Managing Decreased Appetite in Elderly Patients with Dementia

Medication Review and Management

Polypharmacy is robustly associated with malnutrition in older adults, and nearly all drugs can affect appetite depending on dosage, body weight, renal function, and individual vulnerability 1, 2
Common appetite-suppressing medications include opioids, sedatives, digoxin, metformin, antibiotics, and NSAIDs 1
Cholinesterase inhibitors increase the risk of weight loss in vulnerable patients with dementia 1, 3
Sedatives reduce attention and activity at mealtimes, limiting food intake 1
Diuretics cause excessive fluid losses and worsen dehydration risk 1

Encourage shared meals with family or other patients to improve intake and quality of life 1, 2, 5
Provide adequate time for meals with emotional support and verbal prompting 1, 5
Offer oral nutritional supplements when dietary intake falls to 50-75% of usual intake 4, 5
Provide energy-dense meals and small frequent meals 4
Offer texture-modified foods if dysphagia is present 1, 2

The American Geriatrics Society recommends not using appetite stimulants in dementia patients unless concurrent depression exists 4, 6
Mirtazapine should only be used in dementia patients with concurrent depression, and at a starting dose of 7.5 mg at bedtime 4, 5
Expected weight gain with mirtazapine is mean 1.9 kg at 3 months and 2.1 kg at 6 months, with approximately 80% experiencing some weight gain 4, 5

The American Geriatrics Society explicitly recommends not using appetite stimulants in dementia patients unless concurrent depression exists 4, 6
Clinical nutrition guidelines with 89% consensus agreement state that appetite stimulants show no consistent benefit in dementia patients, and potentially harmful side effects outweigh uncertain benefits 4, 6