Is it bad to eat less as we age?

April 2, 2018

Providence Health Team

[5 MIN READ]

If you have a parent or loved one in their 60s or older, you’re probably keeping a vigilant eye on their health, and that can include what they’re eating — or not eating, as is the case for many seniors whose appetites seem to have diminished. But is that a cause for concern? It can be in certain cases, says Marian O. Hodges, MD, the Bain Chair of Geriatric Medicine and regional medical director for the Providence Oregon Senior Health Program.

“As we age we generally are less active,” says Dr. Hodges. “On average people over the age of 60, and certainly older than 70, have a lower need for energy than when they were younger because they expend less energy, with energy being calories. Generally speaking, their caloric needs are lower because they do less.”

While some people can eat less and maintain their weight, and others actually gain weight because they aren’t eating less (and have other factors such as hormonal changes), the people who experience drastic weight loss can be at risk for broader health issues.

“As a geriatrician, I look carefully at peoples’ weight,” says Dr. Hodges. “If somebody comes in and their weight is down 10 or more pounds from their previous office visits, I worry. And I particularly worry if a patient has lost 10 percent of their body weight — say they’ve gone from 140 pounds to 125,” she explains. “I need to investigate that because that amount of weight loss is not normal.”

The reasons behind that kind of weight loss generally fall into three main categories, Dr. Hodges says.

Physical issues

There are several different factors that can contribute to dramatic weight loss for seniors. Among them:

An underlying medical condition. “They may not have the energy to make lunch or not much of an appetite,” Dr. Hodges says. “So there can be a chronic condition, usually a serious condition, such as heart, kidney or lung disease, or they may have an undiagnosed condition such as cancer.” People should make sure to keep up with their doctor appointments. Dr. Hodges usually sees most of her patients every six months to a year (for people who are doing well) or every three months (for people with chronic medical conditions).

Medication. There are many drugs that can either cause dry mouth, which makes it difficult to chew, or affect the person’s ability to taste food, Dr. Hodges says. One possible solution is changing the type of medication to eliminate those side effects.

Dental problems. Older adults often have dental concerns. These can include dentures that are improperly fitted or lost, or issues such as a diseased tooth or sensitive gums — all of which can pose obstacles to eating. The problem is compounded for seniors, Dr. Hodges says, because Medicare doesn’t cover dental. So unless a patient has dental insurance, costs are all out of pocket. “I think a lot of family members and even patients don’t always think about teeth when people are losing weight and rush to a conclusion that’s way more dramatic when actually you can spot the problem by looking inside the mouth,” Dr. Hodges explains, adding that patients in need of affordable dental care can see if their local dental school offers a low-fee clinic manned by students.

Mental issues

“A cardinal sign of depression is not eating,” Dr. Hodges says. “Our elderly population can be struggling with grief on a daily basis.” That grief has these potential sources:

Loss of someone they cared about, such as a partner or friend.

Loss of independence.

Loss of ability to do the things they enjoy, such as playing the piano or biking.

A final contributor can be a drug or alcohol addiction, which can keep a person from eating a healthy diet. If family members suspect this or any mental health issue is an underlying cause of weight loss, they can seek professional help. Depression may be treated with an antidepressant medication.

Environmental issues

“Say a patient can no longer drive and go to the grocery store and he doesn’t like to bother neighbors to ask for help, or he has a cognitive impairment where he can’t use the telephone,” Dr. Hodges says. “The patient could be dependent on his son to bring groceries, but if the son goes on vacation and misses a week, the patient is stuck. Or the patient may not have enough money for food because the money is being spent on medications. That limited access to food can be a reason someone loses weight.”

In those cases, a program such as Optimal Aging can help patients and family members connect with needed services via vetted community providers at free or affordable costs, Dr. Hodges says. “They can be referred to meal delivery services or grocery stores where a family member can place an order that will be home delivered,” she says. “I have some patients who want to shop because that’s their social venture for the week, but they can’t drive. So Optimal Aging can provide transportation for a reasonable fee. Essentially, Optimal Aging can help assess the food issue — is it a transportation problem, or affordability, or do you need a hot meal?”

One thing that usually doesn’t work when it comes to weight loss for seniors is an appetite stimulant. “I’m asked about them on a regular basis when family members see a parent or spouse lose weight and they feel helpless,” Dr. Hodges says. “There are some situations where an appetite stimulant can help, but there are a lot more, unfortunately, where the patient might gain more fat but not gain any strength or live any longer.”

Lastly, don’t forget about water. Eating habits aren’t the only thing to watch for with senior loved ones. “It’s totally normal as people age to lose their thirst mechanism,” Dr. Hodges says. As a result, it’s easy to run the risk of dehydration. While about 2 liters of water a day is generally recommended, Dr. Hodges says a more realistic goal is at least five 8-ounce glasses. “The main thing is to encourage water drinking because it’s not natural for the average older adult to do it.”