General disease symptoms and their impact on appetite and food intake in older hospitalized patients

This prospective longitudinal observational study investigated the associations between individual disease symptoms and appetite among 200 older hospitalized patients (mean age 81.4±6.8 years, 62.5% women) from admission to 7 days later. The Simplified Nutritional Appetite Questionnaire (SNAQ) and Edmonton Symptom Assessment System (ESAS) were employed to assess appetite and disease symptoms, respectively. At baseline, 32.5% of patients reported very poor or poor appetite, a proportion that decreased significantly to 23.5% at follow-up. Notable improvements were observed in pain, fatigue, well-being, and shortness of breath at follow-up. Across both time points, appetite was most strongly negatively correlated with nausea, poor well-being, drowsiness, and anxiety. In particular, patients whose nausea worsened over time experienced a marked reduction in appetite (48%), compared to those with stable (21%) or improved nausea (9%, p<0.001). Declines in well-being were also significantly associated with worsening appetite (p=0.002), with 40% of patients reporting reduced appetite when well-being declined, versus 20% and 12% among those whose well-being remained unchanged or improved, respectively. Changes in other symptoms including pain, fatigue, depression, anxiety, drowsiness, and shortness of breath, did not significantly correlate with appetite changes (p>0.05). In a multiple logistic regression analysis, only nausea and poor well-being were significant predictors of lower appetite scores at baseline and of further appetite reduction over time. This study provides evidence that among older hospitalized patients, sustained nausea and reduced well-being are key determinants of appetite loss. Although depressive symptoms, fatigue, and pain also play roles, their impact appears to fluctuate during hospitalization.