Poor appetite is a common problem in older adults, especially for those living in long-term care.
It can contribute to unintentional weight loss and nutritional deficiencies, and is associated with poor health outcomes such as malnutrition.
To counter the dwindling appetite of older adults, appetite stimulants are often prescribed.
Little is known, however, about their safety or effectiveness for increasing appetite in older adults.
This article discusses whether an appetite stimulant is safe and effective for increasing appetite in older adults, and explains how the health care team can work together to counter a declining appetite.
Poor appetite is common among older adults
Older adults often feel less hungry than their younger counter parts, both between meals and after meals (2).
There are several factors that contribute to older adults’ declining appetites.
- Depression. Medical conditions, loss of a significant other, and financial constraints may lead to depression and a loss of appetite.
- Hormonal changes. Older adults have changes in the gut hormones that lower hunger and increase satiety, or feelings of fullness.
- Sensory changes. Smell and taste — potent appetite stimulators — diminish with age, leading to less enjoyment with eating.
- Diseases. Chronic diseases such as diabetes and heart disease are highly prevalent among older adults and can decrease appetite.
- Medications. Most of the medications used to treat chronic diseases have side effects that can decrease appetite such as constipation, diarrhea, and taste changes.
- Immobility. Whether from disease or physical injury, immobility and less physical activity decreases calorie needs along with appetite.
Although the first line of treatment should be to identify and treat any underlying cause of poor appetite, appetite stimulant medications are often turned to first.
Common appetite stimulant medications and their side effects
Appetite stimulants are medications that can increase appetite.
Currently, there are no medications approved by the Food and Drug Administration (FDA) for appetite stimulation in older adults.
The American Geriatrics Society Beers Criteria for potentially inappropriate medications use in older adults recommends caution with the use of some appetite-stimulating medications and recommends avoiding others due to their ineffectiveness and high risk of side effects (6).
Megestrol acetate, sold under the brand name Megace among others, is a man-made version of the hormone progesterone.
It’s used to treat breast cancer and endometrial cancer, and to stimulate the appetite of people with wasting diseases due to severe chronic illness.
Significant side effects, however, have been observed with the use of megestrol in older adults such as harmful blood clots, toxic reactions in those with impaired kidney function, and an increased risk of death (9, 10)
Mirtazapine is an antidepressant sold under the name Remeron.
It has been used to help increase appetite and weight gain in older adults that are depressed.
The sedating properties of the drug can increase the risk of other side effects, namely falls.
Although studies involving the use of mirtazapine for weight gain in older adults not depressed are lacking, studies suggest mirtazapine may be effective for older adults with weight loss who are also experiencing depression (11, 12).
Dronabinol, commercially sold as Marinol, is a drug that contains tetrahydrocannabinol (THC), the compound responsible for marijuana’s mind-altering effects.
It’s approved by FDA for the treatment of nausea and vomiting associated with cancer chemotherapy as well as appetite stimulation in people with acquired immune deficiency syndrome (AIDS)-related weight loss (15, 16).
The FDA advises caution in prescribing dronabinol to older adults because they are generally more sensitive to the mind-altering effects of the drug (19).
Sold under the brand name Periactin, among others, cyproheptadine belongs to a class of medications called antihistamines.
It works by blocking the action of histamine, a substance in your body that causes allergic symptoms such as itch, watery eyes, sneezing, and runny nose caused by allergies or irritants in the air.
Cyproheptadine has also been used for the purpose of weight gain.
No evidence, however, has shown cyproheptadine effective for increasing appetite or weight in older adults.
Moreover, the most common side effect of the medication is drowsiness, which can increase the risk of falls in older adults.
The importance of the health care team
Identifying the reasons for a poor appetite in older adults is best achieved through an interdisciplinary approach.
Physicians should work closely with members of the healthcare team to identify and treat the underlying causes contributing to weight loss.
Registered dietitians are trained in identifying risk factors of malnutrition and unintended weight loss and implementing individualized evidenced-based nutrition interventions.
Pharmacists can identify medications that may decrease appetite and favor weight loss and adjust medications as necessary.
Speech therapy can assess for swallowing and oral issues, and physical therapy can implement exercise programs that can stimulate appetite.
Nursing can assist in feeding and relay information from observations that may be related to poor appetite and weight loss to the appropriate health care professional for treatment.
Current evidence is lacking for the use of an appetite stimulant in older adults.
Several factors contribute to older adults’ declining appetite including depression, hormonal and sensory changes, disease, medications, and immobility.
Identifying and treating the root cause(s) of poor appetite in older adults should be the first line of defense rather than appetite stimulant medication.