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

Clinical Conditions: Patients Who May Benefit From Orexigenics

Risk factors associated with IWL include various forms of cognitive and functional decline. Dementia, Parkinson's disease, eating dependencies and constipation were the strongest risk factors when individual diagnoses were analyzed independently.[23]

Elderly patients with dementia who are dependent on others for daily care are more likely to suffer IWL than either patients with dementia who are more independent, or patients without dementia.[24] IWL also occurs frequently in patients with Alzheimer's disease (AD), with some indications that weight loss may occur before clinical symptoms of AD.[25] During the progression of AD, patients have been known to develop either pseudobulbar dysphagia or a loss of appetite.[26] In patients with AD, the patient's IWL correlates with disease progression, and a weight loss of at least 5% of their baseline bodyweight is considered a significant predictor of death.[27] The prevalence of depression in nursing home residents ranges from 36 to 58%.[28,29] IWL is one of the key symptoms associated with a diagnosis of depression, and has also been noted to be present with bipolar, delusional and paranoid disorders, as well as with alcohol abuse.[30]

Comprehensive psychotropic medication history is a valuable tool in analyzing patients with IWL and depression. It is well known that some selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine, have an anorexic effect.[31] Similarly, sedatives and narcotic analgesics may interfere with cognition and the ability to eat.[32] Conversely, subtherapeuctic dosage of this medication may not ameliorate depression, which itself can lead to poor oral intake.[29,33] Table 1 lists drugs which may cause anorexia/weight loss, either directly, or via troublesome side effects.

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