problems. Coughing during meals, food sticking, a wet voice, avoiding certain textures. Common after stroke and in Parkinson’s and dementia. A speech-language pathologist evaluates this; Medicare covers it.
• Depression. Loss of appetite is a core symptom, and depression in older adults is common and under-diagnosed. Grief after a spouse’s death is a frequent trigger.
• Dementia. People forget to eat, forget they have not eaten, lose the ability to prepare food, or lose interest. Weight loss can precede a dementia diagnosis by years.
• Medical illness. Thyroid disease, heart failure, COPD, kidney disease, digestive disorders, infection and cancer all reduce appetite. Unexplained weight loss is one of the reasons doctors look for cancer.
• Practical barriers. Cannot get to the store, cannot stand long enough to cook, cannot afford food, cannot open packages, cannot see well enough to read labels or use the stove safely.
• Loneliness. People do not cook for one and do not enjoy eating alone. This is real and it is one of the most fixable.
• Alcohol, which replaces meals and worsens everything else.

1. 1.Make a doctor’s appointment and say the words “unintentional weight loss”. It should trigger a workup: history, exam, medication review, blood work, and a depression and cognitive screen.
2. 2.Bring every medication and supplement to that appointment, or ask the pharmacist for a review first.
3. 3.Look in her mouth, or ask the dentist to. Book a dental visit if it has been more than a year.
4. 4.Watch a meal. Does she cough, struggle, avoid textures, get tired, lose interest, forget she is eating? Tell the doctor what you saw.
5. 5.Look in the kitchen honestly. Is there food she can actually prepare and eat? Is the stove being used? Are there unopened deliveries?
6. 6.Ask her, gently and once, whether she has felt low or lonely. Ask separately whether food tastes different.

• Smaller meals more often. Six small plates beat three large ones for a shrunken appetite.
• Calorie- and protein-dense foods: eggs, full-fat dairy, nut butters, cheese, smoothies, oatmeal with cream. Do not make an older adult with weight loss eat a heart-healthy diet unless the doctor specifically says so.
• Company. Eat with her when you can. Arrange for a companion, a neighbor, a senior center lunch program. Meals eaten with others are larger.
• Meal delivery. Meals on Wheels and similar programs exist in nearly every community, often free or low-cost through the Area Agency on Aging, and the daily visit is a safety check too.
• Fix the mouth. Dentures relined or replaced, dry mouth treated, thrush cured.
• Season generously. Taste dulls with age and with many medications. Herbs, spices, lemon and umami flavors help; salt restriction may need to be relaxed if she is losing weight, but ask.
• Fluids between meals, not with them, so the stomach has room.
• A dietitian. Medicare covers medical nutrition therapy for diabetes and kidney disease with a referral, and many other conditions through home health or as part of a care plan. Ask.
• Oral nutrition supplements, used as a bridge, not a replacement for food.

In advanced dementia, end-stage heart or lung disease, and the final months of any serious illness, reduced appetite is often part of the natural course. The body needs less, wants less, and forcing food causes distress rather than strength. Families in this situation often feel that feeding is love and that not pressing is giving up. It is not. Comfort feeding, offering favorite foods in small amounts without pressure, is the approach palliative care recommends, and feeding tubes in advanced dementia do not extend life or prevent pneumonia. If this is where your parent is, the right conversation is with the doctor and, if not already involved, palliative care. It is a conversation about what she wants, not about calories.