Medical Associates Clinic

 Quality Care Close To Home

Gettysburg Medical Center
The Clinical View
by P.E. Hoffsten, MD OF
1 August 2007

“GRANNY JUST WON’T EAT”

            The lady was 74-years-of-age and lived in the home that she occupied with her husband for many years.  It was early summer and her daughter came to visit after a three year absence.  The daughter was very concerned about her mother’s health and after about a week-long stay, the daughter brought her mother to the clinic for “a check-up”.  Mother really hadn’t had medical attention in an extended period of time but said that she was feeling fine and wasn’t sick.  The daughter was very concerned about her mother’s diet and stated in an exasperated way that “Granny just won’t eat”.  Looking at what little medical information there was in our chart, it was seen that Granny had dropped about 4 pounds from 131 to 127 in the last four years.  But she appeared robust.  A series of blood tests were carried out and all were found to be normal.  Several other tests were done and all were normal.  On a return visit, the daughter was informed that her mother appeared to be in good health but the daughter again insisted that her mother just didn’t eat enough.

            Nutrition in the elderly is very different than it is for children and young adults.  If one  watches children on a playground, it is seen that they running  about, jumping on swings and merry-go-rounds and monkey bars.  The grandparents watching them are sitting still on the bench spending nowhere near the energy that the children are.  Thus, rule #1 is that as individuals age, their energy requirements go down.  Something not always appreciated is that the elderly get a lot more efficient in what they do.  As my daddy taught me, “old folks learn to work smarter, not harder”. The elderly don’t need as much food as the younger individuals. 

            There are other factors decreasing what elderly individuals will eat.  As a general rule, elderly individuals tend to have a decrease in their sense of taste and smell making food less attractive than it is to younger individuals.  In addition, elderly individuals empty their stomachs much more slowly than younger individuals.  Thus, hunger pangs become less frequent and potent in the elderly than in the younger. 

Providing adequate spice to enhance taste is an important part of nutrition in the elderly.

There is a general rule that people should eat less salt.  When this is applied to the elderly, it can be disastrous.  With less salt their food begins to taste like cardboard.  It would not be advocated that a high salt intake be provided, but placing elderly individuals on low salt diets can badly impair nutrition and food intake.

            There are situations in which decreased appetite represents the results of a disease or depression.  Certainly the elderly individual who is progressively losing weight warrants a medical evaluation to determine if there are pathological factors that require address.  It is well known from scientific research studies that progressive weight loss in the elderly is associated with an increased mortality.

  But medical evaluation had been done for this granny and there was no abnormality or disease identified.  The daughter now wanted to know what she could do to stimulate her mother’s appetite and maintain her mother’s weight.  I went over the steps available to stimulate appetite.  Perhaps the most important and the cheapest financially is a simple exercise program.  As a group, elderly individuals don’t run, play basketball or tennis.  However, exercise by what is called resistance training can be a significant help in maintaining muscle mass and would stimulate appetite.  A weight-lifting program for the elderly is available through many local agencies including the YMCA and will definitely improve appetite, muscle mass, and strength.  This is a recommended activity and is safe when done in moderation.

            The second step that might be used is supplements to the diet.  There are products such as Ensure and Boost which are high calorie drinks that a person can use.  They are best used a half hour to one hour prior to a meal.  An extra 400 calories in mid-morning and mid-afternoon will not necessarily impair the individual’s appetite at mealtime and can be a definite help for increasing calories.  As mentioned above, providing adequate spice and flavor to food can be a big help in the elderly whose sense of taste and smell are decreased.

            Occasionally in very ill individuals, “tube feedings” or intravenous feedings are used to supplement nutrition for a brief period of time.  These are useful when the individual is expected to recover from whatever medical problem they have had; but as a long term medical solution to nutrition is associated with substantial complications and is used only in extreme situations.

            The daughter then asked if there wasn’t a pill or some other medication that her mother can take that would stimulate her mother’s appetite.  Indeed there are such things.  You just about can’t pick up a newspaper today without reading about “doping” scandals in amateur and professional athletes.  The reason these athletes use muscle enhancing drugs is that they work.  Indeed, there are a number of complications to overusing these medications but the so called “anabolic drugs” really do stimulate appetite and increase muscle mass.  Many of them have masculinizing effects and when used in women may result in the growth of facial hair that they find objectionable.  Be that as it may, in individuals with chronic lung disease, or heart failure or kidney disease, these medications may be helpful facial hair and all.  I didn’t suggest that they would be helpful for this daughter’s mother.

            As some people may know, marijuana smokers as a group tend to gain weight.  A long time ago, scientists dissected out the factor in marijuana that stimulates appetite and it now is available as a pill that can be prescribed by physicians.  This pill has relatively few side effects and can stimulate appetite substantially.  It is often used for individuals with malignancies, or with AID’s when their weight loss is progressive and detrimental.

            The daughter was told that her mother appears to be healthy and the decreased intake that her mother has does not seem to be detrimental.  If Granny didn’t eat as much as she used to, it would really be all right.  Granny herself was very relieved with this information and said that she didn’t want to be taking any medicines or any supplements and she wasn’t real interested in an exercise program.  I am not sure that the daughter left happy but her mother did. 

This and other columns available at www.macpierre.com.