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Biological and psychosocial issues

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Seniors and Problems with Taste

 

Taste is one of our most robust senses. Although there is some decline in taste as people get older, normal aging does not greatly affect our sense of taste. Sensitivity to taste begins to gradually decrease as people get older, but in some people, not at all.

Taste contributes greatly to our ability to enjoy food and beverages. Problems with taste can have a big impact on the lives of older people. When taste is impaired we tend to eat poorly, socialize less, and generally feel worse.

Taste helps us recognize when food is good or bad for us. But, even more important, loss of taste can cause a loss of appetite in older people, which can lead to loss of weight, malnutrition, weakened immunity, and even death.

Our sense of taste is part of our chemical sensing system or the "chemosenses." Normal taste occurs when tiny molecules released by the food we eat stimulate special cells in the mouth and throat. These special sensory or gustatory cells send messages through nerves to the brain, where specific tastes are identified.

The taste cells are clustered in the taste buds of the mouth, tongue, and throat. Many of the small bumps that can be seen on the tongue contain taste buds. At birth we have about 10,000 taste buds scattered on the back, side, and tip of the tongue. After age 50, we may start to lose taste buds.

We can identify five different taste sensations: sweet, sour, bitter, salty, and umami. Umami is the taste of glutamate, a building block of protein found in chicken broth, meat extracts, and some cheeses.

The ability to perceive the flavor of food occurs through a complex process that combines taste with temperature, texture, odor, and sensations from the common chemical sense -- a system of thousands of nerve endings on the moist surfaces of the eyes, nose, mouth, and throat. It is flavor that lets us know whether we are eating an apple or a pear.

Many people are surprised to learn that we recognize flavors largely through our sense of smell. Try holding your nose while eating chocolate. You will be able to distinguish between its sweetness and bitterness, but you cannot identify the chocolate flavor. That's because the distinguishing characteristic of chocolate is largely identified by our sense of smell.

Smell and taste are closely linked in the brain. Many people mistakenly believe they have a problem with taste, when they are really experiencing a problem with smell. It is common for people who lose their sense of smell to say that food has lost its taste. This is incorrect; the food has lost its aroma, but taste remains. Loss of taste occurs less frequently than loss of smell in older people. People may be classified according to their ability to identify a bitter compound, phenylthiocarbamide or PTC.

Our sense of taste is so important that a distorted sense of taste can be a serious risk factor for heart disease, diabetes, stroke, and other illnesses that require sticking to a specific diet. When taste is impaired, food loses its appeal and we may eat too much and gain too much weight or eat too little and lose too much weight.

Loss of taste can cause us to eat too much sugar or salt to make our food taste better. This can be a problem for people with certain medical conditions, like diabetes or high blood pressure. In severe cases, loss of taste can lead to depression.

When an older person has a problem with taste, it is often temporary and minor. True taste disorders are uncommon. When a problem with taste exists, it is usually caused by medications, disease, or injury.

Many older people believe that there is nothing they can do about their weakened sense of taste. Depending on the cause of your problem, your doctor may be able to suggest ways to regain your sense of taste or to cope with the loss of taste. In many cases, the loss of taste turns out to be a loss of smell. If you think you have a problem with your sense of taste, see your doctor.


Causes and Prevention


Loss of taste may be permanent or temporary, depending on the cause. As with vision and hearing, people gradually lose their ability to taste as they get older, but it is usually not as noticeable as loss of smell. Medications and illness can make normal loss of taste worse.

Problems with taste are caused by anything that interrupts the transfer of taste sensations to the brain, or by conditions that affect the way the brain interprets the sensation of taste. The most common causes of taste disorders are
  • Medications
  • Infections
  • head injuries
  • dental problems.

Other causes are radiation therapy for head and neck cancers, mouth dryness, heavy smoking, vitamin deficiencies, Bell's palsy, and Sjogren's syndrome.

Taking medications can affect our ability to taste. Some antibiotics and some blood pressure pills can cause a bad taste in the mouth or a loss of taste. If you think your medication is causing a problem with your sense of taste, talk to your doctor about it.

Gum disease can cause problems with taste, as can inflammation or infections in the mouth and dentures. If you take several medications, your mouth may produce less saliva. This causes dry mouth, which can make swallowing and digestion difficult and increase dental problems. Practice good oral hygiene, keep up to date with your dental appointments, and tell your dentist if you notice any problems with your sense of taste.

Problems with taste can have serious consequences because taste affects the amount and type of food we eat. Loss of smell and taste can cause weight loss in the elderly. In some cases, loss of taste can accompany or signal a more serious condition, such as diabetes or some degenerative diseases of the central nervous system such as multiple sclerosis. Be sure to see your doctor if you have had a taste problem for a while or if you notice that your problem with taste is associated with other symptoms. Let your doctor know if you are taking any medications that might affect your sense of taste. You may be able to change or adjust your medicine to one that will not cause a problem with taste. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects.

The most distressing taste disorders are those in which there is a persistent, often chronic bad taste in the mouth, such as a bitter or salty taste. This is called a dysgeusia and it occurs in older people, usually because of medications, dental and oral health problems. The medicines that most frequently cause dysgeusias are drugs to lower cholesterol, antibiotics, blood pressure pills, medications to lower anxiety, and antidepressants.

Taste problems that appear with normal aging cannot be prevented. In many cases, people regain their sense of taste when they stop taking medications or when the illness or injury clears up.

Smokers often report an improved sense of taste after quitting. Sometimes exposure to certain chemicals, such as insecticides and solvents, can impair taste. Avoid contact with these substances, and if you do come in contact with them, see your doctor.

You can help prevent problems with taste caused by respiratory infections by washing your hands frequently, especially during the winter months. If your taste disorder is made worse by allergies, you should avoid allergens, like ragweed, grasses, and pet dander. Also, get a flu shot every year to prevent influenza and other serious respiratory conditions that can result from the flu.

Be sure to see your doctor if you have had a taste problem for a while or if you notice that your problem with taste is associated with other symptoms. Let your doctor know if you are taking any medications that might affect your sense of taste. You may be able to change or adjust your medicine to one that will not cause a problem with taste. Your doctor will work with you to get the medicine you need while trying to reduce unwanted side effects.


Symptoms and Diagnosis


There are several different types of taste disorders depending on how the sense of taste is affected. People who have taste disorders usually lose their ability to taste or can no longer perceive taste in the same way. The most common true taste complaint is "phantom taste perception" -- tasting something when nothing is in the mouth.

Some people have hypogeusia, or the reduced ability to taste. This disorder is usually temporary. True taste disorders are rare. Most changes in the perception of food flavor result from the loss of smell.

Other people can't detect taste at all, which is called ageusia. This type of taste disorder can be caused by head trauma, surgical procedures, radiation therapy, and infections. People with taste disorders experience a specific ageusia of one or more of the five taste categories: sweet, sour, bitter, salty, and umami or "savory."

If you think you have a taste disorder, try to identify and record the circumstances surrounding it. Ask yourself the following questions:
  • When did I first become aware of it?
  • What changes in my taste do I notice?
  • Do all foods and drinks taste the same?
  • Have there been any changes in my sense of smell?
  • Does the change in taste affect my ability to eat normally?
Bring this information with you when you visit the doctor. Also, be prepared to tell him or her about your general health and any medication you are taking. Your doctor may ask if you recently have had a cold or the flu. Sometimes these conditions can affect taste.
Your doctor may refer you to an otolaryngologist, or specialist in diseases of the ear, nose, and throat. After a complete medical history and physical examination, your doctor may run special tests to find out what type of taste disorder you have and how serious it is.

Some tests are designed to measure the lowest concentration of a chemical that a person can detect or recognize. Your doctor may ask you to compare the tastes of different chemicals or to note how the intensity of a taste grows when the chemical's concentration is increased.

Scientists have developed taste testing in which the patient responds to different chemical concentrations. This may involve a simple "sip, spit, and rinse" test or chemicals may be applied directly to your tongue. By using these tests, your doctor can determine if you have a true taste disorder and what type it is.

If your doctor suspects that nerves in your mouth or head may be affected, he or she may order an X-ray, usually a CAT scan, to look further into the head and neck area.

If you think you have a taste disorder, see your doctor. The correct diagnosis by a trained health professional can provide reassurance that your problem is not imaginary.

Loss of taste can be a sign of a more serious condition. It also can deprive us of an early warning system that most of us take for granted. Taste helps us detect spoiled food and beverages. Perhaps more serious, loss of the sense of taste can lead to depression and a reduced desire to eat. This can be especially serious for older people with chronic illnesses.

Diagnosis of a taste disorder is important because once the cause is found, your doctor may be able to treat your taste disorder. Many types of taste disorders are reversible, but, if not, counseling and self-help techniques may help you cope.


Treatment

Although there is no treatment for the gradual loss of taste that occurs with aging, relief from taste disorders is possible for many older people. Depending on the cause of your problem with taste, your doctor may be able to treat it or suggest ways to handle it. Scientists are studying how loss of taste occurs so that treatments can be developed.

Often, a certain medication is the cause of a taste disorder, and stopping or changing the medicine may help eliminate the problem. If you take medications, ask your doctor if they can affect your sense of taste. If so, ask if you can take other medications or safely reduce the dose.

Do not stop taking your medications unless directed by your doctor. Your doctor will work with you to get the medicines you need while trying to reduce unwanted side effects.

Some patients regain their sense of taste when the condition or illness that is causing the loss of taste is over. Often, correcting the general medical problem can restore the sense of taste.

Because your sense of taste may diminish gradually, you may not even notice the change. But your diet may change, and not for the better. You may lose interest in food and eat less, but you may choose foods that are high in fat and sugars. Or, you may eat more than you should, hoping to get more flavor from every bite.

If you lose some or all of your sense of taste, there are things you can do to make your food taste better:
  • Prepare foods with a variety of colors, shapes, and textures
  • Use aromatic herbs and hot spices to add more flavor
There are more things you can do to make your food taste better:
  • If your diet permits, use cheese sauces, bacon bits, or small amounts of butter on vegetables
  • Add sharp cheese, olive oil, or toasted nuts
  • Avoid combination dishes that can hide individual flavors and dilute taste
If you cannot regain your sense of taste, there are things you can do to ensure your safety. Take extra care to avoid food that may have spoiled. If you live with other people, ask them to smell and taste food to see if it is fresh. People who live alone should discard food if there is a chance it is spoiled.

For those who wish to have additional help, there may be support groups in your area. These are often associated with smell and taste clinics. Some on-line bulletin boards also allow people with chemosensory disorders to share their experiences. Not all people with taste disorders will regain their sense of taste, but most can learn to live with it.

 


 
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