ANOREXIA IN OLDER PERSONS - EPIDEMIOLOGY AND OPTIMAL TREATMENT

Anorexia and weight loss are common findings in older persons. Over a lifetime, normal persons decrease their food intake to counterbalance the decrease in physical activity and resting metabolic rate that occu rs with aging. This physiological anorexia of aging increases the prop ensity to develop pathological anorexia and weight loss when an older person develops either a medical or psychological illness. The physiol ogical anorexia of aging is due to a decreased opioid (dynorphin) feed ing drive and an increase in the satiating effect of the gastrointesti nal hormone, cholecystokinin. Nitric oxide deficiency may play a role in the early satiation commonly seen in older persons. A variety of so cial, psychological and medical conditions can lead to pathological an orexia. Depression is the most common cause of weight loss and anorexi a in older persons. A number of conditions such as cancer and rheumato id arthritis produce their anorectic and wasting effects by releasing cytokines. An idiopathic pathological senile anorexia has been charact erised which also appears to be a cytokine-dependent syndrome. Early s creening for malnutrition is a cornerstone of the management of anorex ia; the Mini Nutritional Assessment is a well validated screening tool available for this purpose. Aggressive use of caloric supplements, en teral tube feeding and peripheral parenteral nutrition all have a role in the early management of anorexia. Numerous drugs (growth hormone, megestrol, cyproheptadine, tetrahydrocannabinol, anabolic steroids, pr okinetic agents and antidepressants) have been utilised to treat the a norexia of aging with varying success.