Exploring the experience of appetite loss in older age: insights from a qualitative study.

Background: Poor appetite is common in older age, with estimated prevalence figures ranging between 15-30% in community-dwelling populations. Despite known links between poor appetite and adverse health outcomes, appetite is not routinely assessed and the causes and impact of appetite loss in older age are not well understood. This study aimed to improve understanding of the influences on, and experiences of, appetite loss among older people who have poor appetite and to consider the implications for prevention and treatment strategies.

Methods: Thirteen older adults aged 60-93 years (9 women) identified as having poor appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) scores < 14; ranging from 8-11) took part in semi-structured interviews. Open-ended questions focused on influences on and experiences of appetite and appetite loss in older age. Interviews were transcribed; reflective thematic analysis was conducted using an inductive approach.

Results: The analysis generated three themes: 1) a complex web of influences on appetite loss, that include biological, psychological, and social factors; 2) living with poor appetite-variation in perceptions of poor appetite and attitudes to appetite loss; 3) living with poor appetite-the role and importance of the eating environment and social interactions. The themes highlight marked differences in individual 'journeys' to poor appetite, with variation in the balance and role of specific causal influences, that impact on the experience of appetite loss and on coping strategies.

Conclusions: A broad range of influences (including biological, psychological and social factors) and experiences of appetite loss in older age were described. Future research should consider person-centred approaches, that take account of individual narratives of appetite loss, in the design of effective strategies to support older adults.