Use of Orexigenic Medications in Geriatric Patients

Background

The loss of appetite, anorexia, is commonly observed in older persons and associated with adverse outcomes. It is becoming increasingly apparent that anorexia is the chief factor in producing weight loss in older adults. Although common and expected in acute illness, anorexia is also frequently associated with chronic diseases and leads to inadequate nutrient intake.

Objective

The aim of this paper was to review clinical studies on the use of orexigenic drugs to stimulate appetite.

Methods

Clinical trials were identified related to improving appetite and/or weight gain in older persons. Articles were identified by Ovid search using terms nutrition, anorexia, cachexia, weight loss, orexigenic drugs, and by searching references from retrieved papers.

Results

Environmental and nutritional interventions to improve intake should be the first intervention. When these fail to produce adequate intake, orexigenic drugs should be considered. No drug has received approval from the US Food and Drug Administration for geriatric anorexia.

Conclusions

In the presence of adequate food, weight loss most often is due to cytokine-associated cachexia and anorexia. Assessment of changes in appetite is essential to evaluating older persons with weight loss. When anorexia is identified, a search for reversible causes should be instituted. Intervention should first be aimed at the provision of adequate calories and protein, often in the form of high-density nutritional supplements. Failure to respond to adequate nutrition or supplements should trigger a concern for cachexia. Orexigenic drugs have been reported to improve appetite and produce weight gain. The mechanism is unknown, but it may relate to suppression of proinflammatory cytokines.