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Dericioglu D, Methven L, Clegg ME. Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population. Proc Nutr Soc 2024:1-13. [PMID: 38557431 DOI: 10.1017/s0029665124002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
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.
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Affiliation(s)
- Dilara Dericioglu
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
| | - Lisa Methven
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- Food Research Group, Department of Food and Nutritional Sciences, University of Reading,Whiteknights, Reading RG6 6DZ, UK
| | - Miriam E Clegg
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6DZ, UK
- Institute of Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6EU, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Cox NJ, Lim SE. The anorexia of ageing and risk of mortality: More than a story of malnutrition? J Nutr Health Aging 2024; 28:100173. [PMID: 38320381 DOI: 10.1016/j.jnha.2024.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK.
| | - Stephen Er Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK; NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
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Wakabayashi H, Kinoshita S, Isowa T, Sakai K, Tohara H, Momosaki R. Impact of Motivation for Eating Habits, Appetite and Food Satisfaction, and Food Consciousness on Food Intake and Weight Loss in Older Nursing Home Patients. Ann Geriatr Med Res 2024; 28:110-115. [PMID: 38246748 PMCID: PMC10982441 DOI: 10.4235/agmr.23.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study analyzed data from the Long-term care Information system For Evidence (LIFE) database to examine the effects of motivation to eat, appetite and food satisfaction, and food consciousness on food intake and weight loss. METHODS Of the 748 nursing home residents enrolled in the LIFE database, 336 met the eligibility criteria for this cross-sectional study. Motivation to eat, appetite and food satisfaction, and food consciousness were rated on five-point Likert scales (e.g., good, fair, normal, not so good, and not good). We applied Spearman rank correlation coefficient and multiple regression analyses to analyze the relationships between these three items, daily energy and protein intake, and body weight loss over 6 months. RESULTS The mean participant age was 87.4±8.1 years and 259 (77%) were female. The required levels of care included-level 1, 1 (0%); level 2, 4 (1%); level 3, 107 (32%); level 4, 135 (40%); and level 5, 89 (27%). The mean daily energy intake was 28.2±7.8 kcal/kg. The mean daily protein intake was 1.1±0.3 g/kg. The mean weight loss over six months was 1.2±0.7 kg. We observed strong positive correlations among motivation to eat, appetite and food satisfaction, and food consciousness (r>0.8). These three items were significantly associated with higher daily energy intake but not with daily protein intake. Only appetite and food satisfaction were significantly associated with lower weight loss over six months. CONCLUSION The observed associations of appetite and food satisfaction suggest that these factors may be more important to assess than motivation to eat or food consciousness among older adult residents of long-term care facilities.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Tokiko Isowa
- Department of Nursing, Graduate School of Medicine, Mie University, Mie, Japan
| | - Kotomi Sakai
- Department of Research, Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Graduate School of Medicine, Mie University, Mie, Japan
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Dagenais S, Clark S, Fielding RA, Cantu C, Prasad S, Dai F, Groarke JD. Risk of mortality in older adults with loss of appetite: An analysis of Medicare fee-for-service data. J Nutr Health Aging 2024; 28:100035. [PMID: 38308921 DOI: 10.1016/j.jnha.2023.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES Prior research suggested that loss of appetite (LOA) among adults with Medicare fee-for-service (FFS) insurance in the United States increased the risk of mortality within 1 year; those findings were not adjusted for risk factors and confounders. The objective of this study was to compare the risk of mortality among Medicare FFS beneficiaries with LOA to a control group without LOA while controlling or adjusting for age, comorbidities, body mass index (BMI), and weight loss. DESIGN Retrospective and observational analysis of Medicare FFS health insurance claims data from October 1, 2015 to December 31, 2021. SETTING Claims from all settings (e.g., hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home) were included in these analyses. PARTICIPANTS The LOA group included all individuals aged 65-115 years with continuous Medicare FFS medical coverage (Parts A and/or B) for at least 12 months before a claim with ICD-10 diagnosis code "R63.0 Anorexia". The control group was drawn from individuals aged 65-115 years with continuous Medicare FFS coverage who did not have a diagnosis of R63.0. Individuals with LOA were matched 1:3 to those in the control group based on age, sex, and race/ethnicity. MEASUREMENTS Mortality in the LOA group was compared to mortality in the control group using Kaplan-Meier and Cox regression analyses and stratified or adjusted in terms of Charlson Comorbidity Index (CCI), claims-based frailty index (CFI), BMI, and weight loss. RESULTS The study population of 1,707,031 individuals with LOA and 5,121,093 controls without LOA was 61.7% female and 82.2% White. More individuals with LOA compared with the control group had a CCI score 5+ (52.4% vs. 19.4%), CFI score 5+ (31.6% vs. 6.4%), and BMI < 20 kg/m2 (11.2% vs. 2.1%). Median follow-up was 12 months (individuals with LOA) and 49 months (control group). In a matched population, the risk of mortality was significantly higher (unadjusted hazard ratio 4.40, 95% confidence interval 4.39-4.42) for individuals with LOA than the control group. Median survival time was 4 months (individuals with LOA) and 26 months (control group); differences in survival time remained when stratifying by CCI, BMI, and weight loss. CONCLUSION Individuals with LOA had a substantially increased risk of death even after matching for age, sex, race/ethnicity, and adjusting for comorbidities. These findings highlight the burden of illness in older adults with LOA and the need for therapies.
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Affiliation(s)
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
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Han S, Zhao D, Ping P, Zhang P, Zhao Y, Yang K, Wang X, Fu S. Prevalence and correlates of malnutrition risk among Chinese centenarians and oldest-old adults. iScience 2023; 26:107076. [PMID: 37534156 PMCID: PMC10391718 DOI: 10.1016/j.isci.2023.107076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/25/2023] [Accepted: 06/06/2023] [Indexed: 08/04/2023] Open
Abstract
This study was to explore epidemiological characteristics of malnutrition and factors associated with malnutrition in centenarians and oldest-old adults, so as to provide a reference for family members and government departments to take effective measures and promote healthy aging. Median age of all 1,654 participants was 100 (85, 102) years old, and prevalence of high malnutrition risk was 65.54% in all participants. Proportion of high-malnutrition risk was higher, and proportion of normal physical function was lower, in centenarians than those in oldest-old adults (p < 0.05 for all). Univariate and multivariate Poisson regression analyses showed that normal physical function was negatively associated with malnutrition risk in all participants, centenarians, and oldest-old adults (p < 0.05 for all). In conclusion, proportion of centenarians at malnutrition risk was significantly higher than that of oldest-old adults, and the independent factor associated with malnutrition in people aged over 80 years was physical function.
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Affiliation(s)
- Songmei Han
- Department of General Medicine, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Dongxu Zhao
- Department of General Surgery, the Second Naval Hospital of Southern Theater Command of People’s Liberation Army, Sanya, China
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Control, Joint Logistic Support Force of Chinese People’s Liberation Army, Beijing, China
| | - Pei Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Kaidi Yang
- Department of Oncology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Xuejiao Wang
- Pediatric Department, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
- Department of Geriatric Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
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Rudzińska A, Piotrowicz K, Perera I, Gryglewska B, Gąsowski J. Poor Appetite in Frail Older Persons-A Systematic Review. Nutrients 2023; 15:2966. [PMID: 37447292 DOI: 10.3390/nu15132966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Anorexia of aging is a common problem in older adults. Depending on the setting, its prevalence varies from about 10% (among community-dwelling older adults) to over 30% in acute wards and nursing homes. The objective of this systematic review was to establish the prevalence of poor appetite in frail persons ≥60 years of age. We performed a literature search for studies where the prevalence of anorexia of aging among frail and pre-frail old adults was reported. 957 articles on this topic were identified. After eligibility assessment, three articles were included in the review. The studies included 4657 community-dwelling older adults. The weighted total prevalence of anorexia of aging in all the included studies was 11.3%. Among frail and pre-frail participants, loss of appetite was reported in 20.5% (weighted estimate). Overall, robust status was associated with a 63% lower probability of concomitant anorexia of ageing (OR 0.37, 95%CI 0.21-0.65, p = 0.0005). Frailty or risk of frailty are associated with more prevalent anorexia of ageing. This has potential practical implications; however, more research, especially to elucidate the direction of the relation, is needed.
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Affiliation(s)
- Anna Rudzińska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Ian Perera
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., Building I, 5th Floor, 30-688 Kraków, Poland
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Garnsey MR, Smith AC, Polivkova J, Arons AL, Bai G, Blakemore C, Boehm M, Buzon LM, Campion SN, Cerny M, Chang SC, Coffman K, Farley KA, Fonseca KR, Ford KK, Garren J, Kong JX, Koos MRM, Kung DW, Lian Y, Li MM, Li Q, Martinez-Alsina LA, O'Connor R, Ogilvie K, Omoto K, Raymer B, Reese MR, Ryder T, Samp L, Stevens KA, Widlicka DW, Yang Q, Zhu K, Fortin JP, Sammons MF. Discovery of the Potent and Selective MC4R Antagonist PF-07258669 for the Potential Treatment of Appetite Loss. J Med Chem 2023; 66:3195-3211. [PMID: 36802610 DOI: 10.1021/acs.jmedchem.2c02012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The melanocortin-4 receptor (MC4R) is a centrally expressed, class A GPCR that plays a key role in the regulation of appetite and food intake. Deficiencies in MC4R signaling result in hyperphagia and increased body mass in humans. Antagonism of MC4R signaling has the potential to mitigate decreased appetite and body weight loss in the setting of anorexia or cachexia due to underlying disease. Herein, we report on the identification of a series of orally bioavailable, small-molecule MC4R antagonists using a focused hit identification effort and the optimization of these antagonists to provide clinical candidate 23. Introduction of a spirocyclic conformational constraint allowed for simultaneous optimization of MC4R potency and ADME attributes while avoiding the production of hERG active metabolites observed in early series leads. Compound 23 is a potent and selective MC4R antagonist with robust efficacy in an aged rat model of cachexia and has progressed into clinical trials.
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Affiliation(s)
| | - Aaron C Smith
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Jana Polivkova
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Autumn L Arons
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Guoyun Bai
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | | | - Markus Boehm
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Leanne M Buzon
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Sarah N Campion
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Matthew Cerny
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Shiao-Chi Chang
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Karen Coffman
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | | | - Kari R Fonseca
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Kristen K Ford
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Jeonifer Garren
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Jimmy X Kong
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Martin R M Koos
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Daniel W Kung
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Yajing Lian
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Monica M Li
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Qifang Li
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | | | | | - Kevin Ogilvie
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Kiyoyuki Omoto
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Brian Raymer
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Matthew R Reese
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Tim Ryder
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | - Lacey Samp
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
| | | | | | - Qingyi Yang
- Pfizer, Incorporated, Cambridge, Massachusetts 02139, United States
| | - Kaicheng Zhu
- Pfizer, Incorporated, Groton, Connecticut 06340, United States
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Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey. Arch Gerontol Geriatr 2023; 110:104986. [PMID: 36913881 DOI: 10.1016/j.archger.2023.104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association. METHODS The national survey conducted from 2013 to 2015 recruited 5631 people aged >60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested. RESULTS The DDS was inversely associated with mortality (HRadj 0.98, 95%CI: 0.96-1.00). This association was stronger in people aged >70 years (HRadj 0.93, 95%CI: 0.90-0.96 for aged 70-79 years, and HRadj 0.92, 95%CI: 0.88-0.95 for aged >80 years). Inverse association between DDS and mortality was also found in the underweight older population (HRadj 0.95, 95%CI: 0.90-0.99). A positive association was found between DDS and mortality in the overweight/obese group (HRadj 1.03, 95%CI: 1.00-1.05). However, the interaction between the DDS with sex to mortality was not statistically significant. CONCLUSION Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.
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Fielding RA, Landi F, Smoyer KE, Tarasenko L, Groarke J. Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review. J Cachexia Sarcopenia Muscle 2023; 14:706-729. [PMID: 36807868 PMCID: PMC10067499 DOI: 10.1002/jcsm.13186] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
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.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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10
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Cox NJ, Roberts HC. Editorial: Anorexia of Ageing and Routinely Collected 'Big Data'- Helpful Insights and New Challenges. J Nutr Health Aging 2023; 27:182-183. [PMID: 36973923 DOI: 10.1007/s12603-023-1899-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- N J Cox
- Natalie J Cox, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK,
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11
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What Is the Relationship between Lifestyle and Frailty Status? Data from the Portuguese Multicentre Descriptive Study. NURSING REPORTS 2022; 12:39-49. [PMID: 35225891 PMCID: PMC8883975 DOI: 10.3390/nursrep12010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
This observational and descriptive study attempted, within the scope of the ModulEn Research Project, to determine associations between lifestyle-related variables and frailty involving 160 community-dwelling older adults aged between 65 and 80 years living in the Central Region of Portugal. Forty-three percent of the study participants were pre-frail and 18% were frail. More than 50% of the frail people had slight cognitive decline, and the frailty condition was more frequently observed in women. As the literature highlights, there is potential for greater reversibility in the pre-frailty condition. To contribute to this reversibility, it is necessary to resort to interventions that promote physical activity and cognitive stimulation, apply adequate eating habits, and/or encourage the adoption of an active and socially integrated lifestyle. A healthy lifestyle implies good sleep and eating habits, and correct metabolic control that allows for effective surveillance of dyslipidemia, diabetes, and blood pressure.
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Kawaharada R, Sugimoto T, Uchida K, Murata S, Tsuboi Y, Isa T, Nakatsuka K, Horibe K, Ono R. Indirect effects of social activity on appetite via depressive symptoms in community-dwelling older adults: A cross-sectional study. Appetite 2021; 168:105705. [PMID: 34547348 DOI: 10.1016/j.appet.2021.105705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022]
Abstract
Depressive symptoms have a strong effect on appetite decline in older adults. There is also an association between social activity and decreased depressive symptoms, but the mechanism between appetite and social activity with respect to depressive symptoms is unclear. This cross-sectional study examined the direct and indirect effects of social activity on appetite, via depressive symptoms. A total of 259 community-dwelling older adults (mean age 75.1 ± 5.3 years; 55% female) completed the Council on Nutrition Appetite Questionnaire (CNAQ) and the 15-item version of the Geriatric Depression Scale (GDS). We used a cutoff score of 6 on the GDS-15 to determine whether participants displayed depressive symptoms. Social activity was assessed based on the number of activities participated in at least 1-3 times per month. The types of social activity consisted of local community, hobby, sports, citizen, industry, religion, volunteer, and others. Other assessed factors included age, sex, education, financial status, living situation, and comorbidities. To examine the relationships among social activity, depressive symptoms, and appetite, structural equation modeling (SEM) was used, adjusting for variables associated with depressive symptoms or appetite in multivariate analyses. SEM revealed that participation in more types of social activity had a significant indirect effect on higher appetite score via less having depressive symptoms (β = 0.04, p = 0.018). Our findings suggest that active participation in social activities may have a positive effect on good appetite via not having depressive symptoms among older adults. Further longitudinal or intervention studies are needed to confirm our findings.
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Affiliation(s)
- Rika Kawaharada
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuaki Uchida
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Yamato Tsuboi
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan; Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Tsunenori Isa
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kiyomasa Nakatsuka
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kana Horibe
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
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Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients 2021; 13:nu13082764. [PMID: 34444924 PMCID: PMC8399049 DOI: 10.3390/nu13082764] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.
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Azzolino D, Marzetti E, Proietti M, Calvani R, de Souto Barreto P, Rolland Y, Cesari M. Lack of energy is associated with malnutrition in nursing home residents: Results from the INCUR study. J Am Geriatr Soc 2021; 69:3242-3248. [PMID: 34369598 PMCID: PMC9290957 DOI: 10.1111/jgs.17393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/16/2021] [Accepted: 07/10/2021] [Indexed: 01/10/2023]
Abstract
Background Lack of energy is a symptom frequently complained by older people, leading to the inability to continue functioning at the expected level of activity. This study aimed to investigate whether nutritional status was associated with lack of energy in nursing home (NH) residents. Methods This was a cross‐sectional study. A total of 570 NH residents (72.1% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents study cohort were included in the study. Lack of energy was measured by the question “Did you feel full of energy during the past week?” from the geriatric depression scale. Nutritional status was evaluated according to Mini Nutritional Assessment Short‐Form (MNA‐SF). Unadjusted and adjusted logistic regression models were performed to test the association of nutritional status with lack of energy. Results The mean age of participants was 86.5 (SD 7.5) years. A total of 246 NH residents (43.2%) reported a lack of energy. Overall, 71 (12.5%) residents were malnourished and 323 (56.7%) residents were at risk of malnutrition. Malnutrition was significantly associated with lack of energy (OR = 3.42, 95% CI = 1.92–6.08, P < 0.001), even after adjustment for potential confounders (OR = 2.41, 95% CI = 1.29–4.52, P = 0.006). Among the single items of the MNA‐SF, decrease in food intake, low mobility, and psychological stress or acute disease were individually associated with lack of energy, independently of potential confounders (OR = 1.85, 95% CI = 1.24–2.77, P = 0.003; OR = 1.43, 95% CI = 1.10–1.86, P = 0.008; OR = 1.48, 95% CI = 1.19–1.84, P < 0.001; for each point respectively). Conclusions Lack of energy and malnutrition were closely associated. The reporting of lack of energy should lead to a comprehensive assessment of the aging individual (as happening for malnutrition) in order to preventively/promptly act on potentially reversible causes.
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Affiliation(s)
- Domenico Azzolino
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Marco Proietti
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Philipe de Souto Barreto
- Department of Internal Medicine and Geriatrics, Gerontopole, CHU, Toulouse, France.,UMR INSERM, 1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Department of Internal Medicine and Geriatrics, Gerontopole, CHU, Toulouse, France.,UMR INSERM, 1027, University of Toulouse III, Toulouse, France
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Functional Constipation and Anorexia in Community-Dwelling Older Adults: Korean Frailty and Aging Cohort Study (KFACS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115754. [PMID: 34071957 PMCID: PMC8198611 DOI: 10.3390/ijerph18115754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
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.
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Aprahamian I, Romanini CV, Lima NA, An VN, Aguirre BN, Galdeano JR, da Costa DL, Petrella M, Ribeiro SML, Borges MK, Morley JE, Voshaar RCO. The concept of anorexia of aging in late life depression: A cross-sectional analysis of a cohort study. Arch Gerontol Geriatr 2021; 95:104410. [PMID: 33823473 DOI: 10.1016/j.archger.2021.104410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Carla Vasconcellos Romanini
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Natália Almeida Lima
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Vinicius Nakajima An
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Bianca Nobre Aguirre
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Júlia Riccetto Galdeano
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Daniela Lima da Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Marina Petrella
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - Sandra Maria Lima Ribeiro
- Universidade de São Paulo, Faculdade de Saúde Pública, São Paulo, SP, Brasil; Universidade de São Paulo, Escola de Artes Ciências e Humanidades, São Paulo, SP, Brasil
| | - Marcus K Borges
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil
| | - John E Morley
- Geriatrics Division, Saint Louis University, Saint Louis, USA
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Oliveira FMRLD, Barbosa KTF, Rodrigues MMP, Fernandes MDGM. Frailty syndrome in the elderly: conceptual analysis according to Walker and Avant. Rev Bras Enferm 2020; 73 Suppl 3:e20190601. [PMID: 32756800 DOI: 10.1590/0034-7167-2019-0601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the concept of "frailty syndrome" in the literature, according to the method proposed by Walker and Avant. METHODS It is a concept analysis, guided by the method proposed by Walker and Avant, made operational through an integrative literature review. The search in a scientific database was carried out using the descriptors: Frail elderly, syndrome, phenotype, geriatric assessment, and aging. The literary corpus comprised 66 studies. RESULTS The study found the antecedents and attributes (categorized as physical, sociodemographic, and behavioral/environmental) that integrate the signs and symptoms evidenced in the "frailty syndrome," as well as the consequences of this concept. The variables were analyzed with emphasis on the conceptions that influence the frailty process of the elderly. CONCLUSION The study demonstrated the complexity arising from the multifactorial genesis of the referred syndrome, emphasizing the specificities of the elderly's frailty. However, we recommend conducting further research involving the phenomenon in question to understand the construct better.
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Cox NJ, Morrison L, Ibrahim K, Robinson SM, Sayer AA, Roberts HC. New horizons in appetite and the anorexia of ageing. Age Ageing 2020; 49:526-534. [PMID: 32043144 DOI: 10.1093/ageing/afaa014] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/15/2019] [Indexed: 01/27/2023] Open
Abstract
Appetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person's society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty. Early identification of poor appetite could allow timely intervention before weight loss occurs. There is no standardised tool for assessing appetite in clinical settings at present but the 4-item Simplified Nutritional Appetite Questionnaire (SNAQ) has the potential to be used in this way. This review, designed for clinicians, will discuss the regulation of appetite and the pathogenesis of the anorexia of ageing. It will describe the current evidence for interventions to manage the anorexia of ageing, which is limited, with little benefit reported from individual studies of education, physical activity and medication. There is some positive evidence for flavour enhancement, fortified food and oral nutritional supplements but mainly within single studies. Looking ahead, the aim is to develop multicomponent approaches to the treatment of the anorexia of ageing based on growing understanding of the role of physiological signalling, hedonism and external cues.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, UK
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Sian M Robinson
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK
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Kojima G, Taniguchi Y, Kitamura A, Fujiwara Y. Is living alone a risk factor of frailty? A systematic review and meta-analysis. Ageing Res Rev 2020; 59:101048. [PMID: 32173535 DOI: 10.1016/j.arr.2020.101048] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Community-dwelling older adults with a mean age of >60 years. METHODS A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies. RESULTS Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13-1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49-1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83-1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76-1.03). CONCLUSIONS/IMPLICATIONS The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.
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Affiliation(s)
- Gotaro Kojima
- Department of Frailty Research, Videbimus Clinic Research Center, Tokyo, Japan; Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Yu Taniguchi
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Ibaraki, Japan.
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
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Kume Y, Takahashi T, Itakura Y, Lee S, Makizako H, Ono T, Shimada H, Ota H. Characteristics of Mild Cognitive Impairment in Northern Japanese Community-Dwellers from the ORANGE Registry. J Clin Med 2019; 8:jcm8111937. [PMID: 31717664 PMCID: PMC6912714 DOI: 10.3390/jcm8111937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022] Open
Abstract
A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older individuals, information on the prevalence and characteristics of MCI in rural older adults is limited. The aim of this study was to investigate differential characteristics between older adults with and without MCI. The investigation was conducted over one year from 2018 to 2019. Participants were recruited from Akita in northern Japan. Neuropsychological assessments were applied to classify MCI, including the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Touch panel-type Dementia Assessment Scale (TDAS) based on the Alzheimer's disease assessment scale. Our samples consisted of 103 older adults divided into 54 non-MCI and 49 MCI. The MCI group had lower scores of all cognitive items. Our results showed that individuals with MCI had significantly slower walking speed (WS) and worse geriatric depression scale (GDS) compared to non-MCI. In addition, WS was significantly associated with some cognitive items in non-MCI, but not in MCI. Finally, we showed that predictive variables of MCI were WS and GDS. Our study provides important information about MCI in rural community-dwellers. We suggest that older adults living in a super-aging society should receive lower limb training, and avoiding depression in older adults through interaction of community-dwellers may contribute to preventing the onset of MCI.
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Affiliation(s)
- Yu Kume
- Department of Occupational Therapy, Graduate School of Medicine, Akita University, Akita 010-8543, Japan;
| | - Tomoko Takahashi
- Integrated Community Support Center, Public Health and Welfare Department, City Hall of Yokote, Akita 013-0525, Japan;
| | - Yuki Itakura
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita 010-8543, Japan;
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; (S.L.); (H.S.)
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Tsuyosi Ono
- Omori Municipal Hospital, Akita 013-0525, Japan;
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan; (S.L.); (H.S.)
| | - Hidetaka Ota
- Advanced Research Center for Geriatric and Gerontology, Akita University, Akita 010-8543, Japan;
- Correspondence: ; Tel.: +81-18-801-7061; Fax: +81-18-801-7062
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The cause of anorexia and proportion of its recovery in older adults without underlying disease: Results of a retrospective study. PLoS One 2019; 14:e0224354. [PMID: 31648285 PMCID: PMC6812872 DOI: 10.1371/journal.pone.0224354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/13/2019] [Indexed: 11/19/2022] Open
Abstract
Aim It is difficult to determine whether or not end-of-life care is necessary for frail older adults complaining of anorexia without underlying disease, such as cancer or organ failure. The main reason for this is the lack of the specification of the anorexia cause and no understanding of the cause-providing factor and the prognostic factor. This study aimed to clarify the cause of anorexia, and the determinant of the cause and recovery from anorexia. Methods Retrospective chart reviews were conducted on patients with anorexia without an underlying disease who were aged ≥65 years and visited the emergency department of a single tertiary care center between 2016 and 2017. Patient characteristics at hospital visit, the cause of anorexia, and diagnostic modalities were summarized. The diagnosis-providing rate, recovery rate, and the association between them were analyzed. Results Eighty-three patients (mean age 82.3 years; 50.6% male) were investigated. In 67 patients (81%), the causes of anorexia were identified, including 18 patients (22%) with infection, 13 (16%) with benign gastrointestinal diseases, and 7 (8%) with cardiovascular diseases. In 16 patients (19%), the causes of anorexia were not identified despite examinations. The modality that most contributed to diagnosis was plain computed tomography followed by blood tests. The value regarding information in history-taking and physical examinations was limited. Sixty-five patients (78%) recovered. Only 73% of patients with a definite cause recovered; all patients with an unknown cause recovered. Conclusions Older adults with anorexia are not always at the end of life, and efforts to identify the cause are crucial. Moreover, it is vital to realize the limitations associated with the treatment of infections and cardiovascular diseases.
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Assessment and Treatment of the Anorexia of Aging: A Systematic Review. Nutrients 2019; 11:nu11010144. [PMID: 30641897 PMCID: PMC6356473 DOI: 10.3390/nu11010144] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
(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.
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Dent E, Hoogendijk EO, Wright ORL. New insights into the anorexia of ageing: from prevention to treatment. Curr Opin Clin Nutr Metab Care 2019; 22:44-51. [PMID: 30394894 DOI: 10.1097/mco.0000000000000525] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment. RECENT FINDINGS Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice. SUMMARY Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H. Aging-related anorexia and its association with disability and frailty. J Cachexia Sarcopenia Muscle 2018; 9:834-843. [PMID: 30109778 PMCID: PMC6204590 DOI: 10.1002/jcsm.12330] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anorexia of ageing may be a precursor to various geriatric syndromes. We elucidated whether anorexia of ageing had a significant impact on incident disability and investigated whether anorexia of ageing had a direct association with future disability or an indirect association with disability via frailty. METHODS This study employed an observational, longitudinal, cohort design in a community setting. Participants were 4393 older adults (75.9 ± 4.3 years). Anorexia of ageing was assessed by a simplified nutritional appetite questionnaire. Frailty was operationalized as slowness, weakness, exhaustion, low physical activity, and weight loss. Participants who had none of these characteristics were considered robust, those with one or two characteristics were considered pre-frail, and those with three or more characteristics were considered frail. We examined sociodemographic variables (age, sex, and education), medical history (medication and chronic disease history), lifestyle factors (smoking and drinking habits and living arrangement), body mass index, blood nutrition data, depressive symptoms, physical functioning, and cognitive functioning. RESULTS The prevalence of anorexia of ageing was 10.7% (n = 468). The proportion of physical frailty, pre-frailty, and robustness were 8.4, 52.0, and 39.6%, respectively, in the without anorexia of ageing group, and 20.3, 57.7, and 22.0%, respectively, in the anorexia of ageing group (P < 0.001). During a 2-year follow-up, the prevalence proportion of disability was 5.6% in the without anorexia of ageing group and 10.7% in the anorexia of ageing group (P < 0.001). Adjusted for covariates (except for frailty status), the participants with anorexia of ageing had an independently associated higher risk of incident disability compared with those without anorexia of ageing (hazard ratio: 1.43, 95% confidence interval: 1.04-1.95, P = 0.03). However, adjusted for covariates (including frailty status), anorexia of ageing was not significantly associated with incident disability (P = 0.09). Structural equation models revealed that anorexia of ageing had no direct effect on disability; however, anorexia of ageing was associated with frailty. CONCLUSIONS Older adults with anorexia of ageing had a higher proportion of frailty and a higher prevalence proportion of disability compared with those without anorexia of ageing. Although anorexia of ageing may not have a direct effect on incident disability, the structural equation model suggests an indirect relationship between anorexia of ageing and incident disability via frailty status.
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Affiliation(s)
- Kota Tsutsumimoto
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Takehiko Doi
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hyuma Makizako
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Department of Physical Therapy, School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryo Hotta
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Sho Nakakubo
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Keitaro Makino
- Section for Health Promotion, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takao Suzuki
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Doi T, Makizako H, Tsutsumimoto K, Nakakubo S, Kim MJ, Kurita S, Hotta R, Shimada H. Transitional status and modifiable risk of frailty in Japanese older adults: A prospective cohort study. Geriatr Gerontol Int 2018; 18:1562-1566. [PMID: 30225955 DOI: 10.1111/ggi.13525] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/13/2018] [Accepted: 07/30/2018] [Indexed: 12/23/2022]
Abstract
AIM The purpose of the present study was to identify risk factors for physical frailty and to understand the transitional status of frailty. METHODS The participants were 4676 older adults in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. Physical frailty status was classified as robust, pre-frail and frail at baseline and 4-year follow up (mean follow up 47.9 ± 1.8 months). Data for demographic variables, medical conditions, fall, depressive symptoms and cognitive function were also collected. Multiple imputation was used to reduce selection bias and loss of information. RESULTS Progression occurred from a robust to frail status in 52 participants (2.6%) and from pre-frailty to frailty in 281 participants (12.0%). Mortality increased with frailty status at baseline: robust 46 (2.3%), pre-frail 112 (4.8%) and frail 54 (15.6%). In logistic regression analysis, age (OR 1.10, 95% CI 1.06-1.13), sex (men; OR 0.67, 95% CI 0.46-0.95), body mass index (OR 1.06, 95% CI 1.01-1.12]), fall (OR 1.92, 95% CI 1.31-2.81), Geriatric Depression Scale (OR 1.15, 95% CI 1.08-1.22), Mini-Mental State Examination (OR 0.87, 95% CI 0.82-0.93) and education (OR 0.91, 95% CI 0.85-0.98), were related with new incident frailty. Among participants in the pre-frail class at baseline, exhaustion (OR 3.24, 95% CI 1.97-5.34), physical inactivity (OR 3.09, 95% CI 1.94-4.93), lower muscle strength (OR 3.77, 95% CI 2.35-6.03) and lower mobility (OR 2.54, 95% CI 1.57-4.10) were related to progression to frailty (all P < 0.05). CONCLUSIONS The results of the present prospective study provide key information on the transitional status of frailty and the risk factors for progression to frailty. A further study is required to determine the pathophysiological changes that underlie the transition to frailty. Geriatr Gerontol Int 2018; 18: 1562-1566.
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Affiliation(s)
- Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Sho Nakakubo
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Min-Ji Kim
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Satoshi Kurita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryo Hotta
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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Perna S, Rondanelli M, Spadaccini D, Lenzi A, Donini LM, Poggiogalle E. Are the therapeutic strategies in anorexia of ageing effective on nutritional status? A systematic review with meta-analysis. J Hum Nutr Diet 2018; 32:128-138. [PMID: 30159922 DOI: 10.1111/jhn.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- S Perna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - M Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Italy
| | - D Spadaccini
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - A Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - L M Donini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - E Poggiogalle
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
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Nishioka S, Wakabayashi H, Momosaki R. Nutritional Status Changes and Activities of Daily Living after Hip Fracture in Convalescent Rehabilitation Units: A Retrospective Observational Cohort Study from the Japan Rehabilitation Nutrition Database. J Acad Nutr Diet 2018; 118:1270-1276. [DOI: 10.1016/j.jand.2018.02.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/17/2018] [Indexed: 11/16/2022]
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28
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Association between pain and frailty among Chinese community-dwelling older adults: depression as a mediator and its interaction with pain. Pain 2017; 159:306-313. [DOI: 10.1097/j.pain.0000000000001105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0126-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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