All About Anorexia in The Elderly
Czeresna H. Soejono

ABSTRACT A complaint of unwillirzgizess to eat in the elderly is often overlooked, both b j ~ patient, the fomil~ror the doctor the Such condition may have a more serious underlying baclground, sucl? as irfection. A red~icedphysiologicaldeposit and different clinical manfesattiorzs gives in~portance the to analysis of the problem of anorexia. Changes in body corriposition, reduced physical activity and basal metabolism rate, reduced Nu'-Ki-ATP-ase, teeth that are no longer in optimal condition, i*educedtaste andsmell ability, increased CCKsatiation effect, reducedgastric emp@ing,reducedN0syntlzase activity of the gastric fundus, as well as reduced endogenous opioid level, could all inflzrence the development of anorexia. In addition, there are also several other clinical conditiom that play a role, such as polypharinacy, dementia, depression, andphysiological disfurbance in swallowing. Kej>words:Anorexia, elderly.


Various nutritional problems (malnutrition, poor nutrition, hypoalbuminemiaand anemia) make up 28.8% out of all geriatric patients admitted to the Geriatric Acute Inpatient Ward of Cipto Mangunkusumo General Hospital in the year 2001. Patients with a primary diagnosis of pneumonia (6 1.6%) and (11.6%) are admitted to the inpatient ward through the emergency unit or the outpatient unit with various chief complaints, 27.4% of which due to inadequate food intake. Feeding difficulty in the elderly are often easily dismissed by the family and health professionals at the first encounter. This is greatly detrimental for patients since their nutritional status would deteriorate in a short period of time and it becomes difficult for physicians to assist the patient in regaining a satisfactory nutritional status due to a limited physiological depo~it.',~.~
Appetite Control


Food intake in the elderly often becomes a problem among out-patients and particularly among in-patients. The problems that could be caused by a low food intake could be well understood, but there is still the argument low on what causes tl~e food intake. Anorexia as a cause turns out to have various unexplored aspects associated with it. This paper intends to briefly discuss these aspects. The understanding that elderly patients should receive comprehensive assessment is another aspect that should maintained.

Appetite control or regulation is a coinplex process involving a central as well as a peripheral mechanism. Various neurotransmitters play an important role in this regulation; at the central level, the neurotransmitter works at the paraventricular and the ventromedial nuclei of the hypothalamus, as well as nuclei located near the fourth ventricle." The neurotransmitters that play a role in increasing food intake are endogenous opioids, which are particularly associated with K receptors in the brain; galanine (a peptide) that also plays a role in increasing intake; the two more associated with fatty intake. Other neurotransmitters that also function to stimulate a person to eat are the Y-neuropeptide, norepinephrine (that stimulates gamma amino butirate acid receptors) as well as melanin-concentrating hormone (MCH), all three of which play a role on carbohydrate intake. Increased nitric oxyde synthase (NO-synthase) activity can also increase the stimuli to eat through a certain mechanism in the central nervous system.',' Neurotransmitters that inhibit food appetite include the corticotrophin releasing factor, 5-hydroxytriptamin
Acta Medica Indonesians


reduced paranoid ideas (that their food is being poisoned) often endogenous opioids. Albumin levels are usually not too obstructive pulmonary disease. except in highly advanced stages. cause low food intake among dementia patients. equate fundslpove~iy) causing them to have limited funds to purchase R endah garam. Depression among young adultsrarely reduced. malabsorptiou. Along with this. composition (loss of muscle mass) causes a reduced lean The most common psychological cause of anorexia body mass along with an age-related reduction in calorie is depression or adaptation disturbance with a requirement. heart failure. fluoxetin.Czeresna Heriawan Soejono I 1 I THE PHYSIOLOGY OF ANOREXIA classes who have been abused by family members. along with it. r e m i u d e d . low. and medical causes. rheumatoid arthritis. anorexia could common.~ Skin fat becomes very thin and finally protein (muscle) Medial conditions such as malignancy. These extreme conditions are now patients. which tends to progress to and heart failure also often cause dyspepsia and sarcopenia and failure to t h r i ~ e . psychological. COPD often causes aerophagia and increased hypoalbuminemia and kwashiorkor occurs. patients need to h e . burns). hut it is not the case among the basal restlng metabolism rate that in turn also reduces elderly. reducing food of marasmus-kwashiorkor in the elderly is often called intake and nutritional status. an~rexia." . Marasmus is associated with long term first appear during old age. and is known as tardive insufficient intake of carbohydrate (years or months). kwashiorkor or a Anorexia nervosa could also occur among elderly combination of both. which dyspepsia. elderly patients to become more forgetful. caused by teeth and gums that are no longer in optimal Swallowing apraxia. wandering. resulting in a reduced food intake. there is usually limThe following acronym may be used as a pneumonic ited access to shopping centers and a lack of adequate device "Kulw?g Makan" (Inadequate food intake) or transportation facilities (the public buses in Jakarta do "Poor In(n)takeVto explore possible causes of anorexia not allow a 75-year old or 80-year old to get on by him1 among elderly patients: herself to buy groceries). reduced taste and nose buds. but progression towards such conditions is still during young adulthood. inadequate carbohydrate and. low fat) Another social cause that is starting to become more A noreksi akibat infeksi? (Anorexia due to infec common in Indonesia is elderly abuse. rendah lemak? (diet terlalu ketat groceries. are used include: digoxin. and condition. Poverty is the most '. If the condition of insufficient carbohydrate intake could also cause anorexia. Drugs that for practical purposes could be classified as social. Drugs that are used in COPD the senile rusting syndrome. and is considered as a recurrence of anorexia rare. even Reduced food intake due to anorexia may also be forgetting whether they have or have not eaten. a slower rate of gastric en~ptying. Take note that doctors often K onsumsi banyak obat? (many Kinds of drugs) prescribe drugs that are too expensive. A smaller lean body mass causes a reduced influence food intake. chronic catabolism ensues. physical activity is also depression affect. Changes in body or live properly. From 2001 to May tion) 2003. NSAID. and a reduction in Swallowing apraxia refers to the condition where fundal nitric oxide synthase activity?. Conditions use of accessory respiratory muscles. trauma. the satiation effect of increased CCK. Their funds were discreetly taken from them and they became A reduced food intake in the elderly may be financially distraught and unable to continue treatment physiological caused by several things. The use of multiple drugs due to Causes of Anorexia multiple pathology certainly increases the possibility of There are various factors that cause anorexia. appetite.low salt. ~ disturbs food intake. t o . protein their meal? intake could cause marasmus. sometimes even to the point of a passive suicide Such reduction in basal metabolism rate in the elderly may also be caused by reduced Na+-K+-ATPDementia or reduced cognitive function also causes ase activity and a slight reduction in triiodothyronine.1 4 and iron supple~nentation?~'~ common social cause. Nevertheless. Malignancy and rheumatoid (starvation) continues or is accompanied by physical arthritis causes increased cytokine that influences stressors (infection. teophyllin. forcing geriatric U ang tak cukup lmiskin? (Unable to buylinad patients to allocate their grocery money for medications. and poly-pharmacy. surgery. dementia drugs. records show eight geriatric patients from various Acta Medica Indonesiana . ?) (Rigorous diet . ~ . Such condition almost always reduces food energylfood intake. ~ ~ a after chewing llo~ Clinically.

Blass JP. Weight loss should also be inquired to screen reduced nutritional status. editors. Soejono CZ H. J Nutr Health Aging 2002. 838. 5. Weight loss should also be inquired to screen reduced nutritional status. Am J Clin Nutr 1998. Several diseases often influence a person's nutritional status. Difficulty swallowing and uncomfortable oral and dental conditions often reduce appetite. 3. Geriatric nutrition. Russell RM. since they have a great influence on food intake. low fat I nfection N eoplasm (N)eglected T oo hard to swallow A MT score reduction K een on someone they have lost E ating but not absorbing properly The factors that play arole in determining an elderly person's appetite and physiological causes of anorexia in the elderly have been discussed. Number 3 July-September 2003 . paresis of the muscles used to swallow as well as oral and dental hygiene. 28 Nov 1994 : lampiran 1. p. L Z Rubinstein. 186-7. The type and amount of Volume XXXV 2. Hosam KK. Tucker KL. Jakarta: KPPlK FKUI. The nutritional program should be administered according to current findings. Makalah. Eninger WH. Age-associated changes in gastrointestinal function. Roberts SB. Understanding ofthe physiology of appetite and anorexia greatly determine the assessment process of geriatric patients. Oxford textbook of geriatric medicine. p. 2002.6(4):237-42. apa manfaatnya?. p.49-58. During the physical examination. editors. Wilcock GK. bag. Stern F. In: Evans JG. CONCLUSION P oly pharmacy 0 nly little money 0 ral and dental hygiene problems R igorous diet . it should not be too difficult to take further measures. 2003. Berner YN. Williams TF.158-61.All About Anorexi: I in The Elderly N eoplasma? (Neoplasm) G igi-geligi dan higiene mulut buruk? (Gums and teeth hygiene . Anorexia of ageing. editors. In: Hazzard WR. Wood RJ. Cognitive and psycho-affective states also need to be assessed. Morley JE. Aging and body composition. Nutritional history and the patient's access to food should be assessed to obtain a more detailed picture. After a complete picture of the geriatric patient's nutritional status and influencing factors is obtained. these causes usually can be controlled as long as they are identified as early as possible. hemoglobin. Attention needs to be paid when determining body height that is usually reduced with age. and plasma cholesterol levels. 2000. 7. Anthropometric measurements to determine body mass index could be used to determine nutritional status. Nutrition and aging. Suplementasi vitamin dan mineral pada pasien geriatri. Sastre A. Important supporting examinations are albumin. Kehayias JI..Nutritionand aging. 8. Wilson PWF. Halter JB. Pentingnya gizi bagi lansia sehat. 4. Beanie BL. editors. Z Glick. Sastre A. Attention needs to be paid when determining body height that is usually reduced with age. Fleming DJ. a comprehensive review. Polyak Z. New York: Raven Press Ltd. Jacques PF. p.. REFERENCES 1. More careful and continuous intake evaluation should be undertaken.poor) M enelan ada gangguan? (many Kinds of drugs) A bsorbsi terganggu ? (Absorption problems) K ehilangan seseorang? (Keen on someone they have lost) A MT (abbreviated mental test) menuruu? (Abbreviated Mental Test score reduction) N eglected ? (Neglected) nutrition should be adjusted to the patient's existing condition. 2"" ed. Salzrnan JR.67:722.63-73.low salt. Rumawas SSP. 2002. Michel J-P. Switzerland: Karger-basel-nestec Ltd. Further management depends on existing findings and the patient's overall condition. p. particularly those associated with issues of nutritional intake. In: Rosenberg IH. Dietary intake analysis in institutionalzed elderly: a focus on nutrient density.1995. Dror Y. Wiley J W. 9. Hall K E. Switzerland: Karger-baselnestec Ltd. Gastrointestinal function and aging. Impaired regulation of energy intake in old age. Lokakaryanutrisi padageriatri. In: Rosenberg IH. . ilmupenyakit dalam FKUI I RSCM. Oxford: Oxford university press. . Dallal GE. noting that the clinical change that takes place among geriatric patients is often different to what was originally predicted.. 6. 2nd ed. Dietary determinants of iron stores in a free-living elderly population: the framingham heart study. Jakarta. In: J E Morley. Changes in the type and amount of nutrient should take place gradually and food intake should be more carefully evaluated.

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