Orexigenic Agents in Geriatric Clinical Practice

Vishal Viswambharan; Jothika N Manepalli; George T Grossberg

Disclosures

Aging Health. 2013;9(1):49-65. 

In This Article

Causes of IWL

IWL is a predictor for the decline in activities of daily living, higher rates of institutionalization and mortality. The most common cause of IWL is depression, followed by cancer, cardiac disorders, such as congestive cardiac failure, and benign gastrointestinal diseases, such as malabsorption.[16] Common mental health disorders, such as dementia and depression, are also associated with IWL. More than half of all cases of IWL in nursing home patients are attributable to some form of psychiatric disorder, such as depression.[17] The most common, treatable cause of anorexia is depression, and effective treatment of depression may lead to a reversal of patient weight loss.[18] The etiology of IWL is unknown in 25% of cases.[1] In patients older than 85 years, between 25 and 45% of the patient population have a diagnosis of severe dementia. Among this group of patients with severe dementia, approximately half also suffer from malnutrition.[16] Malnutrition in the elderly can also lead to complications such as anemia, immune deficiency, pressure ulcers, postoperative complications and increased mortality.[19] It has been noted that resistance to eating at meal time is a major contributor to IWL in people with dementia.[20] Simmons et al. did a crossover trial to see whether feeding assistance has a beneficial effect on overall food intakes.[21] The study found that in a total of 76 residents at risk for IWL, feeding assistance intervention at meal time had a positive impact on overall food intake and weight gain. Providing snacks between meals is an effective intervention requiring less expenditure of staff time and is more practical to implement.[20,22]

When a clinical diagnosis of anorexia is made, the medical provider should begin to examine possible reversal through treatment of the underlying cause(s) of the weight loss. Clinical management of IWL in elderly patients requires a comprehensive approach involving psychological support, nutritional supplementation and often pharmacotherapy, which may include orexigenic agents. A patient's failure to respond to nutritional supplementation should cause concern regarding possible cachexia.

The primary clinical background for the study of orexigenic medications occurred during clinical observation of weight gain as a side effect of the use of these medications when treating other conditions.[18] Many clinicians prescribe orexigenic agents for the purpose of improving patient appetite and lean muscle mass.[16] According to Thomas et al., another possible use of these medications is to preclude patient morbidity and produce weight gain.[18] Many choices of pharmacotherapeutic agents are available; however, evidence underlying their use is limited, and no medications have been approved for geriatric anorexia by the US FDA. This article focuses on the efficacy of various pharmacotherapeutic agents used as appetite stimulants that are available today.

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