Elderly person has no appetite
November 26, 2016 6:08 AM   Subscribe

How can we stimulate appetite in an elderly person?

Eight years ago my father was diagnosed with lung cancer. He underwent chemotherapy and radiation therapy, and the cancer was gone. Since that time, however, he has not been able to put on weight. Before the cancer, he weighed around 145 pounds. For the past eight years he's been hovering around 110 pounds.

The problem is he has no appetite. Many times it will be early- or mid-afternoon before he realizes he hasn't eaten anything yet. He's complained to his doctors but they just say he seems to be the type that doesn't put on weight easily. Is persistent loss of appetite a common occurrence after cancer treatment?

I know they make appetite stimulants, but we were told they don't work very well. Maybe that's why his doctors haven't suggested it to him? Might medical marijuana help? Supplements? Anything?

Does anyone have any experience with this issue?
posted by La Gata to Health & Fitness (29 answers total) 1 user marked this as a favorite
My frail mother has had decent luck with a prescription stimulant called Megestrol. It's not a panacea, I have to remind her to eat and make sure she has appealing food available, but it helps quite a bit.

Don't write off appetite stimulants until you've tried them.
posted by workerant at 6:11 AM on November 26, 2016 [1 favorite]

Could you check in with the docs to see what an appropriate BMI range for his weight/height/age is? If he falls in that range maybe he's okay, even if it looks a little weird. I'm assuming he gets measured frequently on clinic/outpatient visits, so if there were alarm bells at that point maybe they would have rung?

I agree, I think OTC appetite stimulants would be a bad move.
posted by life moves pretty fast at 6:13 AM on November 26, 2016

Also, just checking, how old is he? Is he living alone? Would there be any depression, or cognitive dysfunction symptoms?
posted by life moves pretty fast at 6:14 AM on November 26, 2016

Many (most?) people find that marijuana is a very effective appetite stimulant - if it's available where you are, I definitely think it's worth a try. He can talk to the people there about what strains might be more or less effective. He probably shouldn't smoke it (smoking isn't good for anyone, and especially because of his lung cancer history), but there are lots of alternate delivery methods available.
posted by insectosaurus at 6:20 AM on November 26, 2016 [17 favorites]

It sounds like he might be willing to eat despite lack of interest in it? If so, set mealtimes (with high calorie foods) could help; if the routine is that he always says breakfast at 9am, he's less likely to forget.
posted by metasarah at 6:41 AM on November 26, 2016 [3 favorites]

In terms of appetite stimulants and their effectiveness - I've taken Mirtazapine (aka Remeron) as an anti-depressant, and can definitely vouch for its efficacy in making me want to eat the WHOLE time, especially at 45mg daily dose. It can cause tiredness, especially at first, so he might need to weigh that against the appetite stimulation effects, but it might be worth asking your doctor about. I believe it's sometimes prescribed to anorexic patients as an appetite stimulant. One thing to watch out for - the food cravings can tend towards the sugary, so it's important to make sure there are plenty of easy-to-access healthy snacks around so that it's easy to reach for those when The Hunger is raging.
posted by smock puppet at 6:49 AM on November 26, 2016 [1 favorite]

Loss of appetite is not an uncommon occurrence after cancer treatment and can result from multiple factors. You should talk to your doctor about this, especially if he has had any additional symptoms aside from loss of appetite. Progesterone (megestrol as mentioned above) is sometimes used, but there are other agents that might be useful in this case, such as mirtazapine, especially if he has any mood issues or difficulty sleeping.
posted by gemutlichkeit at 6:49 AM on November 26, 2016

If the loss of appetite is something that needs to be treated with medication, well, that's that. If his not eating is due to cognitive factors or energy level, then depending on doctor's advice/digestive needs, maybe he could try a can or bottle of Ensure first thing in the morning.

If you haven't seen/heard of it, it's a liquid meal replacement that comes in a few different flavors, as well as (I think) a few different sizes. Treating this as just another pill or the like could be a big help -- put it on the daily list, or at the front of the fridge, or whatever will stimulate him to drink it at day's start. Having some calories right off the bat, if he can do that, could be a boost to his overall functioning and quality of life, in that he'd be guaranteed a certain amount of energy before he gets going with the day.
posted by cupcakeninja at 6:56 AM on November 26, 2016

When my mother went through this, we were able to up her calorie intake with ice cream and milkshakes. We used ensure to make the ice cream in a countertop maker. Then is used it to make milkshakes.
posted by raisingsand at 8:01 AM on November 26, 2016 [2 favorites]

I agree with cupcakeninja above about eating early in the day. His situation might definitely not be the same, but I've noticed that when I have something to eat early in the morning I'll be very hungry by lunch, whereas without breakfast I might not feel a need to eat until well after noon. So try the Ensure, and maybe even keep it right next to the bed with a glass of water and have him take it first thing when he wakes up. If he finds that too much, then even an apple or a piece of chocolate first thing in the morning might work.

Make sure he's also drinking enough - aside from it being another easy thing to forget, we also apparently get a fair amount of hydration even from solid foods, so he should be drinking more than he would normally if he's eating less.

Beyond all that: What's his living situation and where is his food coming from? Does he prepare it? How are his energy levels, and does he still enjoy tasty foods while he's eating them? Is he dealing with depression? Does he get nauseous when he eats more than small amounts?
posted by trig at 8:11 AM on November 26, 2016

To answer some questions:

He is currently in his eighties. There is no depression or cognitive dysfunction (his mind is probably sharper than that of most people half his age). He WANTS to eat and put on weight - he just has no appetite for eating.

He wasn't crazy about Ensure but he used to drink the strawberry flavor. They ran out of it at the grocery store so he brought home the chocolate instead. He found the chocolate abhorrent and after that just lost his taste for Ensure completely, and stopped drinking it.

He lives with my mother and she does all his cooking. He does enjoy tasty foods. We went out to dinner recently and he ordered pork chops (a favorite), and remarked how good it was. He's never mentioned nausea. He does have some energy problems, but those are related to his lung issues.

I like the idea of giving him a piece of chocolate in the morning. I've noticed myself that skipping breakfast will sometimes dull my appetite for a morning or even a day.
posted by La Gata at 8:49 AM on November 26, 2016

I had trouble gaining weight when pregnant. I saw a dietician, who worked with my allergies / dislikes / ect to come up with a plan. I had daily milkshakes, switched to high fat dairy (11% fat yogurt is amazing) and upped the avocados. I'd really recommend meeting with a registered dietician, this is exactly what they train for.
posted by Valancy Rachel at 8:55 AM on November 26, 2016

2nding cannabis. If he's worried about getting high, try findings CBD only edibles; they will often have the same appetite stimulation properties and won't get you stoned.

FWIW it's pretty easy and reasonably legal to pick up CBD oil/extract in most parts of the country. Whole foods sometimes carries it, as do many coops.
posted by furnace.heart at 9:50 AM on November 26, 2016 [3 favorites]

It would help to schedule meals and make it easy for him to eat at those times. Eat when it's time to eat, not when he's hungry - after a week or two his body should get the hang of the schedule and start playing along.

Making it easy for him to eat might mean ready-to-heat or ready-to-eat - it's pretty easy to prep a week's worth of hot or cold oatmeal cups, scrambles or breakfast burritos or breakfast sandwiches, or just make sure he has a cereal he likes and whole milk. Lunch can be pre-made sandwiches or wraps, or maybe better would be ready-to-microwave hot lunch like lasagna, meatloaf with potatoes and green beans, creamy soups. Get lots of fat into those foods, and if he's suffering from a diminished/altered sense of taste/smell after chemo it may need to be overseasoned or provide easy condiments (hot sauce, no-salt seasoning, cajun spice, garlic-onion powder mix) to add.

Also prep snack packs and schedule those. Apple slices and peanut butter or nutella, a few crackers with cheese, banana bread, yogurt. The snacks don't need to be huge, 90-110 calories is plenty, just try to get a mix of carbs and protein in.

With my grandfather, who additionally had dysphagia and mouth discomfort from head/neck radiation, we just came to an agreement that food needed to be eaten and his job was to cooperate with the schedule and our job was to make it as pleasant as possible and incorporate his feedback into making it better. His doctor did prescribe him one of the antidepressants most prone to cause weight gain, and we all pretended it was for weight gain and not anxiety and depression, but ultimately it worked for all three.
posted by Lyn Never at 10:15 AM on November 26, 2016 [2 favorites]

Dehydration can decrease appetite & dehydration is a common problem in older people. If nothing else make sure he's drinking enough.

I'd encourage the use of fruit juices for the calories. Or make up your own Ensure type drinks. Chocolate milk with 1/2 & 1/2 stirred in say, smoothies with coconut cream or peanut butter or protein powder in as well as fruit for longer lasting energy not just a sugar burst. Hell if his kidneys etc can handle it try some different brands of protein shakes & get one that's got a lot of calories in. There are breakfast drinks that are a bit like ensure but taste different as well.

Also in regard to eating, food in restaurants is usually a lot more heavily seasoned than home cooking which is why he may like it more. As you get older your sense of smell/taste decrease. While he might not need the sodium of salt there are a lot of herbs & spices that can be used to up the flavor levels.

Also try lots of small meals/snacks during the day.
posted by wwax at 10:26 AM on November 26, 2016 [1 favorite]

Have his medications carefully evaluated. Try holidays from a med or two if his doctor will approve.
My MIL (age 96 and counting) had terrible appetite problems and lost weight for a year. We got her taken off of her cholesterol medication and she started to enjoy meals again. She is not gaining weight back, but she is not losing and her happiness level has increased enormously.
posted by SLC Mom at 10:32 AM on November 26, 2016

High fat dairy (whole milk!), smoothies, soup, and avocados are all great for this, although for older people steeped in past decades' wisdom of dietary fat = unhealthy, it can be a difficult sell sometimes. Pair with a daily multivitamin if he isn't already and avoid the (imo) disgusting flavors of prepackaged nutrition supplements, which only make eating feel more like a gross chore.

Also, if you search AskMeFi for questions about food to eat when you've got no appetite, there are actually a bunch of good threads from younger underweight people, MeFites under stress, drug interactions and other nausea, and what to eat when you're depressed. If he's still enjoying food on occasion, but finds meal replacement shakes gross, you might find a few meal/snack ideas in previous threads that would be worth a shot.
posted by deludingmyself at 10:35 AM on November 26, 2016 [2 favorites]

Marijuana. You can vape it or get it in drops to put in juice or in edible candies.
posted by Jacqueline at 10:43 AM on November 26, 2016

You can get Ensure clear, which is fruit flavored. It's not quite as high calorie as the strawberry/vanilla etc. type, but it might be worth a try. A regular smoothie or milkshake might be a good breakfast option as well.
posted by MadamM at 11:59 AM on November 26, 2016

Peanut butter in whatever his preferred vehicle is. A sandwich for breakfast, or a smoothie, or a milkshake.

Replace milk for half and half. Blend the ensure with half and half. A lot of people find the taste sickly sweet and this seem to help.

You might also try mighty shakes. They are only 4 oz each. IMO they are the best tasting supplement. They do need to be refrigerated.
posted by pintapicasso at 1:41 PM on November 26, 2016

Is he getting any exercise? I have no experience with this in older people, but in myself I find exercise ramps up my appetite way in excess of the number of calories likely burned by the exercise. With his likely frailness this would have be done carefully, of course.
posted by lakeroon at 3:45 PM on November 26, 2016

Make sure he routinely eats something in the morning to kickstart his digestive system- maybe a smoothie with added fat, or milkshake with extra fruit?

Mix added fat and calories into what he does eat- find ways to add spoonfuls of full-fat butter, cream, olive oil, mayonnaise, yogurt, nuts, avocado, bacon, ice cream, cream cheese, a small spoonful of coconut oil in his coffee or smoothies, etc.- find some high-calorie foods he finds palatable and rotate them in (keep rotating or he'll get sick of them though).

Figure out his daily caloric needs and what he should add to gain weight. A man over 70 probably needs about 2050 calories a day just to maintain weight, and a more to gain weight. Assuming he is awake for 16 hours a day, that's 129 calories an hour (for reference, an egg is 155 calories).
Or he could aim for more than 670 calories per meal. Maybe see if it would help to give him caloric goals to shoot for by specific times of day.

And make sure he eats something with fat and protein shortly before bed (even just hot chocolate made with lots of cream?)- as sumo wrestlers know, sleeping after eating helps pack on weight.
posted by pseudostrabismus at 4:26 PM on November 26, 2016

Movement, lemon-water, weed, high-fat foods.
posted by fritillary at 4:33 PM on November 26, 2016

A side effect of the neurological degeneration I have (from post-polio syndrome) is an absolute lack of appetite. I am never hungry. But if I don't eat, after awhile I start to feel really awful, but it doesn't feel like hunger, it feels like being old and sick and tired. It gets worse if I take a hit of sugar first. So I've just learned to check in regularly during the day to see if I've eaten lately. You could use a timer, or a bowl of beads (two bowls, move a bead from the no to the yes bowl), or any other reminder that works for him.

A meal is usually too much for me. So I eat this and that, and save parts of meals for eating later. It might also help if he could do some of the food prep himself; it reinforces that it's something that he's responsible for and he can do it when he wants. We always have hummus and pita on hand, and fruit, and almond butter, and English muffins, and often a roast chicken from the food co-op (take all the meat off the bones and store in the fridge: goes with lots of things or just a hunk of chicken meat). Few things taste great anymore, but lots of things taste okay, and I clearly feel better when I eat.

Now, a word about Ensure: NO! NO! FOR THE LOVE OF ALL THAT'S HOLY, NO!

A Visiting Nurse suggested I buy powdered dry milk (look for local and organic if you can). Put it in whole milk, or a milkshake, or yogurt, or almost anything else that occurs to you. Often it's the protein that gets slighted when you don't feel like eating, and this provides protein & calcium.

Ensure is water, powdered milk, and sugar, with added soy and pea protein. And also:

Water, Corn Maltodextrin, Sugar, Milk Protein Concentrate, Canola Oil, Soy Protein Isolate, Corn Oil, Pea Protein Concentrate. Less than 0.5% of the Following: Natural & Artificial Flavor, Magnesium Phosphate, Potassium Citrate, Soy Lecithin, Sodium Citrate, Potassium Chloride, Calcium Phosphate, Calcium Carbonate, Salt, Choline Chloride, Ascorbic Acid, Potassium Hydroxide, Carrageenan, Ferrous Sulfate, dl-Alpha-Tocopheryl Acetate, Zinc Sulfate, Niacinamide, Manganese Sulfate, Calcium Pantothenate, Cupric Sulfate, Vitamin A Palmitate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Chromium Chloride, Folic Acid, Sodium Molybdate, Biotin, Sodium Selenate, Potassium Iodide, Phylloquinone, Vitamin D3, and Cyanocobalamin.

It's such a scam, AND it tastes nasty.

Please tell your Dad I wish him well; there's lots of interesting stuff out there to put in his mouth, and he can eat what he damn well pleases!
posted by kestralwing at 5:59 PM on November 26, 2016 [2 favorites]

You may want to explore other Ensure-like protein drinks. I think my standards may be low but I actually like the high protein Slim Fast drinks. I like caramel latte the best, but there are several other flavors.
posted by emkelley at 6:42 PM on November 26, 2016

Ensure is water, powdered milk, and sugar, with added soy and pea protein.

Just so you don't get too discouraged about Ensure, a lot of the evil sounding names on the "less than 0,5%" list above are vitamins (tocopherol, ascorbic acid, niacinamide, thiamine, pyridoxine, riboflavin, folic acid, biotin, cyancobalamin) or useful micronutrients (eg, sodium selenate, chromium chloride, sodium molybdate).

Ensure and other Ensure-like drinks are sometimes used as the only source of nourishment and so they have to contain stuff like that. Sodium selenate does not sound nutricious but you can actually get quite sick from selenium deficiency.
posted by M. at 2:23 AM on November 27, 2016 [5 favorites]

TLDNR, I HIGHLY suggest cannabis. I have terminal brain cancer and it's the ONLY thing that's given me an appetite. If he won't smoke or vape it, make him some edibles. I tried the megace and megestrol and they didn't work for me at all.
posted by Amalie-Suzette at 7:07 AM on November 27, 2016

I would really not recommend cannabis for an 80 year old. the psychomotor and mood effects are usually not acceptable in the elderly. a fall with a bad hip fracture could kill him. the best advice is already above:
- purge possibly appetite suppressing meds (with physician oversight)
- make a schedule / routine that encourages timely meals and or snacks. mornings are often an effective intervention. many people seem to eat more with company.
- make sure that meals and recipes are adjusted to a changing palate as the lack of fine smell is common. try anything without regard to what you think of as healthy, and fix it up after you have something that works. salt and sugars vs hypertension/chf and diabetes are two common issues, but nutrition is really fundamental.
- make high calorie density suppplements available after and between meals, not a meal replacement. they don't need to been ensure/boost; those are designed to be complete nutrition replacements (e.g. tube feeds, those who can't take solids) and have compromises make on the palate. the 1.5 cal are remarkably dense for someone who dislikes eating and just has to do it fast.
- stay active, this helps both encourage eating and reduce bone and muscle wasting
- consider discussing an appetite stimulant like mirtazapine with his physician. even the low dose is hugely stimulating in some people. both oncologists and geriatricians will have a decent idea. there is a medical work up for "failure to thrive" that should be (and may already have been) done
posted by a robot made out of meat at 7:47 AM on November 27, 2016

The doctors aren't wrong -- your dad was only 145 pounds before cancer because he's the kind of guy who doesn't gain weight easily and probably didn't have a huge appetite before that. Cancer and cancer treatment knocked 30 pounds off him but didn't change his basic eating / weight gaining dynamics.

Before you get to marijuana or other appetite stimulants, a key thing is maximize the benefit of the appetite he already has -- i.e., make sure he has a big, hearty meal when he's hungry. Your mother may quite naturally react to his not eating breakfast or lunch by cooking him what she sees as a "healthy" afternoon or evening meal, and end up filling his plate with vegetables, high-fiber carbs, and lean proteins -- when what she needs to do is remember the basic law: carbs make you fat. A cheeseburger so make sure he downs the fries and bun and a beer or Coke on the side, etc.
posted by MattD at 11:32 AM on November 27, 2016

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