Skip to main content
SpringerLink
Log in

Senile anorexia in different geriatric settings in Italy

  • JNHA: Geriatric Science
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status.

Design and Setting

Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto).

Participants

526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 “Cause e Prevalenza dell’Anoressia senile”).

Measurements

Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day “Club Francophone de Gériatrie et Nutrition” form), in absence of oral disorders preventing mastication.

Results

The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet.

Conclusion

Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morley JE. Anorexia and weight loss in older persons. J Gerontol A Biol Sci Med Sci 2003; 58:131–137.

    Article  PubMed  Google Scholar 

  2. Morley JE, Silver AJ. Anorexia in the elderly. Neurobiol Aging 1988; 9:9–16.

    Article  PubMed  CAS  Google Scholar 

  3. Hays NP, Roberts SB. The anorexia of aging in humans. Physiol Behav 2006; 88:257–266.

    Article  PubMed  CAS  Google Scholar 

  4. Clarkston WK, Pantano MM, Morley JE, Horowitz M, Littlefield JM, Burton FR. Evidence for the anorexia of aging: gastrointestinal transit and hunger in healthy elderly vs. young adults. Am J Physiol 1997; 272:R243–R248.

    PubMed  CAS  Google Scholar 

  5. MacIntosh CG, Morley JE, Wishart J, et al. Effect of exogenous cholecystokinin (CCK)-8 on food intake and plasma CCK, leptin, and insulin concentrations in older and young adults: evidence for increased CCK activity as a cause of the anorexia of aging. J Clin Endocrinol Metab 2001; 86:5830–5837.

    Article  PubMed  CAS  Google Scholar 

  6. Baumgartner RN, Waters DL, Morley JE, Patrick P, Montoya GD, Garry PJ. Agerelated changes in sex hormones affect the sex difference in serum leptin independently of changes in body fat. Metabolism 1999; 48:378–384.

    Article  PubMed  CAS  Google Scholar 

  7. Parker BA, Chapman IM. Food intake and ageing—the role of the gut. Mech Ageing Dev 2004; 125:859–866.

    Article  PubMed  CAS  Google Scholar 

  8. Chapman IM. Endocrinology of anorexia of ageing. Best Pract Res Clin Endocrinol Metab 2004; 18:437–452.

    Article  PubMed  CAS  Google Scholar 

  9. Salva A, Coll-Planas L, Bruce S, et al. Nutritional Assessment of Residents in Long-Term Care Facilities (LTCFs): Recommendations of the Task Force on Nutrition and Ageing of the IAGG European Region and the IANA. J Nutr Health Aging 2009; 13:475–483.

    Article  PubMed  CAS  Google Scholar 

  10. Morley JE, Anker SD, Evans WJ. Cachexia and aging: an update based on the Fourth International Cachexia Meeting. J Nutr Health Aging 2009; 13:47–55.

    Article  PubMed  CAS  Google Scholar 

  11. Harris Y. Depression as a risk factor for nursing home admission among older individuals. J Am Med Dir Assoc 2007; 8:14–20.

    Article  PubMed  Google Scholar 

  12. Cabrera MA, Mesas AE, Garcia AR, de Andrade SM. Malnutrition and depression among community-dwelling elderly people. J Am Med Dir Assoc 2007; 8:582–584.

    Article  PubMed  Google Scholar 

  13. “Club Francophone de Gériatrie et Nutrition” (http://mapage.noos.fr/cfgn/grille.htm).

  14. Parmelee PA, Thuras PD, Katz IR, Lawton MP. Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 1995; 43:130–137.

    PubMed  CAS  Google Scholar 

  15. Vellas B, Villars H, Abellan G, et al. Overview of the MNA—Its history and challenges. J Nutr Health Aging 2006; 10:456–463; discussion 463–5.

    PubMed  CAS  Google Scholar 

  16. Lohman TG, Roche AF, Martorell R. Manuale di riferimento per la standardizzazione antropometrica. Milano: EDRA, 1992.

    Google Scholar 

  17. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982; 17:37–49.

    Article  PubMed  Google Scholar 

  18. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988; 23:271–284.

    Article  PubMed  CAS  Google Scholar 

  19. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983; 31:721–727.

    PubMed  CAS  Google Scholar 

  20. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9:179–186.

    Article  PubMed  CAS  Google Scholar 

  21. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–198.

    Article  PubMed  CAS  Google Scholar 

  22. McHorney CA, Bricker DE, Kramer AE, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia 2000; 15:115–121.

    PubMed  CAS  Google Scholar 

  23. Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN). Linee Guida per una Sana Alimentazione Italiana Roma, 2003.

  24. Hallfrisch J, Muller D, Drinkwater D, Tobin J, Andres R. Continuing diet trends in men: the Baltimore Longitudinal Study of Aging (1961–1987). J Gerontol 1990; 45:M186–M191.

    PubMed  CAS  Google Scholar 

  25. Briefel RR, McDowell MA, Alaimo K, et al. Total energy intake of the US population: the third National Health and Nutrition Examination Survey, 1988–1991. Am J Clin Nutr 1995; 62:1072S–1080S.

    PubMed  CAS  Google Scholar 

  26. Rolland Y, Abellan van Kan G, Benetos A, et al. Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives. J Nutr Health Aging 2008; 12:335–346.

    Article  PubMed  CAS  Google Scholar 

  27. Rolland Y, Kim MJ, Gammack JK, Wilson MM, Thomas DR, Morley JE. Office management of weight loss in older persons. Am J Med 2006; 119:1019–1026.

    Article  PubMed  Google Scholar 

  28. Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J Clin Epidemiol 2000; 53:579–587.

    Article  PubMed  CAS  Google Scholar 

  29. Thomas DR. Distinguishing starvation from cachexia. Clin Geriatr Med 2002; 18:883–891.

    Article  PubMed  Google Scholar 

  30. Gonzalez Hernandez A, Cuya Lantigua M, Gonzalez Escudero H, et al. [Nutritional status of Cuban elders in three different geriatric scenarios: community, geriatrics service, nursery home]. Arch Latinoam Nutr 2007; 57:266–272.

    PubMed  Google Scholar 

  31. Serra Prat M, Fernandez X, Ribo L, Palomera E, Papiol M, Serra P. [Loss of appetite in elderly people in the community and its relationship with functional capacity]. Med Clin (Barc) 2008; 130:531–533.

    Article  Google Scholar 

  32. Hiesmayr M, Schindler K, Pernicka E, et al. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr 2009; 28:484–491.

    Article  PubMed  CAS  Google Scholar 

  33. Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008; 12:227–231.

    Article  PubMed  CAS  Google Scholar 

  34. Cornali C, Franzoni S, Frisoni GB, Trabucchi M. Anorexia as an independent predictor of mortality. J Am Geriatr Soc 2005; 53:354–355.

    Article  PubMed  Google Scholar 

  35. Arvanitakis M, Beck A, Coppens P, et al. Nutrition in care homes and home care: how to implement adequate strategies (report of the Brussels Forum (22–23 November 2007)). Clin Nutr 2008; 27:481–488.

    Article  PubMed  CAS  Google Scholar 

  36. Morley JE. Weight loss in the nursing home. J Am Med Dir Assoc 2007; 8:201–204.

    Article  PubMed  Google Scholar 

  37. Hollis JH, Henry CJ. Dietary variety and its effect on food intake of elderly adults. J Hum Nutr Diet 2007; 20:345–351.

    Article  PubMed  CAS  Google Scholar 

  38. Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc 2002; 102:1096–1104.

    PubMed  Google Scholar 

  39. Roberts SB, Hajduk CL, Howarth NC, Russell R, McCrory MA. Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2005; 60:613–621.

    Article  PubMed  Google Scholar 

  40. Bartali B, Salvini S, Turrini A, et al. Age and disability affect dietary intake. J Nutr 2003; 133:2868–2873.

    PubMed  CAS  Google Scholar 

  41. Smoliner C, Norman K, Wagner KH, Hartig W, Lochs H, Pirlich M. Malnutrition and depression in the institutionalised elderly. Br J Nutr 2009; 102:1663–1667.

    Article  PubMed  CAS  Google Scholar 

  42. Nijs K, de Graaf C, van Staveren WA, de Groot LC. Malnutrition and mealtime ambiance in nursing homes. J Am Med Dir Assoc 2009; 10:226–229.

    Article  PubMed  Google Scholar 

  43. de Groot LC, Hautvast JG, van Staveren WA. Nutrition and health of elderly people in Europe: the EURONUT-SENECA Study. Nutr Rev 1992; 50:185–194.

    Article  PubMed  Google Scholar 

  44. Gillette Guyonnet S, Abellan Van Kan G, Alix E, et al. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer’s disease. J Nutr Health Aging 2007; 11:38–48.

    PubMed  CAS  Google Scholar 

  45. Rolland Y, Abellan van Kan G, Hermabessiere S, Gerard S, Guyonnet Gillette S, Vellas B. Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 2009; 13:679–683.

    Article  PubMed  CAS  Google Scholar 

  46. Gutierrez Rodriguez J, Jimenez Muela F, Alonso Collada A, de Santa Maria Benedet LS. [Prevalence and therapeutic management of dementia in nursing homes in Asturias (Spain)]. Rev Esp Geriatr Gerontol 2009; 44:31–33.

    Article  PubMed  Google Scholar 

  47. Morley JE. Decreased food intake with aging. J Gerontol A Biol Sci Med Sci 2001; 56 Spec No 2:81–88.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Physiopathology (Food Science Section), University of Rome “La Sapienza”, Rome, Italy

    Lorenzo M. Donini & C. Cannella

  2. Geriatric Unit, Dept. of Internal Medicine and Emergent Pathologies, University of Palermo, Palermo, Italy

    L. J. Dominguez & M. Barbagallo

  3. Rehabilitation Clinical Institute “Villa delle Querce”, Nemi, Rome, Italy

    C. Savina & E. Castellaneta

  4. S. Orsola-Malpighi Hospital, Bologna, Italy

    D. Cucinotta & A. Fiorito

  5. Department of Medical and Surgical Sciences, Geriatrics Section, University of Padua, Padua, Italy

    E. M. Inelmen, G. Sergi & G. Enzi

  6. Department of Medical Physiopathology — Food Science Section, University of Rome “La Sapienza”, P.le Aldo Moro, 5, 00185, Rome, Italy

    Lorenzo M. Donini

Authors
  1. Lorenzo M. Donini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. J. Dominguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Barbagallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Savina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Castellaneta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Cucinotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Fiorito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. M. Inelmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. Sergi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Enzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Cannella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenzo M. Donini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Donini, L.M., Dominguez, L.J., Barbagallo, M. et al. Senile anorexia in different geriatric settings in Italy. J Nutr Health Aging 15, 775–781 (2011). https://doi.org/10.1007/s12603-011-0048-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-011-0048-y

Key words

Search

Navigation