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11th May 2015

Is variety the spice of life for those with poor appetites?

Studies in Europe, US and Australia have reported that up to 65 per cent of older persons in nursing homes experience poor appetite, and this is an important risk factor for malnutrition.

Although there are some physiological reasons why people may experience poorer appetite in older age, factors such as depression, loneliness and lack of support with eating and drinking as well as problems with dental health such as poor fitting dentures, can play a part.

Potential consequences of poor appetite

There is a cause for concern when poor appetite leads to weight loss and/or nutrient deficiencies. Malnutrition in older age, as regular readers of this blog are reminded, is related to increased risk of morbidity and mortality, bone and muscle weakness, prolonged hospital stays, and diminished quality of life including low mood and tiredness.

So for those who are older, disabled or frail and go off their food, finding solutions to maximise nutritional intake and enjoyment of food is important. Indeed the Care Quality Commission standards on meeting nutrition needs specifies that providers must reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrition and hydration.

However when it comes to understanding the nutritional preferences of older adults with poor appetite, research is very limited. Yet this knowledge would be useful in the development of effective strategies to reduce risk of malnutrition in vulnerable older people in care home settings.

New research on food preferences of older adults with poor appetites

A new study published in the journal Appetite that looked at around 350 people living in care home settings in the Netherlands shed some light on the types of food generally preferred by older people with poor appetites. The researchers used a ‘forced-choice’ method, with participants being asked to choose which food they most wanted to eat from pairs of illustrated food cards. The food preferences of older people with poor appetites (those who experienced reduced appetite in the past week – about a third of the sample) were then compared to those with good appetites.

The results indicate that older people with poor appetites had different food preferences to those with good appetites: they tended to prefer meals that included lots of variation, e.g. a vegetable serving that included smaller amounts of three different vegetables rather than one. Furthermore, older adults with poor appetite had a particularly strong preference for variation of high protein foods, therefore, offering a selection of small pieces of fish rather than a large fillet of fish, for example, is more likely to stimulate appetite and encourage food intake. This supports previous studies which suggest that offering a variety of food can increase intake in older adults, including those at risk of malnutrition, and offers new insight into methods for increasing protein intake in frail older adults.

All older adults in the study showed a preference for colour variation. This reinforces good practice in care homes with regards to aesthetic visual presentation of foods to enhance consumption. Another finding was that all study participants preferred foods with a solid texture to semi-solid or liquid foods. This is perhaps surprising, as it may be expected that older adults would prefer foods that require less chewing and are easier to swallow. However, people with severe chewing and swallowing difficulties were excluded from the study (as were those with cognitive difficulties) and so the findings of this study may not be entirely generalizable to all older people in care homes.

Strategies to help poor appetite

In order to encourage better nutritional intake in those with poor appetites a ‘little and often’ approach may be beneficial. Nutrient intakes may be improved by offering small portions of foods with high nutrient density (high calorie/protein foods) rather than offering large portions of less nutrient dense foods.

Importantly, recognise the preferences of your service users. People will eat more of the foods they enjoy so tailor meals and snacks to suit taste preferences. According to the latest study, this includes increasing variety and colour on the menu.

Dr Lucy Chambers and Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributors

Sarah Riley

Senior Customer Care Executive

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