Exploring influences on appetite in ageing

Abstract

Appetite loss is common in older people and when due to the ageing process is termed anorexia of ageing. There is little guidance for management of anorexia of ageing despite its associations with negative health outcomes. This research involved a series of studies, using a range of methods, to explore potentially-modifiable influences on appetite in older people, with a view to informing future interventions for anorexia of ageing.
First, current evidence for influences on appetite was appraised and organised into categories relating to - physiology (maintaining energy balance), hedonism (pleasure and reward in eating) and external cues (social and environmental contexts of eating). Next, a systematic review highlighted multiple approaches to appetite assessment in older people, with the Simplified Nutritional Appetite Questionnaire (SNAQ) a candidate for standardisation. In addition, there was a paucity of interventions for anorexia of ageing with only small single studies signalling benefit of a range of interventions, which were not replicated.
Influences on appetite in older people were then examined in different cohorts of older individuals. Continuous analysis of hospital inpatients (n=474, mean age 84 years) identified that low mood (measured by Geriatric Depression Scale 15) and low level of habitual physical activity (measured by Physical Activity Scale for the Elderly) were associated with poorer appetite during admission (measured by SNAQ). In the community setting, experiences of 13 individuals were analysed using qualitative reflexive thematic analysis. Perceptions of appetite and appetite loss involved use of two narratives- as an emotional experience or a reflection of physical need. Influences on appetite related to these narratives- hedonic factors and external cues to emotional experience and physical factors to physical need. In a second community study, continuous analysis (n=86, mean age 78 years) identified higher social network score (measured by Lubben Social Network Score 6) associated with better appetite (SNAQ). Whereas watching TV more often while eating main meals and greater comorbidities linked with poorer appetite (SNAQ).
This research has identified complex and wide-ranging influences on appetite in older people, organised into the categories- physiological, hedonic and relating to external cues. These categories were represented in hospital and community settings and may also impact individuals differently depending on their perception of appetite and the role it serves. Influences on appetite need to be assessed together and over time to determine their relationships with appetite and one another. There may be a role for multi-component interventions to manage the anorexia of ageing, which will likely be most effective when based on the older individual’s perceptions of their appetite loss and their needs and priorities.

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Identifiers

ORCID for Natalie Cox: orcid.org/0000-0002-4297-1206

ORCID for Helen Roberts: orcid.org/0000-0002-5291-1880

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