Insights towards formation of management framework for persons with age-related appetite loss: a qualitative analysis of interviews with healthcare professionals

Key summary points

Aim

The aim of this study was to gather insights from healthcare professionals regarding managing loss of appetite in the geriatric population.

Findings

The study identified five key themes, revealing that healthcare professionals rely on diverse diagnostic and management strategies while emphasizing the critical need for coordinated interdisciplinary teamwork and increased awareness among staff, patients, and caregivers. Our findings highlight that clinical approaches are often shaped by the hospital environment and the personal experiences of healthcare providers.

Message

Effective management of appetite loss in older adults requires the development of systemic, interdisciplinary protocols that integrate diverse clinical strategies with increased awareness among healthcare professionals, caregivers, and the general public.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s41999-026-01528-5.

Abstract

Purpose

Loss of appetite is frequent in older patients. However, currently there are no internationally recognised guidelines for management of affected patients. Owing to its multifactorial pathophysiology, treatment should involve wide range of healthcare professionals (HCPs) working in a team. This descriptive qualitative study aimed to gather insights concerning appetite loss management from medical professionals working with older adults.

Methods

We conducted semi-structured interviews with 11 medical professionals, transcribed them verbatim and analysed using inductive thematic analysis approach.

Results

We identified five main themes that included diagnostic challenges in patients’ identification and assessment, therapeutic approach to appetite disturbances, involvement of caregivers and healthcare professionals, the interplay between appetite loss and hospital setting, and narratives on appetite. Regardless of their profession, the participants shared a wide variety of diagnostic and management strategies to address appetite loss. They emphasised the importance of performing treatment within a coordinated interdisciplinary team and the need to raise awareness levels among HCPs, caregivers and the patients. For some HCPs, their personal experiences with appetite loss were an important source of insight.

Conclusions

There is a pressing need to implement standardised approaches, that would orchestrate the macro, mezo and micro level actions to address the issue of appetite loss in older patients. Our results, in the context of earlier and ongoing studies, should inform future systemic approaches to the management of appetite loss in older patients across different clinical settings.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s41999-026-01528-5.

Introduction

The loss of appetite in old age is a pressing clinical and societal issue that is underdiagnosed which leads to its mismanagement [1]. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force 2023 document discusses current evaluation, assessment, and management strategies for appetite management [2, 3]. However, no guidelines, standards or formal recommendations for dealing with older patients with appetite loss have yet been published. This means that many healthcare professionals often rely mainly on their previous experience to provide counselling and treatment for older adults with appetite disorders.

Appetite disorders in old age constitute a widespread problem with many potential causes, which include physiological changes in the secretion of hormones that regulate food intake, gastrointestinal diseases, the use of certain medications and polypharmacy, reduced mobility and physical activity as well as psychological factors, such as depression, anxiety or cognitive impairment [4, 5]. Environmental and social factors, such as need for and access to care services, poverty and food insecurity, also play a role in the development of appetite problems. According to the literature, the following interventions for appetite loss have been proposed: nutritional counselling and education, physical exercise, adjusting meals by flavour enhancement, increasing meal variety, providing assistance, dietary supplementation, and introducing appetite-stimulating medication [2, 4]. The broad interplay of causes and management strategies highlight the importance of the interdisciplinary approach but also challenge of treatment of appetite disorders.

The aim of this qualitative study was to gather and analyze information on screening and treatment practices related to appetite loss among healthcare professionals with wide range of professional backgrounds who deliver care for older adults.

Methods

Study design and participants

We performed a qualitative descriptive study that used individual semi structured interviews to explore the healthcare professionals’ views and approach to appetite loss management. The study was performed from November to December 2025. We conducted the study in a single tertiary teaching hospital, with participants recruited from its staff.

The inclusion criteria to the study were: (1) current employment as a healthcare professional; (2) working experience with patients aged ≥ 65 years; (3) informed consent to participate in the study. The participants were recruited through convenience and snowball sampling and were initially approached either by email or in person. The study was conducted until the data saturation was reached, meaning that no new codes emerged from two consecutive interviews.

The study was approved by the Ethics Committee of the Jagiellonian University; 118.0043.1.398.2025. All participants signed an informed consent to participate in this study.

Reflexivity

Members of the research team (AR, RK and KP) have been involved in qualitative studies and had received formal training in qualitative methodology as part of PROGRAMMING COST Action 21,122 [6].

The guide for the interview was developed within the research team consisting of dietitian and psychologist (AR), and medical doctors with specialization in internal medicine and geriatrics (KP, JG). RK is a physician by training and holds a master’s degree in public health and contributed with comments and suggestions for amendments to the tutor guide before it was used during the interviews.

The study formed part of AR’s PhD project, which focused on appetite loss among older patients, both with and without cognitive impairment. Apart from developing Appetite Loss in Older adults with and without Cognitive impairment (ALOC) scale for assessing appetite [7, 8], the project involved conducting research to develop practical solutions for caring for older adults with appetite disorders.

Data collection

The data were collected by one female researcher (AR). A single interview guide was used for all interviews, although the questions were adapted to ensure they were relevant to the respondents’ specific professional roles (supplementary file). The interview structure was as follows: previous experience of working with patients reporting appetite loss; coping in their professional roles with a problem of the patient’s loss of appetite; opinion regarding the current tools for appetite assessment; presentation of two tools for appetite assessment (Council on Nutrition Appetite Questionnaire (CNAQ) [9] and ALOC [7, 8] screening scales); reflection of the management of appetite loss. The interviews were conducted either in person (n = 9) or online (n = 2), depending on the participants' preferences. Regardless of the chosen format, they were all recorded. All participants were aware of the recording and the data security measures were undertaken.

Each participant received a description of the study, as required by the Ethics Committee. Participants were informed of appetite loss definition [3] and were allowed to ask questions before the interview to maximise the common understanding of the interview topic. For the purpose of current study, we defined appetite loss as a loss of yearning for food leading to loss of drive for eating. It arises due to interaction between a wide range of factors including processes of physiologic ageing, disease processes, and qualitative properties of food, and is influenced by psychological, social, economic and other factors. Appetite loss leads to diminished food intake and related risks including risk of or development of malnutrition. Each participant provided basic data on their gender, age, current professional experience and the basic characteristics of their workplace (hospital, ambulatory care, private practice or a combination of these).

The recordings were manually transcribed verbatim, without using automated or software-assisted tools. Identification of no new content in two consecutive transcripts was considered as reaching data saturation. This terminated the inclusion of new participants.

Data analysis

To interpret the data, the inductive thematic analysis approach, following the six-steps process outlined by Braun and Clarke, was adopted [10]. The first step of the analysis was to familiarise all the research team members with the transcripts. While reading the transcripts, two researchers (AR, RK) individually highlighted the key phrases and generated the list of initial codes, with the possibility that more than one code was applied to the same part of the text. Discrepancies in the findings were resolved through iterative discussions among the authors until a consensus was reached. The process was overseen by the senior author (KP), who acted as an arbiter in cases of disagreement. Then, the research team meeting (AR, RK, BG, JG, KP) was held to discuss and establish the potential themes and sub-themes by identifying relationships among the codes. All authors agreed with final themes definition and organization.

Conceptualization and operationalization

We used the identified themes as a benchmark for implementable actions. We categorised them to the three organisational levels: the level of the system (macro), institution (mezo) and individual (micro).

Results

Eleven healthcare professionals (10 female, 1 male, age range 27–63 years) have been included in the study. The average duration of the interview was 24 min. The basic participants’ characteristics are presented in Table 1.

Table 1.

The characteristics of the study participants

	Gender	Age (years)	Profession	Specialization	Interview time (minutes:seconds)
1	F	31	MD, resident	Geriatrics (in training)	19:31
2	F	39	Nurse and physiotherapist	–	21:35
3	F	30	Dietitian	N/A	32:30
4	F	29	Psychologist	Clinical psychology (in training)	15:53
5	F	29	Dietitian	N/A	30:58
6	F	33	MD, specialist	Geriatrics Internal medicine (in training)	33:58
7	F	27	Pharmacist	-	17:04
8	F	40	Physiotherapist	Clinical physiotherapy	20:23
9	F	63	Psychologist, consultant level	-	27:39
10	F	50	MD, consultant level	Geriatrics Internal medicine	10:05
11	M	29	Dietitian	N/A	31:01

F female, M male, MD medical doctor, N/A not applicable

Through thematic analysis, five main themes were identified: (1) Diagnostic challenges in patients’ identification and assessment; (2) Therapeutic approach to appetite disturbances; (3) Involvement of caregivers and healthcare professionals; (4) The interplay between appetite loss and hospital setting; (5) Narratives on appetite. The Fig. 1 presents the thematic areas identified in the study. The coding tree can be accessed in supplementary files.

Fig.1.

Thematic areas identified in the study

Theme 1: diagnostic challenges in patients’ identification and assessment

Healthcare professionals paid attention to the language used by patients to communicate eating difficulties. The term 'forcing oneself to eat' was frequently cited, as were patients' comments that food did not taste as good as it used to. A clear need to directly ask about appetite problems emerged.

Sometimes they [patients] say that food isn't what it used to be.

F, psychologist, 29 years

They complain, they definitely complain about not wanting to eat, about not enjoying food, but they have to force themselves – whether it's eating or drinking. That nothing tastes good to them – this often happens, sometimes also in patients who are unable to express it fully, but for example shake their heads as if to say ‘no, I won't eat’, ‘no, I don't want to’.

F, medical doctor, 33

In the internal medicine ward, most patients complain of appetite problems, but sometimes they do not mention this spontaneously and need to be asked about it.

F, psychologist, 29 years

Participants described the actions they take to diagnose appetite disorders. They highlighted the challenges they face in assessing the appetite among other tasks to be completed during hospital stay such as priorities of medical treatment.

If a patient is in a serious condition when they arrive at our ward, as sometimes happens, we do not always notice it [appetite loss] at first. Our initial focus is on treating the somatic condition in order to save the patient's health and life. Later, when they have recovered, we notice that their appetite simply does not return.

F, medical doctor, 31

During the interview, none of the study participants mentioned knowing and using any questionnaires to screen for appetite. Instead, some of the participants referred to the Nutritional Risk Score-2002 (NRS-2002) tool. They also emphasised the importance of conducting an in-depth nutritional interview with the patient as an integral part of diagnosing appetite disorders.

No, I have never had the opportunity to work with such a tool [for assessing appetite]. I think I have heard of these tools, but I have never used one.

F, medical doctor, 33

But once the patient has been admitted, we talk to the family – what the patient likes, how they have been recently, what they have been eating at home, and if they haven't been eating, how long they haven't been eating, if they haven't been drinking, how long they haven't been drinking. If they drink, what do they like – sweet, bitter? Kefir? Buttermilk? Do they have a preference for certain flavours? At the beginning, I want to find out what their preferences are, what they like. (…) What does such a patient like, how do they eat, what are their capabilities? The patient may not have teeth, for example.

F, dietitian, 30

It was pointed out that following and observing how a patient eats is an important factor in making an accurate diagnosis.

As for appetite, it is assessed in the course of hospitalisation, because we also need to get to know the patient, see what their habits are, what they like and what their problems are. On the second day of their stay, we can see that they are not eating, they don't want to, they are fussy, and so on.

F, dietitian, 30

I keep repeating the word ‘monitoring,’ but I think that's where we need to start in order to be able to identify the issues at stake. And to understand how it looks over time – whether it [appetite loss] is chronic or situational.

F, psychologist, 29 years

However, it often turns out that the issue of eating will be discussed at the second meeting, or it will simply turn out that I will see the patient while they are eating.

F, physiotherapist, 40

Physical appearance and laboratory test results were identified as important factors to consider appetite disorders. The most commonly reported findings during the physical examination were muscle wasting, skin deconditioning, and oral cavity condition.

There's definitely muscle wasting; there's a lot of that. Sometimes it's not something you can see during a physical examination, but when a patient arrives wearing baggy clothes, we immediately think, 'Has he lost weight?' There's more skin, so you can see that there used to be more body mass. There is probably some fat loss too, although that would be less common. Any swelling, especially generalised oedema, would also suggest that something might be wrong.

F, medical doctor, 33

Well, it's obvious, for example, very low body fat and muscle mass. Patients who are severely malnourished – you can see it with the naked eye. Dry mouth, dry tongue. You can automatically tell just by looking. If the urine in the catheter is very yellow, it means the patient is dehydrated. Dry skin, spots.

F, dietitian, 30

One participant stressed that assessing appetite should not be delayed until there are noticeable changes in the patient's appearance.

A change in appearance… Well, certainly, but it must be combined with methods that can detect it at an earlier stage, because when there is a change in appearance, it is usually already at an advanced stage of nutritional status deterioration.

F, physiotherapist, 40

In general, the participants expressed positive perceptions on the CNAQ and ALOC screening scales. Some participants reflected that older patients may find it difficult to choose from the five answer options on the CNAQ scale and preferred the simpler ‘yes–no’ format of the ALOC scale.

Yes, I think both would be informative. I would definitely draw some conclusions from both. So these are rather important questions, helpful scales.

F, dietitian, 29

I think the second one, ALOC, is definitely simpler, because there are yes/no answers without any gradation. Obviously, it all depends on the patient's condition, whether they can do it themselves or not. But this one is clearer, I think a yes/no answer is a better solution, in my opinion. (…) This scale [CNAQ] is more difficult, because take a question with answers such as ‘1/3’, “half”, ‘average’ – it is difficult to grade it like that.

F, medical doctor, 31

Theme 2: therapeutic approach to appetite disturbances

Subtheme: therapeutic interventions related to dietary modifications

The proposed interventions for appetite loss mainly involved modifying the diet by adding preferred foods to meals, reducing meal size, increasing the caloric content of portions and adjusting the consistency and texture.

Once I get to know a patient, they usually stay with us for a long time, so I know what they like and can prepare food that I know they will definitely eat. This could be pâté, cottage cheese, a spread or cream cheese with jam, for example, as some patients like sweet things.

F, dietitian, 30

Well, if a patient is given a whole portion of chicken, which happens to be included in all diets, it is obvious that they will not eat it. And the portions are enormous if you have no appetite and see a whole plate of food. It is obvious that the quantity alone overwhelms them.

M, dietitian, 29

For me, it's important to figure things out with the patient, listen to them, and give them what they want.

F, dietitian, 30

Patients enjoy sweet meals with a mousse-like consistency – yoghurts, mousses, sweet drinks, desserts. Smooth things like that. And generally sweet, fruity things.

F, nurse, 39

Subtheme: therapeutic interventions related to environment modifications

Participants paid attention to modifications concerning the patient's hospital environment, with many suggesting that having company during mealtimes would be especially beneficial for patients.

As in some nursing homes, patients are taken to a common room and do not eat their meals alone in bed. It tastes completely different at the Table. (…) When you sit somewhere with someone else and talk, you eat. But when you sit alone, you look at your plate and it seems endless – you lose your appetite.

F, medical doctor, 33

Yes, there is nowhere for patients who can walk to go and eat a meal. I think this would be useful in our geriatric ward.

F, medical doctor, 50

Subtheme: the use of oral nutritional supplements (ONS), enteral and parenteral nutrition

The use of ONS was frequently referred to by study participants as a way to increase patients’ caloric intake. Some of the participants mentioned the possibility to employ other forms of medical nutrition therapy such as enteral and parenteral nutrition.

We also try to enrich these meals with oral nutritional supplements to compensate for those who are unable to consume enough protein due to not liking the taste of supplements. These supplements help to address this issue to some extent.

F, medical doctor, 33

They do indeed ask about oral nutritional supplements. I have also noticed advertisements for ONS on television, so I think this may be because they are becoming more widespread.

F, dietitian, 29

Then there are oral nutritional supplements to consider. There are many of these, and older people often dislike the taste. However, because there is such a wide variety, it is always possible to find something suitable. It is worth trying them.

F, medical doctor, 31

Well, if nothing works, but of course, we don't give up on oral feeding either. If there is parenteral nutrition, we usually try oral feeding as well.

F, dietitian, 29

Subtheme: pharmacological interventions

Participants mentioned pharmacological interventions, including supplementation and the use of over-the-counter drugs, as another type of intervention for appetite loss. Some participants expressed doubts about the effectiveness of such treatments.

Taking medication… Does it even work?

F, nurse, 39

Older people tend to prefer to fix the problem with medication. They are more likely to ask if there is a medicine that will make them want to eat.

F, pharmacist, 27

Here, doctors sometimes prescribe medication, but I would say that improvements are generally 'average'. There's no 180-degree change after a certain medication is prescribed, with the patient improving day by day and developing a good appetite. In fact, I would say that the results are very poor – the medication doesn't usually solve the problem completely.

M, dietitian, 29

Subtheme: cognitive impairment as a challenge in appetite loss treatment

Cognitive impairment and advanced age were seen as barriers to the treatment of appetite loss, impacting the ability to self-manage the eating process, choose from different menu options, and explore new flavours. Participants noted that patients with cognitive impairment require greater awareness and assistance from medical personnel.

[About dementia] It may also be related to sensory sensitivity, which deteriorates, and this aversion to food is not just the result of apathy, but the fact that it ceases to be enjoyable, rewarding. There is no longer any joy in discovering different flavours, the sensations associated with tastes become flattened and everything is, as patients sometimes say, “like sawdust”, i.e. devoid of any expression.

F, psychologist, 63

Well, sometimes older patients, even filling out what they want to choose to eat, can be a problem.

F, dietitian, 30

It is also important that this information [on dementia] is provided to staff, as they are sometimes unaware that a patient may have forgotten to eat.

F, psychologist, 29

Theme 3: involvement of caregivers and healthcare professionals

All participants agreed that providing care for patients with appetite loss within an interprofessional team, with a patient-centered care is important. Some participants mentioned good communication between team members as a source of professional satisfaction.

I definitely see a necessity here, not so much a field but a necessity, for interdisciplinary cooperation. Current trends show that caring for the older person is not only the responsibility of people with medical training, because we also include formal and informal caregivers, as well as trainers who exercise with people with a higher level of functional fitness.

F, physiotherapist, 40

They take my opinion into account. They [the doctors] come and ask me, which means I am important in this whole process. And I also feel that I have something to say. They ask me, or they prescribe something themselves, and then we discuss whether it's okay, whether the patient wants it or not, but it's nice that they ask me at all.

F, dietitian, 30

The role of the patient's family was seen as crucial in gathering information during the diagnostic process and treatment. Many of the modifications were based on providing home-cooked meals that would remind the patient of positive experiences and stimulate appetite.

Sometimes we tell families to bring their own food from home, and I understand that some people may not like hospital food (…). But we tell families to bring their own soup, main course or something, and then we serve it and heat it up.

F, nurse, 39

I have observed that it works. Patients who, for various reasons, have difficulty with their appetite often tell me, ‘Well, I don't have an appetite, but I would eat this one thing.’ And it often happens that the family is able to organise, for example, dumplings, patients often talk about dumplings or pork chops. And it often happens that when this is organised for the patient, they eat at least part of the meal.

F, psychologist, 29

Loneliness and isolation were the key identified factors affecting appetite in older adults. Activities involving support and keeping company by others were considered significant and meaningful.

I remember one of the wards when I was on my internship, where we had a big discussion because a patient had lost weight. And here, the diagnostics were very extensive in terms of cancer and various other things. But I took a quick look and said that his medical history showed that his wife had died last year – and I said that he probably wasn't eating much. (…) There were children in the hospital room at the time, and I asked if it was true that he was eating less. The patient and the children confirmed that he was eating little and reluctantly, because his wife was a good cook. ‘And now we try and bring him food, but it's not the same.’

F, medical doctor, 33

So that the nurse has time to sit next to the patient, help them eat, and keep them company while they eat. Well… We both know how it is.

F, nurse, 39

I know it [the meal] all looks nice, because we have a general rule with the staff to do it the way you would like to eat yourself. (…) Just set high standards for yourself, and don't let it be dirty and disgusting.

F, dietitian, 30

Theme 4: the interplay between appetite loss and hospital setting

The hospital environment was considered as an important factor in loss of appetite, due to different presentation of food served, anxiety relating to diagnostic and therapeutic processes, and, in some cases, loss of functional independence.

In my opinion, this is a very common problem among older people, not only problems with appetite, but also their food preferences – sometimes hospital diets are not entirely suited to these preferences.

F, medical doctor, 31

When I was at the European Geriatric Medicine Society Conference, I also heard that even pureed foods should be shaped to resemble real food as closely as possible, so that their appearance encourages patients to eat. But how can this be done in a hospital?

F, medical doctor, 33

For example, older patients are often prescribed a blended diet. And this is where the problem lies, because a blended diet, like any blended diet, does not taste good and does not look appealing.

F, dietitian, 30

I think that in terms of psychological aspects, there is definitely anxiety related to the diagnostic process, and the question is whether patient tend not to eat when they are under such stress.

F, psychologist, 29

But I have also encountered situations where older people consciously refuse to eat or drink because they are bedridden and use diapers. They don't want to eat or drink because they think that if they don't, they won't need to urinate and the problem will go away. It's a vicious circle, and the same applies to eating.

F, nurse, 39

Organisational barriers, such as a shortage of skilled personnel, were seen as an obstacle to providing proper nutritional care for older patients with loss of appetite.

And this [meals modification] is, in my opinion, something small, but it requires sacrifice, well, maybe not sacrifice, but it takes me a lot of time, because you have to do something like this for every patient – it's really hard.

F, dietitian, 30

It is also important to have personnel in the ward who simply have the time to feed the patient. Because sometimes it really takes a long time if there is only one person feeding a 24-bed ward and 10 people need help with feeding. It's just unrealistic; the soup that was warm for the first person will be cold by the time it reaches the 10th. This certainly does not help with these [appetite] disorders either.

F, medical doctor, 31

Theme 5: narratives on appetite

Subtheme: awareness among healthcare professionals

The participants considered loss of appetite to be an important issue in clinical practice. All participants admitted that they often deal with patients who show signs of appetite disturbances, and that they usually discuss nutrition-related topics in their daily work, regardless of their healthcare profession. The participants emphasised the need to raise awareness of loss of appetite among a wider group of medical professionals.

I think that we do this relatively often [assess appetite]. It is not a question asked as routinely as the question about weight loss, but due to the specific nature of the ward, and also the team I work in, because malnutrition is something we deal with on a daily basis, we do ask about it. It should probably be part of our routine – but let's be honest, it isn't. But we ask it relatively often, and the topic is coming up more and more frequently; we are thinking about it.

F, medical doctor, 33

[On documenting appetite loss] Any mention that the patient has a poor appetite? No… well, maybe it [medical documentation] says that the patient was on some kind of nutritional treatment, or that they are malnourished. That's the only way I can figure it out. But the word ‘appetite’ doesn't appear.

M, dietitian, 29

Subtheme: awareness among patients

Awareness of appetite disorders among patients was perceived by HCPs as low. Participants referred to the misconceptions held by older patients, viewing these as a barrier to diagnosing and treating appetite loss.

They also often report that “I hardly eat at all,” “I’ve been eating like this for several years,” and that they don’t even notice the difficulties in an, so to speak, more objective way. Sometimes you have to ask them further what it actually looks like, how much they eat. And I also have the impression that they often downplay this issue.

M, dietitian, 29

And then there’s the other side as well—some older women who used to take care of themselves. They believe that if they’re lying in bed, they don’t need to eat—and that, too, can be detrimental.

F, medical doctor, 31

Subtheme: personal experiences with appetite

Some participants in the study recalled their own or their family members' struggles with appetite in order to better understand the problems observed in patients.

This thought occurred to me today—I had never thought about it this way before. I had always thought, “oh, it’s an infection, you need to eat.” Recently, when I myself had a severe infection, eating lunch was such a big effort that I then had to sleep for three hours to recover. And that’s when I noticed that our patients are the same—that they get tired very quickly.

F, medical doctor, 33

Subtheme: emotions in appetite loss care

The study participants discussed the emotions they observe in patients with appetite disorders.

The increase in anxiety leads to reduced activity, reduced activity leads to reduced fitness, first physical, then functional, which increases the risk of falling. And I think that when it comes to eating, it definitely fits into this cycle.

F, physiotherapist, 40

I also try to take a psychological approach with these patients, to encourage them, to explain things to them, and to support them as well—to say, “I understand that you don’t have an appetite, that this is difficult.”

F, dietitian, 29

When we have palliative patients, it’s about enjoying food at all, because it’s often their only kind of pleasure. I don’t know—ice cream on the ward, which is very common. We allow patients to eat ice cream.

F, dietitian, 30

Conceptualization and operationalization

We subdivided the results of thematic analysis into the following actionable levels:

Macro level recommendations (actions at national level):

• Incorporating learning outcomes related to appetite and its assessment into all levels of professional education.

• Adaptation of legal framework to foster interprofessional care that includes dietitians.

• Providing framework (including rules, funding, reimbursement) for programmes designed to improve hospital diet and make it more appetising.

• Developing national-level campaigns targeting healthcare professionals, patients and caregivers, and general public, aiming to raise awareness of the problem of appetite loss (narrative-based).

Mezo level recommendations (actions at the hospital level):

• Providing access to educational activities, requirement and incentives to take part in them.

• Establishing interprofessional team-work culture oriented on patients with feeding difficulties, including appetite loss.

• Implementation of measures to improve the hospital diet and create appropriate logistics, including spaces for shared meals, personnel, equipment, availability of ONS.

• Implementation of the principle of uninterrupted mealtimes. This should involve avoidance of procedures that can be postponed for after the meal-time (narrative-based).

Micro level recommendations (actions at individual level):

• Involvement in education activities focused on diagnosing appetite loss and nutritional status.

• Collaboration between all team-members, the patient and the caregiver.

• Promoting oral intake during hospital stay.

• Encouraging the involvement of family and caregivers including by bringing home-prepared meals (when in line with medical restrictions).

• Taking the patient’s perspective into account when treating appetite loss (narrative-based).

Discussion

We performed a qualitative descriptive study to serve as a benchmark to inform formulation of management framework for appetite loss in older patients. We collected qualitative insights regarding appetite loss from various healthcare professionals working with older adults. Further, based on the identified codes we formulated five thematic areas referring to diagnostic and therapeutic process, involvement of healthcare professionals and caregivers, impact of the hospital environment and finally personal narratives.

The first theme reflected challenges in appetite loss identification and assessment in older patients in the hospital setting. The participants reported that they have not used scales to assess appetite. The reasons for that may range from the lack of validated translation of internationally agreed tools, lack of clear division of responsibilities between health-related professions, the lack of incentives to perform the assessment that is viewed as an additional burden in already demanding daily chores, and the still weak patient-centred institutional culture, where issues of appetite may be viewed as “minor” or as “fineries”. Instead of tools to assess appetite, the respondents reported using techniques specific to the diagnosis of malnutrition, and further, the methods they employed differed. Using the mismatching diagnostic methods may lead to introduction of different treatment modalities or, to the contrary, lack of treatment in the case of missed diagnosis [11]. A lack of routine appetite assessment for both the acute and elective hospital admissions of older people was declared. This is in line with our earlier results, where we found that only about 13% of electronic medical records contain mentions of appetite status [12]. This contrasts with the reported prevalence of appetite disorders in hospitalised older persons of approximately 30% and in some reports as high as over 40% [13–15].

Reflections on treatment strategies for patients diagnosed with or at risk of appetite loss were grouped into the second theme. This included dietary modifications, changes to patients' environment, the use of oral nutritional supplements (ONS), enteral and parenteral nutrition and pharmacological interventions. The study participants emphasised the importance of clinically observing and acquainting themselves with patients to personalise diet modifications and increase dietary intake. This is consistent with results obtained by Jinnette et al. suggesting, that personalised nutritional strategies could help increasing food intake in older adults [16]. Optimising oral nutrition is also important for effectively treating other comorbidities that are more common in old age and can reciprocally affect appetite [17]. In addition to strategies based on modifying oral nutrition, the use of ONS was frequently mentioned as an intervention, though medical professionals reported that patients often complained about their taste. This is consistent with the results of studies regarding patient tolerance of the ONS flavours [18, 19]. While there is no scientific evidence that oral nutritional supplements improve appetite, they help to increase intake and may contribute to improved nutritional status [20].

A third theme that emerged was the involvement of interprofessional teams in the care of patients with appetite loss. This is in line with a call to action published in 2025 as part of the COST PROGRAMMING CA 21122 Action in which professionals associated within the Action stressed the need for joint educational activities and cooperation in interdisciplinary therapeutic teams in geriatrics [21]. While some research supports this approach for different age-related conditions such as sarcopenia and frailty, few studies addressed the role of joint education across health care professions to improve care for older patients with appetite loss [22, 23]. The approach involving interdisciplinary teams has been employed for a variety of clinical situations and healthcare settings including topics related to appetite loss such as malnutrition in the long-term care setting [24]. Discussions with professionals also revealed the importance of involving the patient's family in the treatment process, an aspect that is frequently sidelined [25, 26]. Cooperation with the family was considered important for gathering information about the patient and for adjusting hospital dietary routines for instance by providing home-cooked meals as treats to facilitate oral intake. Although little research has been conducted on the effectiveness of such interventions, the available results suggest that feelings of nostalgia while eating may enhance older people's satisfaction with a meal [27, 28].

The study participants rarely addressed issues related to patient involvement in the therapeutic process. It has been demonstrated that patients’ involvement in their treatment increases the commitment to therapy, consequently improving its effectiveness [29]. At the same time, the professionals surveyed seemed more likely to involve families than patients themselves in the care process. This might stem from the stereotypic view of older people as having poorer cognitive abilities [30].

The fourth theme was related to appetite in the context of hospital setting. The respondents stressed the importance of impact of hospitalisation on functional status of older patients. Lack of functional independence may induce appetite loss, acting through low physical activity and thus decreased caloric demand, as well as through imposed isolation and loneliness [15]. Mikami et al. demonstrated that eating meals alone was associated with both decreased appetite and more severe depressive symptoms [31]. What is more, the need to be supported by medical personnel and family in terms of basic activities of daily living may cause shame and lead to self-imposed dietary restrictions to limit the amount of assistance required from others [25]. The environmental stress during meals including noise or chaotic service has in the past been identified in patients and HCPs’ perspective as interfering with adequate food intake [32, 33]. Although the literature does not offer unequivocal advice on how best to help the older patient with the meals, fostering social interaction has the potential for improving food intake [34].

The participants in our study emphasised that, although there are some potentially effective strategies to improve appetite, it would be challenging to implement them in a hospital environment. For example, they suggested setting-up a canteen for patients, which would address the perceived need of social interaction among hospitalised patients. Another suggested improvement would be to provide small kitchens in hospital wards where patients could warm up meals brought by their families, prepare drinks or simple desserts. Providing round-the-clock access to favourite drinks and finger foods in such a space could also help to combat dehydration and malnutrition [35, 36]. At the same time, despite research showing the potential benefits of such intervention, it remains challenging to implement substantial changes in many hospitals due to local food safety regulations [37, 38]. This highlights the need to design healthcare facilities in a way that makes them adapted to the needs of older patients.

The last theme referred to the personal experiences of staff when interacting with patients who have appetite disorders. When caring for older patients at high risk of malnutrition, the surveyed professionals recalled their own or their family members’ experiences of disturbed appetite, for example during an acute illness [39]. The willingness to draw on personal experience when caring for older patients highlights the importance of empathy-based learning strategies in the education of medical professionals.

Our study needs to be interpreted in the context of its limitations. First, our institutional tertiary care setting may not be representative of other clinical contexts. This may have contributed to the researcher bias. However, the clinical experiences of our staff cover large pool of patients, as our hospital admits patients from both the large urban community and the rural areas, and large proportion are admitted via the Emergency Department without prior selection. Second, our respondents were mostly women. This homogeneity reflects the broader issue of gender imbalance in both geriatric medicine as well as in the fields of psychology, nursing and dietetics, where most of the practitioners are women [40–43]. The higher proportion of women in the study sample may have influenced the results. Women tend to pay more attention to the nutritional properties of food, and as a result they may focus on patients’ eating habits and consequently their appetite [44]. It is also commonly believed that women are more likely to show empathy and adopt the patient’s perspective [45]. For this reason, patients may be particularly willing to share their complaints about appetite with female members of the staff. Third, the majority of our respondents were relatively young, which may have altered their perceptions of the appetite as a clinical problem in older patients. The age composition of our participants tends to reflect the age composition of the staff in our institution that includes residents and young specialists. This is important as over the past years the curricula of health-care professions started to include structured information concerning diet-related topics. This may have sensitised younger participants to the issues of appetite loss in older patients. There has also been an educational shift towards a patient-centred model of care from a disease-centred one [46, 47]. To reduce the bias potentially created by relatively young age of the participants, we also included two senior colleagues.

We did not include older patients and their caregivers or family members in our study, and we focused solely on the perspective of healthcare professionals. Although the respondents frequently referred to the patients’ perspective during the interviews, it is important to be aware that this is only the view of those working with older people with appetite loss, which may differ from the perspective of the patients themselves. Further qualitative research is essential to gain more understanding of this perspective, and to further develop tools and care processes that would be tailored to the needs of patients and their formal and informal caregivers.

Conclusions

Interviewed healthcare professionals perceived the topic of appetite loss as an important part of hospital care for older adults. They recognised wide range of opportunities but also challenges in course of diagnosis and treatment of appetite disorders that are strongly linked to interdisciplinary care, involvement of caregivers and hospital environment. There is a pressing need to implement standardised approaches, that would orchestrate the macro, mezo and micro level actions to address the issue of appetite loss in older patients. Our results, in the context of earlier and ongoing studies, should inform future systemic approaches to the management of appetite loss in older patients across different clinical settings.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

AR: conceptualization, data curation, formal analysis, investigation, methodology, visualization, project administration, writing – original draft, writing – review and editing. RK: methodology, investigation, formal analysis, writing – original draft, writing – review and editing. BG: conceptualization, writing – review and editing, supervision, JG: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing. KP: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing, supervision.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data that support the fi ndings of this study are available from the corresponding author upon reasonable request.

Declarations

Conflict of interest

The authors have no conflict of interest to report.

Ethical approval

The study was approved by the Ethics Committee of the Jagiellonian University; 118.0043.1.398.2025.

Informed consent

All participants signed an informed consent to participate in this study.