​In both continuing care retirement communities (CCRCs) and skilled nursing facilities (SNFs), addressing the concern of residents consuming less food and experiencing weight loss requires a sensitive approach. Residents or their family members may inquire about the possibility of using appetite enhancers. But such options should only be contemplated after all other alternatives have been considered. Ensuring the residents' well-being through safe and effective measures is, of course, of the utmost importance.

Approximately 20 percent of elderly individuals encounter unanticipated weight reduction, potentially resulting in an increased likelihood of health complications and a greater risk of severe diseases. While weight loss in older adults is frequently attributed to an existing medical condition, there are instances where physicians are unable to identify a concrete cause for this issue.

Numerous factors can lead to unintentional weight loss, encompassing ailments of the heart and lungs, kidney dysfunction, autoimmune diseases, cancer, diabetes, gastrointestinal issues, problems with swallowing, dental challenges, and even social or psychological influences. Additionally, certain medications might contribute to this issue through side effects that affect appetite, including changes in taste and smell, anorexia, dry mouth, difficulty swallowing, nausea, and vomiting.

When unexpected weight loss is observed, it's crucial for the health care team to identify the underlying cause and develop a strategy to tackle it. It involves thoroughly assessing the resident's general health and any recent shifts, ensuring they can adequately chew and swallow food, and verifying adequate hydration. Additionally, it's important to evaluate any alterations in their mental and emotional health and to scrutinize all prescribed medications, particularly recent additions.

When the reason behind a resident's weight loss remains uncertain, considering nutritional supplements as an interim measure could be beneficial while further investigations are conducted. Exploring additional strategies to enhance eating habits is also advisable, such as providing favored meals and beverages, easing dietary restrictions, and enhancing the dining atmosphere. Observing the individual during mealtimes may reveal any difficulties with chewing or swallowing. Resorting to appetite stimulants should be considered only as a final option.

The American Geriatric Society recommends against the use of prescription medications for appetite stimulation, citing a lack of substantial evidence supporting their effectiveness. While certain drugs are currently utilized for this aim, none have received formal endorsement from the FDA for application in the elderly population. Moreover, these medications come with possible adverse effects that could pose significant health risks.

There may be natural methods to stimulate appetite in the elderly. Consuming fish oil or smelling the aromas of essential oils (such as cinnamon, clove, fennel) has been proposed as ways to enhance appetite, though the existing research on their effectiveness is not definitive. Additionally, the supplementation of nutrients such as zinc, iron, and thiamine has been suggested for individuals deficient in these elements. While the evidence supporting the benefits of these natural remedies in older adults is limited, there is also minimal evidence suggesting they pose any harm.

In addressing unintentional weight loss, it's essential to recognize that increasing weight might not necessarily enhance a resident's functional abilities or life quality. Nevertheless, identifying the underlying reasons for the weight loss and exploring all possible strategies to boost dietary intake should be prioritized before considering the use of stimulants.

Phyllis Famularo, DCN, RD, FAND, LDN, serves as a senior manager of nutrition services for Sodexo Seniors and has worked with the older adult population nutrition in the Northeast for over 30 years. She is a registered dietitian nutritionist with a doctorate in clinical nutrition from Rutgers University and is a board member of Dietetics in Healthcare Communities.