Alexandra Mignucci
Albany, New York, United States

While working at a medical home for patients with Alzheimer’s, I became fascinated by the difference in how much food the patients would eat when sitting at the table as a group versus when I would feed them in their rooms or on the couch. There was no difference in the type of food they were eating or whether or not they were being spoon fed, but they always seemed to do better together. Later, this difference again came up during a palliative care rotation as I observed many of the older patients reject eating anything while lying in their hospital beds.

I wondered what it was about aging that made people eat less. I thought about my ninety-four-year-old grandfather. Someone who was once a booming force, who has tapered down from a hearty breakfast of three eggs, sausage, bread with butter, and oatmeal every single day, to two pieces of stale bread that he eats as he sits alone on his porch.

Aside from potential physical or financial limitations, older people experience reduced hunger and increased satiety.¹ This is partially due to decreased energy requirements with age but also has to do with incompletely understood increases in satiety hormones that are released for the same amount of food.¹ Clearly, physiologic mechanisms are at work, but what else?

Taste, I am sure, is a part of it. Taste is mediated by facial, glossopharyngeal, and vagus nerves, meaning damage to any portion of these nerves may decrease taste. Damage could be transient due to infections of the ear or upper respiratory tract or more permanent from dental hardware impinging these nerves. Disordered taste, or dysgeusia, is more common with increasing age and in hospitalized or institutionalized older adults.² Disorders of taste and smell can cause food aversion in the elderly.² Medications and decreased salivary flow can alter or blunt taste; saliva is needed to spread food particles around the mouth to stimulate more taste buds. If less saliva is produced, which commonly occurs in the elderly as a side effect of medication, they will experience less taste and enjoyment of their food.

Certainly, physical limitations play a role in preventing the mechanical act of eating. Some physical limitations include difficulty swallowing, physical obstruction, and inadequate lubrication because of decreased salivary production. These can be addressed by swallowing evaluations and use of sialagogues such as sour foods, gum, or medication. Pain in the oral cavity, whether due to sores, oral cancers, or another cause, must be identified and rectified. Dentition is a huge issue in the elderly. Inadequate dental hygiene, a lack of teeth, or a need for dentures may all prohibit proper eating ability.

Yet one obstacle that may be overlooked is the social change associated with aging. Eating is inherently community-based, and as people get older, their support system often shrinks. Without people close by to cook for or eat with, many elders resort to eating alone or just not eating. They may have lost the routine of sitting down at the dinner table with the family or the celebratory meals that go hand in hand with birthday parties or holidays. Too, they no longer have reminders of the physical pleasure they used to get from meals.

Decreased eating in the elderly is associated with reductions in dietary diversity and oral intake and increased risk of malnutrition, sarcopenia, and frailty.¹ Improving social and environmental awareness of eating may go a long way to increase the amount and frequency of eating for these individuals. Some older adults, particularly in the hospital setting, think they will not be hungry because they do not feel well, but should be encouraged that they likely are hungry and should try. If visitors bring in foods with strong memories and favorite flavors, this can access the joy of food, beyond its caloric value.

I remember one patient’s family who brought in their grandmother’s recipe for pasta e fagioli and the smile on their mother’s face when she took that first bite—she had been transported back to her family’s dinner table. Eating foods we love and with those we love allows us to enjoy eating.

Food plays an enormous role in our culture and health, both physical and mental. It allows us to survive, but also connect with those around us. As our loved ones age, we must maintain and nurture this connection through eating. So please, grab a loved one, have a meal, and make a memory.

References

1. Cox, Natalie J, Leanne Morrison, Kinda Ibrahim, Sian M Robinson, Avan A Sayer, and Helen C Roberts. “New Horizons in Appetite and the Anorexia of Ageing.” Age and Ageing 49, no. 4 (2020): 526–34. https://doi.org/10.1093/ageing/afaa014.
2. Syed, Quratulain, Kevin T. Hendler, and Kenneth Koncilja. “The Impact of Aging and Medical Status on Dysgeusia.” The American Journal of Medicine 129, no. 7 (2016): 753.e1–753.e6. https://doi.org/10.1016/j.amjmed.2016.02.003.