It’s common for your sense of smell to change as you age. More than half of people over the age of 65 experience some loss of smell (anosmia) or change in their ability to smell (dysosmia). This can have a big impact on your life and enjoyment of food. Understanding the causes and what you can do about it is important.
What causes smell changes as you age?
There are several reasons why smell can decline with age:
- The number of nerve cells responsible for smell decreases. These olfactory receptor cells are high up inside the nose and detect smells. As you age, these cells become fewer and fewer.
- The olfactory bulb shrinks. This is the structure in the brain that receives information from the olfactory receptors. It becomes smaller which reduces its ability to process smells.
- The pathways responsible for transmitting smell signals deteriorate. The connections from the nose to the brain weaken.
- Less mucus is produced. Mucus helps odor molecules stick to olfactory receptors. With less mucus, smells can’t bind as easily.
- The blood supply to the nose decreases. This means the nose receives fewer smells from the environment.
In essence, the nose is less able to detect smells and the brain is less able to process smell signals as you get older. Other factors like medications, nasal or sinus problems, head injuries and neurodegenerative disease can also contribute.
When does smell start to decline?
Some loss of smell is common from around age 60 onwards. Studies show:
- Around half of 60-69 year olds have some degree of loss
- This rises to 75% in 70-79 year olds
- Over 80, only around 5% have a normal sense of smell
However, there is significant variation between individuals. Some people maintain a good sense of smell throughout life while others notice decline much earlier.
How does loss of smell affect you?
Losing your sense of smell can have wide-ranging effects:
- Food enjoyment – Up to 80% of what we taste comes from smell. Food can seem bland without it.
- Appetite – Smell influences appetite. People who can’t smell tend to eat less and often lose weight.
- Safety – Smell alerts you to fires, gas leaks, spoiled food and other hazards.
- Socializing – Smell contributes to pleasure when socializing and intimacy.
- Mood – Memories are strongly tied to smell which can affect mood. Loss of smell can contribute to depression.
- Personal hygiene – You can’t detect your own body odors or bad breath.
Losing enjoyment of food and drink is often one of the hardest effects to deal with. Fortunately, there are ways to make eating more pleasurable – see tips below.
Will my smell improve?
In some cases, loss of smell from aging is permanent. But in others, it may be possible to improve things:
- If the cause is nasal polyps or a sinus infection, treating these may restore smell.
- Stopping a medication that affects smell like certain blood pressure drugs may help.
- “Smell training” can sometimes stimulate and regrow olfactory nerves.
- Supplements like vitamin A and zinc may provide modest improvement.
Discuss options with your doctor if you’re experiencing smell issues. Treatments for sinus problems or changing medications can often provide improvement.
Tips for coping with smell loss
If your smell change is permanent, there are things you can do to make life more enjoyable:
Boost flavor of foods
- Use aromatic herbs and spices like garlic, onion, chili, basil, oregano, mint
- Include ingredients like fruit zest, pickled foods, wine or vinegar
- Try umami flavors found in soy sauce, mushrooms and aged cheeses
- Use more texture and crunch with ingredients like nuts, toast and fried onions
- Vary temperatures – hot, cold, crunchy and smooth
Practice smell training
- Exposure to smells can potentially re-grow olfactory neurons
- Buy four essential oils like rose, lemon, clove and eucalyptus
- Sniff each oil for 20 seconds twice a day every day
- With concentration, you may start to smell subtle differences
Stay safe
- Use smoke and gas alarms in your home
- Check food expiration dates and be cautious if food smells “off”
- Ask others if you have noticeable body odor
Consider smell devices
- Digital scent speakers can emit food smells like coffee or bread
- Some forks or chopsticks contain scent cartridges to odorize food
When to see a doctor
See your doctor if you notice a persistent reduction in your ability to smell. Get checked if you have:
- Unexplained weight loss
- Head injury
- Loss of smell after a respiratory infection
- Exposure to chemicals or toxins
- Chronic sinus problems or allergies
A simple smell identification test can confirm if you have anosmia. Your doctor can then investigate potential causes and treatment options.
Tests for smell function
Tests that may be used include:
UPSIT smell test
- Uses 40 different odors like chocolate, leather, banana, soap
- Scratch and sniff cards provide standardized odors
- Identifying fewer scents indicates worsening smell ability
Threshold test
- Dilutions of an odorant like phenylethyl alcohol are sniffed
- Ability to detect lower concentrations corresponds to better function
- Results plotted on a sensitivity curve
Brain imaging
- CT or MRI scans check for damage or shrinkage to smell regions
- Specialized PET/SPECT scans measure brain activation from odors
- Help determine extent of injury for head trauma or neurodegenerative disease
Medical treatments
If the cause is identified, your doctor may recommend:
- Nasal corticosteroid sprays for sinusitis or rhinitis
- Oral steroids for nasal polyps or chronic rhinosinusitis
- Surgery for structural problems or nasal polyps
- Stopping medications affecting smell like antihistamines
- Antibiotics for sinus infection
- Zinc or vitamin A supplements
Smell training may also help some people recover function. Discuss all options thoroughly with your ENT specialist.
When to see a specialist
See an ear, nose and throat (ENT) specialist if:
- You have persistent smell loss (anosmia)
- You have safety concerns from reduced smell
- Smell declines after an illness or head trauma
- CT scan shows inflammation or polyps
- The cause is unknown
An ENT can carry out a detailed assessment of your nose structure and function. They can determine if any anatomical problems are contributing and advise on next steps.
Outlook for smell loss
The outlook depends greatly on the cause:
- Age-related loss often can’t be restored but coping strategies help
- After head trauma, smell may spontaneously recover or remain lost
- With sinus disease, recovery is possible if cause is treated
- Viral infections often impair smell temporarily but function returns
- In Alzheimer’s disease, smell continues to deteriorate
While smell problems can be frustrating, concentrating on enhancing flavor, smell training and home safety provide the best path forward. Discuss your concerns thoroughly with your doctor.
Conclusion
Smell change is common as you get older, affecting over half of people by age 65. Deterioration of olfactory nerves, receptors and pathways means smells become less intense and food seems blander. Loss of smell can have a big impact on appetite, safety, socializing and mood.
Treatable causes like sinusitis may be helped by medications or surgery. Smell training may provide modest improvement. Adapting to loss by boosting food flavors, smell training and using devices can make life more enjoyable. See a doctor if smell loss persists to identify the cause and discuss ways to help cope with the changes. With creativity, compromise and adaptation, it’s possible to thrive despite smell loss.