Work Package 1

Led by Newcastle University (NU)

Poor appetite is common in older age, affecting an estimated 15-30% of older adults. Understanding the causes of poor appetite is important because it may lead to lower food consumption and changes in diet, and result in weight loss and muscle loss. However, appetite is not routinely assessed. Research suggests a range of influences may be important, such as illness and the effects of medication, but understanding is limited. Importantly, there are few treatment options at present. 

The AGE research group (https://research.ncl.ac.uk/ageresearchgroup/) at Newcastle University is part of a new European consortium: APPETITE. The aim of the research is to gain detailed insights into the characteristics and preferences of older adults who have poor appetite and to develop new approaches to support older adults whose appetite is poor. The research being carried out in Newcastle is the first phase of the project - to interview older adults who have poor appetite to improve understanding of influences on appetite and to gain insights into strategies they may use to make sure they eat enough.

Our research has two stages. Firstly, working with VOICE (https://www.voice-global.org/) we recruited members to join an advisory panel to oversee the research in Newcastle, who will meet every 6 months for its duration. These meetings are an opportunity to discuss how we carry out the research, how we recruit older participants to take part in interviews, and how we interpret our findings. The first meeting of the panel included a focus group discussion of the factors that are associated with poor/declining appetite in older adults.

The second stage is to carry out one-to-one interviews with older adults who have poor appetite. To recruit participants, an ‘opportunity to take part in our research’ is circulated via the VOICE network. Older adults who are interested in taking part complete the SNAQ (Simplified Nutritional Appetite Questionnaire) on-line, to assess their level of appetite. A researcher contacts individuals who have low SNAQ scores to invite them to attend an interview and to obtain their written consent. The interviews are semi-structured, based on a guide that was informed by the focus group discussion in the first stage of our research.

All interviews will be recorded and transcribed. The transcripts will be analysed thematically, with development of a coding frame to identify emerging themes. Interviews will continue until no new themes are emerging, judged to be a point of ‘saturation’. The interviews started in August 2021 and are ongoing.

This work with older people with poor appetite or at risk of undernutrition will be supported by analysing a large dataset of Dutch older people with poor appetite [from the Longitudinal Aging Study Amsterdam (LASA)] and comparing those with poor appetite to older adults with a normal appetite with respect to physical, emotional, cognitive and social factors as well as their nutrient and food group intakes. Information on appetite in two waves of the Dutch study will be used to distinguish short-term from long-term poor appetite, and to clarify whether older adults with short-term and those with long-term poor appetite differ in their characteristics.

The findings from WP1 will inform the development of food products high in protein and fibre that can be used by older people to support them to remain healthy.