Editorial
Anorexia of Aging: Can We Decrease Protein Energy Undernutrition in the Nursing Home?

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The Physiological Anorexia of Aging

Normal aging involves a decline in appetite, decrease in muscle mass, increase in fat mass, and decrease in energy expenditure.11, 12, 13, 14, 15 The age-associated natural decline in appetite and food intake and early satiation proves to be pathologic. Total energy expenditure in older persons declines because of a decline in physical activity and decreased resting metabolic rate. The fall in food consumption is far greater than the total energy expenditure, which contributes to weight loss

The Pathological Anorexia of Aging

Besides malignancy, heart failure, and chronic obstructive pulmonary disease, which lead to cachexia,40, 41, 42, 43, 44 there are numerous, potentially reversible causes of anorexia and weight loss that are associated with aging. Of these, depression represents the most common cause of anorexia and weight loss.45, 46, 47, 48, 49 Depression leads to an increase in corticotrophin-releasing factor, a potent anorectic neurotransmitter.50 Other psychological conditions, such as late-life paranoia,

Seven Simple Steps to Reducing Undernutrition

Step 1: Reduce polypharmacy. Much medication use in nursing homes is inappropriate and many drugs are easy to eliminate with no obvious deleterious effects to residents.

Step 2: Screen all persons losing weight for depression using the Patient Health Questionnaire-9, which is now part of the Minimum Data Set 3.0.61 Psychological therapy and exercise should be the primary treatment.62 Electroconvulsive therapy should be used when appropriate.

Step 3: Do not allow therapeutic diets in the facility

Conclusion

The World Health Organization/International Association of Gerontology and Geriatrics have strongly recommended high-quality care for and research into major problems that occur in nursing homes.73 A study in the Netherlands suggested that to manage undernutrition in nursing homes will increase the required nutritional budget in nursing homes by 80%.74 These costs would include increased nutritional screening, such as using the Simplified Nutritional Assessment Questionnaire,65, 75 increased

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