What Is Anorexia of Aging?
Anorexia of aging is a well-recognized condition characterized by a reduction in appetite and diminished food intake in older individuals, typically occurring in late life, particularly after the age of 70 to 75. Anorexia aging is intertwined with several syndromes and effects that result from the accumulation of health impairments across multiple systems in older adults, rendering them more susceptible to both internal and external stressors.
Notably, substantial weight loss is a common occurrence among the elderly and is a major contributor to increased morbidity and mortality. The decreased appetite and food intake associated with the anorexia of aging lead to alterations in the quantity and quality of energy supplied to the body, potentially causing a mismatch between the calories ingested and the physiological energy demands of the individual. Consequently, this state of malnutrition and impaired metabolism can lead to a range of negative health-related consequences, further emphasizing the significance of understanding and addressing the anorexia of aging in the elderly population.
What Are the Causes of Anorexia of Aging?
The causes of anorexia aging can be categorized into various factors, each contributing to the decreased appetite and food intake observed in older individuals:
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Medical Conditions and Health Impairments: Specific medical conditions in older persons, such as gastrointestinal diseases, malabsorption syndromes, acute and chronic infections, and hypermetabolism (e.g., hyperthyroidism), often lead to anorexia and micronutrient deficiencies. Additionally, diseases like congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and Parkinson’s disease can modify appetite and increase energy expenditure, further exacerbating anorexia.
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Physical Factors: Functional impairments in activities of daily living (ADL and IADL), such as mobility limitations, can contribute to reduced food intake. Issues like difficulty in self-feeding, accessing food, and impaired cooking skills are significant risk factors. Sensory impairments, including hearing and vision problems, can hinder shopping, food preparation, and consumption. Poor dentition and ill-fitting dentures also limit food choices and quantity, leading to nutritional deficiencies.
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Psychological Factors: Depression is a prevalent psychological disorder among older individuals and is often associated with loss of appetite. Depressed older adults may experience severe appetite and weight loss, along with symptoms like weakness, stomach aches, nausea, and diarrhea. Cognitive impairment, especially in advanced stages, is linked to decreased appetite and food intake.
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Medications: Older individuals often take multiple medications, both prescription and over-the-counter, some of which can cause malabsorption, gastrointestinal problems, loss of appetite, and reduced food intake. Polypharmacy increases the risk of drug-induced anorexia due to potential drug interactions and gastrointestinal issues.
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Social Factors: Socioeconomic inequality and social isolation are significant social factors contributing to decreased appetite and food intake in older age. Living alone is associated with reduced appetite and energy intake. In institutionalized settings, monotony and lack of attention to residents’ food preferences can lead to anorexia and unintentional weight loss.
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Physiological Changes of Aging: Aging itself brings physiological changes that contribute to anorexia. These include slowed gastric emptying and alterations in hormones related to appetite control, such as lower ghrelin levels, higher cholecystokinin levels, and elevated baseline leptin levels. Sensory changes, like poor dentition, reduced taste perception, decreased vision, and decreased sense of smell, can also play a role.
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Other Contributing Factors: Coordination difficulties, memory issues, and chronic medical conditions like heart failure, COPD, and malignancies can all contribute to anorexia and should be addressed during evaluation.
What Are the Signs and Symptoms of Anorexia in the Elderly?
The signs and symptoms of anorexia nervosa in elderly individuals are as follows:
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Weight Loss: Weight loss is a prominent and common sign of anorexia nervosa in older adults. This weight loss can be either intentional or unintentional. Unintentional weight loss may indicate underlying health conditions, such as cancer or thyroid problems. Conversely, intentional weight loss may result from practices like dieting, fasting, or purging.
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Changes in Eating Habits: Anorexia nervosa often leads to noticeable changes in eating habits. Older adults with this condition may begin to avoid meals altogether, consume smaller portions, or restrict their diet to specific foods.
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Muscle Weakness: Muscle weakness is a manifestation of anorexia nervosa. The body breaks down muscle tissue to use as an energy source, resulting in this physical weakness.
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Preoccupation with Food: Anorexia nervosa often leads to a preoccupation with food. Individuals with this condition may think about food incessantly, engage in meal planning, or even cook for others regularly.
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Mood Changes: Elderly individuals with anorexia nervosa may experience changes in mood, including increased irritability, anxiety, or depression. Additionally, they may encounter difficulty concentrating and suffer from sleep disturbances.
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Difficulty Concentrating: Anorexia nervosa can impair concentration and cognitive function. The lack of essential nutrients can affect brain function, leading to difficulties in focusing and cognitive tasks.
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Decreased Appetite: Many older adults with anorexia nervosa exhibit a reduced appetite. This decreased appetite may stem from their fear of gaining weight or their distorted perception of their body size and shape.
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Constipation: Constipation is a common symptom of anorexia nervosa in older individuals. This is often due to insufficient fiber intake and may also be related to dehydration.
Additional symptoms and indicators of anorexia nervosa in seniors include:
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Pale or bluish skin tone.
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Thinning hair, which may be falling out.
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Dizziness and episodes of fainting.
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Constant preoccupation with weight, appearance, and calorie consumption.
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Onset or worsening of osteoporosis.
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Defensiveness or denial regarding eating behavior.
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Intolerance to cold temperatures.
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Ritualistic eating practices.
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Excessive thinness, occasionally punctuated by sudden weight loss.
What Are the Treatment Options of Anorexia of Aging?
The treatment of anorexia encompasses a multifaceted approach that addresses various aspects of this condition. Here are the key elements of the treatment of anorexia:
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Food Manipulation: Enhancing the texture and palatability of food, improving flavor, offering dietary variety, and providing assistance with feeding as needed are essential strategies in treating anorexia. These measures aim to make meals more appealing and enjoyable.
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Environmental Adaptation: Preventing social isolation and promoting a sense of conviviality, especially in nursing home residents, can help combat anorexia. Creating a positive dining environment with social interactions can encourage older individuals to eat more.
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Medication: The evaluation of pharmacological therapies is necessary to identify drugs that may decrease appetite and/or contribute to weight loss. Certain medications, including cardiovascular drugs, psychiatric drugs, anti-rheumatic drugs, and others, may hinder appetite. Additionally, medications that cause malabsorption or increase metabolism can contribute to weight loss.
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Medical Diagnosis: Identifying and addressing any underlying medical causes contributing to weight loss is crucial. These causes may include swallowing disorders, dyspepsia, malabsorption syndromes, neurological conditions, endocrine disorders, psychiatric disorders, respiratory diseases, and cardiovascular diseases. Treating the root medical condition can help alleviate anorexia.
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Specific Treatments: Currently, there is no specific therapeutic agent proven to be highly effective in treating anorexia or aging directly. Nutritional supplements can help manage the consequences of anorexia, such as weight loss and energy-protein malnutrition. Protein supplementation, in particular, has shown positive effects in reducing muscle loss and frailty. However, the applicability of supplementation protocols may vary.
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Appetite-Stimulating Medications: Several medications have been explored to stimulate appetite in older adults, including corticosteroids, growth hormone, anabolic steroids, metoclopramide, and other appetite-stimulating drugs. While some of these medications have shown positive results, they often come with a range of adverse effects, making them of limited benefit in routine clinical practice.
Conclusion
Anorexia of aging has a significant impact on the health and mortality of older individuals who are affected by it. Individuals should be aware of this condition and its association with mood disorders, particularly major depression. Also, this condition brings about a range of consequences, both in the short-term and long-term. In the short term, it can lead to critical issues such as electrolyte imbalances, dehydration, hair loss, and irregular periods. Over the long term, anorexia nervosa can result in severe complications, including liver damage, bone loss leading to osteoporosis, kidney failure, an irregular heartbeat, respiratory problems, and cognitive issues. These consequences underscore the urgency of seeking medical help for those battling anorexia nervosa, as early intervention is pivotal to recovery and avoiding the worsening of these serious health impacts.
