An elderly, weak, or sick person who stops eating calories and fluids may only stay a few days and fall asleep more and more. It may take two or even three weeks for a person with a stronger body to deteriorate to the point of coma. Reduced appetite is a sign that someone may be in the last days of their life. They may no longer want to eat or drink anything.
This may be because they feel that the effort to eat or drink is too much. But it may also be because they have little or no need or desire to eat or drink. Refusal to eat and drink is a common and distressing precursor to malnutrition among older adults, both in institutional and community settings. Malnutrition due to inadequate food intake is responsible for 40 out of 100,000 deaths in adults over 85 years.1 The causes of refusal to eat and drink may include physiological changes associated with aging, mental disorders such as dementia and depression, medical, social and environmental factors.2 Many older adults experience a decrease in body weight as a result of aging, along with a decrease in energy intake, a decrease in the basal metabolic rate, and the decline in mass lean body, decreased appetite, satiety and decreased sense of taste and smell, 2 Refusing to eat and drink is common among patients with cerebrovascular diseases, dementia and Parkinson's disease who have difficulty expressing their desires and have mechanical difficulties chewing and swallowing.
2 A phenomenon known as idiopathic senile anorexia or late-onset anorexia nervosa can also be the cause of refusal to eat. These patients are less likely to have an altered body image and to worry about weight, diet and fitness, and are more likely to have a persistent depressed mood. These patients may feel that eating is meaningless as death nears. 2 Sociocultural and environmental factors also contribute to poor intake.
Long-term care facility residents who don't speak English, have absent family members and are diagnosed with dementia tend to have high rates of poor intake, 1.