Prevalence and potentially reversible factors associated with anorexia among older nursing home residents: results from the ULISSE project

Prevalence of Opioid Use in Nursing Homes Over the Last Decade: A Systematic Literature Review

Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes.

Dietary characteristics of community-dwelling older adults with poor appetite: a cross-sectional analysis

RATIONALE

Poor appetite is considered a key factor in the development of malnutrition, a link that can be explained by alterations in dietary intake. Given the limited data on dietary characteristics in community-dwelling older adults with poor appetite, the present study aimed to examine whether poor appetite is associated with lower nutrient intake and more unfavourable food choices.

METHODS

In 569 participants of the Longitudinal Aging Study Amsterdam aged ≥70 years appetite was assessed using the Simplified Nutritional Appetite Questionnaire and dichotomised into normal (>14) and poor (≤14). Intake of energy, 19 nutrients, 15 food groups, the Dutch Healthy Diet Index 2015 (DHD15) and Mediterranean Diet Score (MDS) were calculated from a food frequency questionnaire. Dietary differences between appetite groups were examined using Mann-Whitney U test and binary logistic regression adjusted for potential confounders.

RESULTS

Mean age was 78 ± 6 years and 52% were female. Appetite was poor in 12.5% of participants. Energy intake was 1951 (median; quartiles 1-3: 1,653-2,384) kcal/day with no difference between appetite groups. Poor appetite was associated with lower intake of protein (OR 0.948, 95%CI 0.922-0.973), folate (0.981, 0.973-0.989), zinc (0.619, 0.454-0.846), vegetables (0.988, 0.982-0.994) and lower scores of DHD15 (0.964, 0.945-0.983) and MDS (0.904, 0.850-0.961), as well as higher intake of carbohydrates (1.015, 1.006-1.023), and vitamins B2 (4.577, 1.650-12.694) and C (1.013, 1.005-1.021).

CONCLUSIONS

Community-dwelling older adults with poor appetite showed poorer diet quality with a lower intake of protein, folate, zinc and vegetables, compared with those reporting normal appetite and should be advised accordingly.

Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population

Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.

Consequences of Anorexia of Aging in Hospital Settings: An Updated Review

The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.

Impact of dietary sodium restriction on falls among middle-aged and older adults: Results of an 8-year longitudinal study

AIM

This study aimed to understand the relationship between dietary sodium restriction (DSR) and falling experiences in middle-aged and older adults.

METHODS

The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. Participants were asked to indicate whether they were told by a physician to reduce or avoid sodium intake from food and whether they had had fall experiences during the past year. We modelled falling experiences as a function of DSR (independent variable), involuntary body weight loss and walking difficulty (mediators), and chronic diseases (moderator), adjusting for individual-level characteristics.

RESULTS

Individuals with DSR were at a higher risk of falls compared with those with no DSR (adjusted odds ratio [AOR] = 1.30, 95% confidence interval [CI] = 1.11-1.53). This effect was more prevalent in individuals with a history of stroke (AOR = 1.85, 95% CI = 1.19-2.87). Those told to reduce sodium intake by a physician were likely to lose weight involuntarily (AOR = 1.20, 95% CI = 1.05-1.36) and had difficulty walking up two or three flights of stairs alone (AOR = 2.38, 95% CI = 1.73-3.27), which mediated the effect of DSR on increased fall risk (AOR = 1.15, 95% CI = 0.95-1.38). We found a temporal effect: participant reactions to short- and mid-term DSR were significant.

CONCLUSIONS

DSR was associated with a greater likelihood of falls among middle-aged and older adults, particularly those with a history of stroke. Geriatr Gerontol Int 2024; 24: 292-299.

Relationship between eating problems and the risk of dementia: A retrospective study

BACKGROUND

Older adults and individuals with decreased cognition often experience appetite changes and weight loss. As weight loss can result in cognitive decline, change in appetite may be an important contributor to the onset of dementia. However, there is a lack of relevant studies on this topic. This study aimed to determine the relationship between appetite changes, weight loss, and dementia onset.

METHODS

A total of 135 patients with normal cognitive function, subjective cognitive impairment, and mild cognitive impairment who were assessed using the Neuropsychiatric Inventory 12 item version (NPI-12) and followed up for at least 1 month were enrolled in the study. All patients underwent a Mini-Mental State Examination (MMSE). Eating problems were assessed using the NPI Eating Problems Score. Appetite and weight loss were assessed at the first visit by caregivers. Kaplan-Meier survival analyses with a log-rank test were used to compare the time to the onset of dementia between the presence or absence of the NPI eating problems, appetite loss, weight loss, or NPI depression scores. Cox proportional hazards regression models using the forced entry method were employed to estimate the hazard ratio (HR) for dementia.

RESULTS

Weight loss was significantly related to dementia onset (P = 0.027) in the Kaplan-Meier survival analyses, while eating problems, appetite loss, and depression showed no significant association (P = 0.519, P = 0.326, and P = 0.317, respectively). In the Cox proportional hazards regression models, the MMSE score was found to be a significant factor (P = 0.021, HR = 0.871); moreover, weight loss tended to increase the risk of dementia onset (P = 0.057, HR = 1.694).

CONCLUSIONS

Weight loss experienced by older adults could contribute to an increased risk of developing dementia.

The Burden and Treatment of Chronic Constipation Among US Nursing Home Residents

OBJECTIVE

To evaluate the burden of chronic constipation (CC) and the use of drugs to treat constipation (DTC) in 2 complementary data sources.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

US nursing home residents aged ≥65 years with CC.

METHODS

We conducted 2 retrospective cohort studies in parallel using (1) 2016 electronic health record (EHR) data from 126 nursing homes and (2) 2014-2016 Medicare claims, each linked with the Minimum Data Set (MDS). CC was defined as (1) the MDS constipation indicator and/or (2) chronic DTC use. We described the prevalence and incidence rate of CC and the use of DTC.

RESULTS

In the EHR cohort, we identified 25,739 residents (71.8%) with CC during 2016. Among residents with prevalent CC, 37% received a DTC, with an average duration of use of 19 days per resident-month during follow-up. The most frequently prescribed DTC classes included osmotic (22.6%), stimulant (20.9%), and emollient (17.9%) laxatives. In the Medicare cohort, a total of 245,578 residents (37.5%) had CC. Among residents with prevalent CC, 59% received a DTC and slightly more than half (55%) were prescribed an osmotic laxative. Duration of use was shorter (10 days per resident-month) in the Medicare (vs EHR) cohort.

CONCLUSIONS AND IMPLICATIONS

The burden of CC is high among nursing home residents. The differences in the estimates between the EHR and Medicare data confirm the importance of using secondary data sources that include over-the-counter drugs and other treatments unobservable in Medicare Part D claims to assess the burden of CC and DTC use in this population.

Dysphagia and its association with other health-related risk factors in institutionalized older people: A systematic review

BACKGROUND

Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people.

METHOD

We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers.

RESULTS

Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found.

CONCLUSIONS

There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.

Characterisation of community-dwelling older adults with poor appetite

PURPOSE

A poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The present study, therefore, aims to characterise older adults with poor appetite.

METHODS

As part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains-physiological, emotional, cognitive, social, and lifestyle-and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model.

RESULTS

The prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 [95% confidence interval 1.10-3.44]), self-reported chewing problems (2.4%, 5.69 [1.88-17.20]), any unintended weight loss in the last 6 months (6.7%, 3.07 [1.36-6.94]), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 [1.04-3.39]), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 [1.04-1.21]) were associated with an increased likelihood of having poor appetite.

CONCLUSION

According to this analysis, older people with the characteristics described above are more likely to have a poor appetite.

Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review

Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.

Anorexia in Medicare Fee-for-Service Beneficiaries: A Claims-Based Analysis of Epidemiology and Mortality

OBJECTIVES

Loss of appetite in older adults can lead to malnutrition, weight loss, frailty, and death, but little is known about its epidemiology in the United States (US). The objective of this study was to estimate the annual prevalence and incidence of anorexia in older adults with Medicare fee-for-service (FFS) health insurance.

DESIGN

Retrospective and observational analysis of administrative health insurance claims data.

SETTING

This study included Medicare FFS claims from all settings (eg, hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home).

PARTICIPANTS

This study included all individuals aged 65 to 115 years old with continuous Medicare FFS medical coverage (Parts A and/or B) for at least one 12-month period from October 1, 2015, to September 30, 2021 (ie, approximately 30 million individuals each year).

INTERVENTION

Not applicable.

MEASUREMENTS

Anorexia was identified using medical claims with the ICD-10 diagnosis code "R63.0: Anorexia". This study compared individuals with anorexia to a control group without anorexia with respect to demographics, comorbidities using the Charlson Comorbidity Index (CCI), Claims-based Frailty Index (CFI), and annual mortality. The annual prevalence and incidence of anorexia were estimated for each 12-month period from October 1, 2015, to September 30, 2021.

RESULTS

The number of individuals with anorexia ranged from 317,964 to 328,977 per year, a mean annual prevalence rate of 1.1%. The number of individuals newly diagnosed with anorexia ranged from 243,391 to 281,071 per year, a mean annual incidence rate of 0.9%. Individuals with anorexia had a mean (±standard deviation) age of 80.5±8.7 years (vs 74.9±7.5 years without anorexia; p<.001), 64.4% were female (vs 53.8%; p<.001), and 78.4% were White (vs 83.2%; p<.001). The most common CCI comorbidities for those with anorexia were chronic pulmonary disease (39.4%), dementia (38.3%), and peripheral vascular disease (38.0%). Median (interquartile range [IQR]) CCI with anorexia was 4 [5] (vs 1 [3] without anorexia; p<.001). The annual mortality rate among those with anorexia was 22.3% (vs 4.1% without anorexia; relative risk 5.49 [95% confidence interval, 5.45-5.53]).

CONCLUSION

Approximately 1% of all adults aged 65-115 years old with Medicare FFS insurance are diagnosed with anorexia each year based on ICD-10 codes reported in claims. These individuals have a higher comorbidity burden and an increased risk of annual mortality compared to those without a diagnosis of anorexia. Further analyses are needed to better understand the relationship between anorexia, comorbidities, frailty, mortality, and other health outcomes.

Prevalence of malnutrition risk among older French adults with culinary dependence

OBJECTIVE

The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence.

METHOD

The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected.

RESULTS

The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition.

CONCLUSION

Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people.

Appetite loss, death anxiety and medical coping modes in COVID-19 patients: a cross-sectional study

AIM

This study aims to explore the current level and associated factors of appetite and death anxiety amongst COVID-19 patients and also to identify correlation between the two variables.

DESIGN

A cross-sectional study.

METHODS

Demographic and characteristic questionnaires, templer death anxiety scale, council on nutrition of appetite questionnaire and medical coping modes questionnaire were utilized.

RESULTS

The average scores of appetite and death anxiety were 19.46 (4.09) and 6.58, (3.21) respectively. 76 patients (100%) suffered from appetite loss, whilst 27 (35.50%) patients suffered from severe death anxiety. Marital status, COVID-19 disease condition ranks, educational level and death anxiety were explained 55.20% of the total variance in the appetite regression model (F = 31.83, p < .001), whilst the gender, avoidance coping strategy and appetite level were explained 49.80% of the total variance in death anxiety model (F = 17.80, p < .001). A moderate negative correlation between appetite and death anxiety was also confirmed (r=-.55, p < .001).

Poor oral health and anorexia in older rehabilitation patients

OBJECTIVE

To investigate the association between anorexia and comprehensive oral health status in older inpatients.

BACKGROUND

Anorexia in older inpatients is a major concern, but whether it is associated with oral problems is currently unclear.

METHODS

This cross-sectional study included 160 participants (42.5% men) aged ≥65 years (mean age 78.6 ± 7.9) who had been admitted to a rehabilitation hospital. A score of ≤14 on the Simplified Nutritional Appetite Questionnaire for Japanese Elderly indicated anorexia. A score of ≥3 on the Oral Health Assessment Tool (OHAT) indicated poor oral health. Malnutrition was diagnosed according to the criteria set out by the Global Leadership Initiative on Malnutrition. Multivariate logistic regression was used to investigate the association between poor oral health and anorexia and, additionally, which subcategory of the OHAT (represented by a score ≥1) was associated with anorexia.

RESULTS

Anorexia and poor oral health status were observed in 86 (53.8%) and 85 (53.1%), respectively. Poor oral health was associated with anorexia after adjusting for potential confounders (adjusted odds ratio [AOR] 2.7; 95% confidence interval [CI]: 1.3-5.9). Additionally, poor status of dentures (AOR 2.6; 95% CI: 1.2-5.7) and poor oral cleanliness (AOR 3.0; 95% CI: 1.4-6.4) were independently associated with anorexia.

CONCLUSIONS

Poor oral health was associated with anorexia in older inpatients. Detection of poor oral health status using a comprehensive oral health assessment may be useful for anorexic patients. Early detection for poor oral health using comprehensive oral health assessments and oral care and prosthetic treatment may be useful for anorexic patients.

Older individual's perceptions of appetite, its loss, influencing factors and adaptions to poor appetite. A qualitative study

Appetite loss in later life is common and associated with malnutrition; however, there is limited knowledge on older individuals' perspectives of appetite. This study aimed to explore what 'appetite' means to older adults, how they experience its change and perceived influences on this experience. Semi-structured interviews were conducted with thirteen participants, aged ≥65 years, in their own home, following a recent arm fracture. Transcripts were analysed using reflexive thematic analysis with inductive coding resulting in three themes. 1. 'Appetite as an emotional experience' encompassed positive or negative thoughts and feelings driving or undermining desire to eat. Mood, the appeal of food, cooking and effects of interaction and experiences with other people were factors in this narrative. 2. 'Appetite reflects a physical need' comprised physical bodily sensations or requirements as a driver for appetite with poor appetite resulting from early or over fullness. Declines with age, illness and less activity, were factors in this narrative. 3. 'Adaption to poor appetite aligns with perception of appetite and wider physical health' accounts for how experiential strategies, or practical strategies were used to mitigate poor appetite depending on the narrative of appetite loss, alongside perceptions of physical health and unplanned weight loss. Most individuals used one narrative in their discussions and reflections but for some, perceptions of appetite and its change were more complex. Understanding relationships between these perceptions of appetite and influential factors could facilitate development of multi-component, person-centred, strategies that are optimally meaningful and relevant to address appetite loss in later life.

Texture-Modified Diets are Associated with Poor Appetite in Older Adults who are Admitted to a Post-Acute Rehabilitation Hospital

OBJECTIVE

This study aimed to clarify the association between texture-modified diets and poor appetite in older adults, as it is not fully understood.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

We included 208 inpatients who were aged ≥65 years (mean age 78.9 ± 7.6 years, 57.7% female) and admitted to a rehabilitation unit with stroke, musculoskeletal disease, or hospital-associated deconditioning covered by the Japanese insurance system, between January 2019 and January 2020.

METHODS

Participants were divided into 2 groups according to their food texture level: International Dysphagia Diet Standardization Initiative (IDDSI) levels 3 to 5 for the texture-modified diet group and levels 6 and 7 for the normal diet group. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire for the Japanese elderly, and a score ≤14 was defined as poor appetite. The relationship between IDDSI levels and poor appetite was analyzed using the Cochrane-Armitage trend test. Logistic regression analysis was used to investigate the relationship between the consumption of texture-modified diets and poor appetite. Statistical significance was set at P < .05.

RESULTS

The numbers of participants on modified diets according to the IDDSI framework were as follows: 4, 11, 41, 76, and 76 in levels 3, 4, 5, 6, and 7, respectively. In total, 152 and 56 patients were classified into the regular diet group and texture-modified diet group, respectively. A significantly higher prevalence of poor appetite was observed with the consumption of texture-modified diets (P < .001 for trend). Logistic regression analysis showed that poor appetite was independently associated with the consumption of texture-modified diets (odds ratio 3.443, P = .011).

CONCLUSIONS AND IMPLICATIONS

These findings indicate that the consumption of texture-modified diets is associated with poor appetite. Further studies are required to verify whether a multimodal approach involving improvement in the appearance, taste, flavor, and nutrients of the food can improve poor appetite.

Functional Constipation and Anorexia in Community-Dwelling Older Adults: Korean Frailty and Aging Cohort Study (KFACS)

Anorexia is a relevant geriatric syndrome because it accounts for most malnutrition in older adults. Constipation has been suggested as a risk factor for anorexia. This study aimed to examine the association between anorexia and functional constipation in community-dwelling older adults. Data on 899 subjects aged 72–86 years were obtained from a follow-up survey of the Korean Frailty and Aging Cohort Study in 2018. Anorexia was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ), while functional constipation was diagnosed based on Rome IV criteria. Anorexia and functional constipation were present in 30.9% and 19.6% of the participants, respectively. Age, female sex, chewing problems, malnutrition, polypharmacy, low Mini-Mental Status Examination (MMSE) score, depressed mood, low serum albumin, and functional constipation were associated with anorexia in the univariate analysis. In the multivariate logistic regression, functional constipation was associated with anorexia (OR 1.478, 95% CI 1.038–2.104) after adjusting for age, female sex, and MMSE score. However, after further adjusting for depressed mood (OR 2.568) and chewing problems (OR 2.196), the relationship was no longer significant. This study showed that functional constipation is associated with anorexia in community-dwelling older adults, but this association is confounded by depressed mood and chewing problems.

Food perception, lifestyle, nutritional and health status in the older people: Typologies and factors associated with aging well

The aging process is associated with physiological, sensory, psychological, and sociological changes likely to have an impact on food intake and the nutritional status. The present study aimed to explore the heterogeneity of the French older population (>65 years old) using a multidisciplinary approach. More specifically, the study aimed to highlight different typologies (i.e. clusters of individuals with similar characteristics) within the older population. We conducted face-to-face interviews and tests with 559 French older people, recruited from different categories of dependency (at home without help, at home with help, in nursing homes). Clustering analysis highlighted seven clusters. Clusters 1-3 contained 'young' older people (<80) with a good nutritional status; these clusters differed according to food preferences, the desire to have a healthy diet, or interest in food. Clusters 4-7 mainly contained 'old' older people (80+), with an increase in the nutritional risk from cluster 4 to cluster 7. Two of these clusters grouped healthy and active people with a good level of appetite, while the two other clusters were associated with a clear decline in nutritional status, with people suffering from eating difficulties or depression. The results raise the need to develop targeted interventions to tackle malnutrition and implement health promotion strategies among the seniors.

Is loneliness a predictor of the modern geriatric giants? Analysis from the survey of health, ageing, and retirement in Europe

BACKGROUND

The modern Geriatric Giants have evolved to encompass four new syndromes, of frailty (linked to fatigue and physical inactivity), sarcopenia, anorexia of ageing, and cognitive impairment. In parallel, loneliness has been established as a risk factor for adverse mental and physical health outcomes among older adults.

OBJECTIVE

To analyse loneliness as a predictor of the modern Geriatric Giants in European older adults, using a longitudinal design of nationally representative data.

DESIGN

Longitudinal population-based cohort study.

SUBJECTS

Data from countries that participated in waves 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe project. The sizes of the subsamples analysed ranged from 17,742 for physical inactivity to 24,524 for anorexia of ageing.

METHODS

Loneliness (measured from wave 5) was the independent variable of interest. The dependent variables were incidence of fatigue, physical inactivity, sarcopenia, anorexia of ageing, and cognitive impairment from wave 5 (baseline) to wave 6. Poisson regression models were used for multivariable analysis, obtaining Relative Risk (RR) and 95 % confidence intervals (CI).

RESULTS

The prevalence of loneliness ranged from 9.2%-12.4% at wave 5. The 2-year incidence of fatigue was 16 % (95 % CI: 15.5-16.5), physical inactivity 9.8 % (95 % CI: 9.4-10.3), sarcopenia 5.6 % (95 % CI: 5.3-5.9), anorexia of aging 5.4 % (95 % CI: 5.1-5.7), and cognitive impairment 10.3 % (95 % CI: 9.9-10.8). The multivariable analysis showed that loneliness was a predictive factor for fatigue (30 %, CI: 17-45 % higher risk), physical inactivity (24 %, CI: 7-43 % higher risk) and cognitive impairment (26 %, CI: 9-46 % higher risk), adjusted by age, sex, number of chronic diseases, education level, region and depression.

CONCLUSIONS

Loneliness is an independent risk factor for fatigue, physical inactivity, and cognitive impairment in older adults. The incidence of anorexia of ageing and sarcopenia was not associated with loneliness over the 2-year observation period.

Chronic Dehydration in Nursing Home Residents

Chronic dehydration mainly occurs due to insufficient fluid intake over a lengthy period of time, and nursing home residents are thought to be at high risk for chronic dehydration. However, few studies have investigated chronic dehydration, and new diagnostic methods are needed. Therefore, in this study, we aimed to identify risk factors for chronic dehydration by measuring serum osmolality in nursing home residents and also to evaluate whether examining the inferior vena cava (IVC) and determining the IVC collapsibility index (IVC-CI) by ultrasound can be helpful in the diagnosis of chronic dehydration. A total of 108 Japanese nursing home residents aged ≥65 years were recruited. IVC measurement was performed using a portable handheld ultrasound device. Fifteen residents (16.9%) were classified as having chronic dehydration (serum osmolality ≥295 mOsm/kg). Multivariate logistic regression analysis showed that chronic dehydration was associated with dementia (odds ratio (OR), 6.290; 95% confidential interval (CI), 1.270–31.154) and higher BMI (OR, 1.471; 95% CI, 1.105–1.958) but not with IVC or IVC-CI. Cognitive function and body weight of residents should be considered when establishing a strategy for preventing chronic dehydration in nursing homes.

Association between Changes in Nutrient Intake and Changes in Muscle Strength and Physical Performance in the SarcoPhAge Cohort

Muscle weakness and physical performance impairment are common geriatric conditions that raise morbidity and mortality. They are known to be affected by nutrition, but only a few longitudinal studies exist. This study aims to fill this gap by exploring the association, over 3 years, between variations of nutrient intakes, as well as, on one side, the variations of handgrip strength, as a surrogate of muscle strength, and on the other side, the physical performance, assessed by gait speed. Participants from the SarcoPhAge study, a Belgian cohort of people aged 65 years and older, were asked to complete a self-administered food frequency questionnaire (FFQ) at the second (T2) and the fifth (T5) year of follow-up. Daily macro- and micronutrient intakes were measured and their changes in consumption over the three years of follow-up were then calculated. The association between changes in nutrients consumption and the variations in muscle parameters were investigated through multiple linear regressions. Out of the 534 participants included in the cohort, 238 had complete data at T2 and T5 (median age of 72.0 years (70.0-78.0 years), 60.9% women). In the cross-sectional analysis, calories, omega-3 fatty acids, potassium, and vitamins D, A, and K intakes were positively correlated with muscle strength. In the longitudinal analysis, neither the gait speed nor the muscle strength changes were significantly impacted by the variations. Other longitudinal investigations with longer follow-up are required to improve knowledge about these interrelations.

Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life

BACKGROUND

Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.

OBJECTIVE

The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.

METHODS

Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.

RESULTS

A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates.

CONCLUSIONS

Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

Changes in micronutrient intake and factors associated with this change among older Australian men: the Concord Health and Ageing in Men Project

OBJECTIVES

To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men.

DESIGN

Prospective study.

SETTING

Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable 'not meeting' (meeting ≤ 6) or 'meeting' (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake.

PARTICIPANTS

Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up).

RESULTS

The mean age was 81 years (range 75-99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services.

CONCLUSIONS

Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.

Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly

Aging impairs senses, mastication, oral status and function, causing nutritional needs and diet insufficiencies. The present needs of independent older adults suggest that health research and oral health care should shift from reductionist disease management to integral and personal treatment plans, including lifestyle, psychological, nutritional and oral health coaching approaches. Dentists and other medical professionals that work in the field of gerodontology should be educated on the macro and micronutrient needs of the elderly and incorporate certain nutritional plans early in the life of their patients with their approval and cooperation, in order to postpone tooth loss and masticatory impairment. Old recipes such as the Mediterranean diet should be kept as a base for all the elderly and be enriched in a customized interpersonal way from the dentist as well as the medical professional according to the specific needs of one's oral and general health status. In this nonsystematic review paper, the basic aspects of the vicious cycle of nutrition and oral health status are discussed and suggestions of major nutrients' influence and needs for independent elders are reported. Based on the scientific data collected, suggestions are made for the food industry for better quality and dosage of foods for this category of individuals. Such strategies can be a whole new area of interest for the food industry in order to obtain better quality of food packaging for the independent OA with accepted texture, odor, colors, macronutrients and micronutrients' consistency and in specific portions.

Factors associated with food intake, nutritional status, and function among nursing home residents with dementia

Declined food intake is prevalent among long-term care (LTC) residents with dementia and associated with deleterious health outcomes. This study explores food intake, nutritional status, and function and its associated factors in LTC residents with dementia. Data from 82 LTC residents with dementia were used in this secondary analysis. The majority of residents were either malnourished or at risk of being malnourished and demonstrated a worse appetite than previously described in the literature. Comorbid illness, depressed mood, and appetite were associated with 37.1% of the variance in food intake over 30 days. Dementia level and appetite were associated with 22.2% of the variance in nutritional status. Food intake and nutritional status were associated with 29.1% of the variance in function. This study also highlights a new demographic that may require extra assistance in combating declined food intake: LTC residents with dementia who reside in a facility that follows restrictive food practices such as a kosher diet. The potential reversibility of factors associated with food intake and nutritional status provides opportunities for intervention.

Examining the role of depression in the Filipino elderly's food preferences in prison setting: data from conjoint analysis and SEM

PURPOSE

Previous studies suggest that the care for elderly prisoners is a growing problem. The emerging phenomenon such as the correctional ageing crisis is an urgent concern that needs to be collectively and holistically addressed from a multi-sectoral perspective. In a developing country, like the Philippines, where prison congestion is alarming, the need for more empirical investigations that probe into the prison life and services is warranted to better inform penal policy and practice that would improve health outcomes among incarcerated individuals. The purpose of this study is to examine the extent to which depression among Filipino elderly prisoners shape their food choices.

DESIGN/METHODOLOGY/APPROACH

A survey of 160 Filipino elderly prisoners of age 60 and above from October to November 2018 was conducted using a three-part research instrument, which consists of a personal and nutrition-related checklist, 15-point geriatric depression scale and a set of cards that were ranked and sorted through the balanced incomplete block design.

FINDINGS

Results of the survey were subjected to conjoint analysis and structural equation modeling using the Statistical Package for the Social Sciences 24. Interestingly, taste was the most considered attribute (30.765%) while portion size (9.759%) is the least considered by the Filipino elderly prisoners. Notably, depression has a significant positive effect on their food preferences in all attributes except portion size.

RESEARCH LIMITATIONS/IMPLICATIONS

This study was limited to two prison settings in the Philippines. Considering the results from the conjoint analysis, strategies can be developed in designing an individualized meal plan suitable for the needs of each elderly prisoner. Also, sizeable government appropriations should be in place to ensure the nutritional quality of food served to aging Filipino prisoners.

PRACTICAL IMPLICATIONS

Provisions for a pool of nutritionists working hand in hand with other health members would guarantee a prison system that promotes the overall well-being of each prisoner. Further, this study can contribute valuable inputs in the menu cycle practice of prisons in the country. There may be a need to prioritize the nutritional aspect of these vulnerable and deprived groups so as to promote a better quality of life among elderly prisoners. Also, other forms of psychosocial, physical and spiritual health activities extended to elderly prisoners may prevent depressive symptoms.

ORIGINALITY/VALUE

Conjoint analysis is remarkably gaining prominence in not only the health-care setting (Phillips et al., 2002; Ryan and Farrar, 2000) but also the field of nutrition. It holds a number of unique and practical promises to prison settings.

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

OBJECTIVES

This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs.

DESIGN

Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources.

SETTING

OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs.

RESULTS

This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed.

CONCLUSION

There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure

BACKGROUND

Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status.

OBJECTIVE

The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association.

METHODS

In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status.

RESULTS

There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001).

CONCLUSIONS

Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

Cachexia and advanced dementia

Cachexia is a complex metabolic process that is associated with several end-stage organ diseases. It is known to be also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown. The present narrative review is aimed at presenting recent insights concerning the pathophysiology of weight loss and wasting syndrome in dementia, the putative mechanisms involved in the dysregulation of energy balance, and the interplay among the chronic clinical conditions of sarcopenia, malnutrition, and frailty in the elderly. We discuss the clinical implications of these new insights, with particular attention to the challenging question of nutritional needs in advanced dementia and the utility of tube feeding in order to optimize the management of end-stage dementia.

Assessment and Treatment of the Anorexia of Aging: A Systematic Review

(1) Background: Appetite loss in older people, the ‘Anorexia of Aging’ (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored.

Are the therapeutic strategies in anorexia of ageing effective on nutritional status? A systematic review with meta-analysis

BACKGROUND

Anorexia of ageing (AA) may be considered as a risk factor for frailty and has an important impact on quality of life, morbidity and mortality.

METHODS

A systematic review and a meta-analysis were performed to summarise the results from several trials on the effectiveness of treatments in AA, as associated with depression, sensory impairment of taste and smell, decreased appetite or early satiety, and disability. Eligible studies were required to report baseline and follow-up values, the mean change (∆-change) from baseline, and/or the mean difference among intervention groups versus control group, concerning food intake (kcal/daily) and/or nutritional outcomes, such as body weight, body mass index, albumin and Mini Nutritional Assessment.

RESULTS

The systematic review included 20 papers based on different therapeutic approaches concerning food intake and/or nutritional outcomes. The results of the meta-analysis indicate that the interventions for AA have an important impact on body weight [+1.59 kg; 95% confidence interval (CI) = 1.48-+1.71 kg; P < 0.001) and on energy intake (+56.09 kcal; 95% CI = -54.05 to +166.25 kcal; P = 0.32). Regarding secondary outcomes, it was not possible to meta-analyse the limited amount of data availab le.

CONCLUSIONS

The different variants of AA need to be defined because diverse therapeutic approaches are available. A more precise definition of the functional impairments associated with AA may allow a more correct decision about the most appropriate therapy to be prescribed. Moreover, this may allow for a more effective performance of the different therapeutic approaches once they are better targeted to the different scenarios of AA.

Relationship between mortality and Council of Nutrition Appetite Questionnaire scores in Japanese nursing home residents

OBJECTIVE

This 1-y cohort study examined whether Council of Nutrition Appetite Questionnaire (CNAQ) scores predicted mortality in 316 elderly Japanese residents of five nursing homes (60 men, 256 women; mean age: 84.9 ± 8.3 y).

METHODS

The baseline survey included participant characteristics (e.g., age, sex, height, weight, and medical history), and Barthel Index (BI), Clinical Dementia Rating (CDR), Mini Nutritional Assessment-Short Form (MNA^®-SF), CNAQ, Simplified Nutritional Appetite Questionnaire (SNAQ; simplified CNAQ), and SNAQ for the Japanese elderly (SNAQ-JE) scores.

RESULTS

Following the baseline survey, mortality data were collected for 1 y; during this time, 62 participants (19.6%) died. The deceased group's CNAQ scores (25.1 ± 4.8) were significantly lower than those of the survival group (28 ± 3.6; P < 0.001). After adjusting for age, sex, medical history, BI, CDR, and MNA^®-SF scores in Cox proportional regression, CNAQ (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.85-0.97; P = 0.004), SNAQ (HR, 0.84; 95% CI, 0.75-0.93; P = 0.001), and SNAQ-JE (HR, 0.84; 95% CI, 0.76-0.92; P < 0.001) scores were related to mortality.

CONCLUSIONS

This study showed that CNAQ scores were inversely associated with 1-y mortality. Furthermore, appetite assessment using the CNAQ predicted the death of Japanese nursing home residents. Similarly, the SNAQ and SNAQ-JE scores were inversely associated with 1-y mortality.

Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents?

The high prevalence of constipation in long-term care (LTC) residents has been a long-standing issue for caregivers, attending health professionals, and the residents themselves. The traditional medical response has been to utilize pharmaceutical laxatives, enemas, and suppositories for treatment. The purpose of this review was to determine if fibre supplementation (including fibre added to foods) is effective in increasing stool frequency, improving stool consistency, and decreasing laxative use in LTC residents. A systematic search was conducted using PubMed and CINAHL databases, inclusive to March 2017. Search terms included: "long-term care" or "nursing home" AND "fiber (fibre)," "bran," "psyllium," "inulin," or "prebiotic." Intervention trials of fibre supplementation with ≥5 LTC residents were included. The search generated 456 articles following removal of duplicates; 8 studies met the inclusion criteria. Three additional trials were identified through a hand search of references of pertinent articles. Current evidence suggests that added fibre may be effective in increasing stool frequency and/or decreasing laxative use in LTC residents and, thus, may lessen the burden of constipation. However, randomized controlled trials are needed to clearly demonstrate the effects of adding fibre to foods, particularly insoluble and less fermentable sources, on constipation in LTC residents.

Anorexia, functional capacity, and clinical outcome in patients with chronic heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF)

Aims

We aimed to assess determinants of anorexia, that is loss of appetite in patients with heart failure (HF) and aimed to further elucidate the association between anorexia, functional capacity, and outcomes in affected patients.

Methods and results

We assessed anorexia status among 166 patients with HF (25 female, 66 ± 12 years) who participated in the Studies Investigating Co‐morbidities Aggravating HF. Anorexia was assessed by a 6‐point Likert scale (ranging from 0 to 5), wherein values ≥1 indicate anorexia. Functional capacity was assessed as peak oxygen uptake (peak VO₂), 6 min walk test, and short physical performance battery test. A total of 57 patients (34%) reported any anorexia, and these patients showed lower values of peak VO₂, 6 min walk distance, and short physical performance battery score (all P < 0.05). Using multivariate analysis adjusting for clinically important factors, only high‐sensitivity C‐reactive protein [odds ratio (OR) 1.24, P = 0.04], use of loop diuretics (OR 5.76, P = 0.03), and the presence of cachexia (OR 2.53, P = 0.04) remained independent predictors of anorexia. A total of 22 patients (13%) died during a mean follow‐up of 22.5 ± 5.1 months. Kaplan‐Meier curves for cumulative survival showed that those patients with anorexia presented higher mortality (Log‐rank test P = 0.03).

Conclusions

Inflammation, use of loop diuretics, and cachexia are associated with an increased likelihood of anorexia in patients with HF, and patients with anorexia showed impaired functional capacity and poor outcomes.

Anorexia of Aging: Assessment and Management

Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

BACKGROUND

Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study.

METHODS

A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined.

DISCUSSION

This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.

Prevalence and associated factors for decreased appetite among patients with stable heart failure

AIMS AND OBJECTIVES

To explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure.

BACKGROUND

Decreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group.

DESIGN

Observational, cross-sectional study.

METHODS

A total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite.

RESULTS

Seventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance.

CONCLUSION

In this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors.

RELEVANCE TO CLINICAL PRACTICE

Loss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments

Older people frequently fail to ingest adequate amount of food to meet their essential energy and nutrient requirements. Anorexia of aging, defined by decrease in appetite and/or food intake in old age, is a major contributing factor to under-nutrition and adverse health outcomes in the geriatric population. This disorder is indeed highly prevalent and is recognized as an independent predictor of morbidity and mortality in different clinical settings. Even though anorexia is not an unavoidable consequence of aging, advancing age often promotes its development through various mechanisms. Age-related changes in life-style, disease conditions, as well as social and environmental factors have the potential to directly affect dietary behaviors and nutritional status. In spite of their importance, problems related to food intake and, more generally, nutritional status are seldom attended to in clinical practice. While this may be the result of an “ageist” approach, it should be acknowledged that simple interventions, such as oral nutritional supplementation or modified diets, could meaningfully improve the health status and quality of life of older persons.

Cachexia: a nutritional syndrome?

Cachexia leads to nutritional deficits including anorexia and loss of fat and muscle mass. In persons with precachexia or early cachexia, for example, old persons with weight loss and chronic obstructive pulmonary disease, there is strong evidence that nutritional support improves outcomes. Limited evidence suggests that this may be true for heart failure and chronic kidney disease. The evidence for nutritional support in refractory cachexia is, not surprisingly, less dramatic. It would appear that early in the cachectic process, nutrition, coupled with exercise, may be an important therapeutic approach.

An overview of appetite decline in older people

Poor appetite is a common problem in older people living at home and in care homes, as well as hospital inpatients. It can contribute to weight loss and nutritional deficiencies, and associated poor healthcare outcomes, including increased mortality. Understanding the causes of reduced appetite and knowing how to measure it will enable nurses and other clinical staff working in a range of community and hospital settings to identify patients with impaired appetite. A range of strategies can be used to promote better appetite and increase food intake.

Mechanisms of the anorexia of aging-a review

Many, even healthy, older people fail to adequately regulate food intake and experience loss of weight. Aging-associated changes in the regulation of appetite and the lack of hunger have been termed as the anorexia of aging. The etiology of the anorexia of aging is multi-factorial and includes a combination of physiological changes associated with aging (decline in smell and taste, reduced central and peripheral drive to eat, delayed gastric emptying), pathological conditions (depression, dementia, somatic diseases, medications and iatrogenic interventions, oral-health status), and social factors (poverty, loneliness). However, exact mechanisms of the anorexia of aging remain to be elucidated. Many neurobiological mechanisms may be secondary to age-related changes in body composition and not associated with anorexia per se. Therefore, further studies on pathophysiological mechanisms of the anorexia of aging should employ accurate measurement of body fat and lean mass. The anorexia of aging is associated with protein-energy malnutrition, sarcopenia, frailty, functional deterioration, morbidity, and mortality. Since this symptom can lead to dramatic consequences, early identification and effective interventions are needed. One of the most important goals in the geriatric care is to optimize nutritional status of the elderly.

Anorexia of Aging

The anorexia of aging is common, leading to adverse health consequences. As populations age, the impacts from anorexia in the older population are set to increase. Only greater awareness will allow for prevention or early intervention. This article discusses the physiologic anorexia of aging, highlights contributing factors, and proposes management strategies, including screening, especially in primary care. Many neuroendocrine factors have been implicated in the pathophysiology; it is clear that further human research is necessary if there is to be a pharmacologic breakthrough. There are currently no approved pharmacologic treatment strategies to prevent or treat the anorexia of aging.