Contents

Search

anorexia

Loss of appetite in the elderly. See anorexia nervosa for anorexia in younger patients. Etiology: - major depression may play a role - diminished smell & taste - reduced salivation Epidemiolgy: - loss of appetite is common in the elderly [4] Complications: - malnutrition, sarcopenia & frailty in the elderly Differential diagnosis: - oral pain in demented patients (refusal to eat) - perform dental examination Management: - hypophagia (loss of appetite) - no effective clinical interventions proven - appetite stimulants do not improve morbidity or mortality [5] - mirtazapine 7.5-45 mg PO QHS may treat major depression - megestrol - increases appetite & fat deposition - does not increase muscle mass - benefit has not been demonstrated - dronabinol 2.5-10 mg PO QD - may cause somnolence & disphoria in elderly - glucocorticoids - olanzapine may improve appetite, weight & quality of life in patients with metastatic cancer [6] - small meals of foods preferred by elderly [1] - at the end of life - cancer cachexia

Related

anorexia nervosa orexigenic

Specific

anorexia-cachexia syndrome

General

sign/symptom

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  2. Cox NJ, Ibrahim K, Sayer AA, Robinson SM, Roberts HC. Assessment and Treatment of the Anorexia of Aging: A Systematic Review. Nutrients. 2019 Jan 11;11(1):144. . PMID: 30641897 Free PMC article.
  3. Cox NJ, Morrison L, Ibrahim K et al New horizons in appetite and the anorexia of ageing. Age Ageing. 2020 Jul 1;49(4):526-534 PMID: 32043144
  4. Cox NJ, Ibrahim K, Morrison L, Robinson SM, Roberts HC What Influences Loss of Appetite in Older People? A Qualitative Study. Age Ageing, Volume 50, Issue Supplement-1 March 16, 2021, Pages i1-i6 Not indexed in PubMed https://academic.oup.com/ageing/article-abstract/50/Supplement_1/i1/6170784
  5. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  6. Sandhya L et al. Randomized double-blind placebo-controlled study of olanzapine for chemotherapy- related anorexia in patients with locally advanced or metastatic gastric, hepatopancreaticobiliary, and lung cancer. J Clin Oncol 2023 May 10; 41:2617 PMID: 36977285 Clinical Trial. https://ascopubs.org/doi/10.1200/JCO.22.01997 - Roeland EJ, Bohlke K, Baracos VE et al Cancer Cachexia: ASCO Guideline Rapid Recommendation Update. J Clin Oncol. 2023 Sep 1;41(25):4178-4179. PMID: 37467399