KURIKULUM VITAE

Dr IGP SUKA ARYANA, SpPD-KGer, FINASIM

(Divisi Geriatri - Interna, FK UNUD /RSUP Sanglah, Bali)
Pendidikan
Dokter umum: FK Unud 1997
Spesialis Penyakit Dalam: FK Unud 2005
Visiting research fellow Kobe Jepang 2002
Konsultan Geriatri: 2009, FINASIM 2011
Geriatric emergency course, Singapore 2010,
Dementia, Beijing 2013, Antioxidants Paris 2013
Penghargaan:
Nominator the Best Young Investigator Award AFES Singapura 2003
Nominator the Best Young Investigator Award AFES Manila 2005
The Best Mustafa-Varon Award for the Best Free Paper On shock and Critical Care 2005
The Best Young Investigator Award, ASMIHA Surabaya 2005
The best Scientific Free paper, TIG 2009, Jakarta
Organisasi/Jabatan : Anggota: IDI, PAPDI, PERGEMI, PEROSI
Wakil Ketua PAPDI Cab. Bali,
Ketua KOMKORDIK RSUP SANGLAH/FK UNUD
Sekretaris TKP PPDS Sp1, UNUD/RS Sanglah
KABID Standarisasi & akreditasi BPH Kolegium Ilmu Penyakit Dalam
Assesor & fasilitator Akreditasi Lam PT Kes
ANOREXIA OF AGING

IGP SUKA ARYANA

DIVISI GERIATRI, BAGIAN/SMF ILMU PENYAKIT DALAM,
FK UNUD/RSUP SANGLAH, DENPASAR, BALI
ANOREXIA OF AGING
OUTLINE

• Introduction
• Mechanism and risk factors anorexia of aging
• Assessment anorexia of aging
• Consequenses anorexia of aging
• Threatments anorexia of aging
 INTRODUCTION
• ANOREXIA : Loss of appetite and/or decreased
food intake
• Multifaceted clinical conditions  common
among frail older persons are not easily grouped
into specific diseases or “traditional” syndrome
categories.
• Related with many comorbidities and adverse
outcomes, comprising disability and poor quality
of life.

Francesco Landi, Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments , Nutrients 2016
 MECHANISM ANOREXIA OF AGING
INFLAMMATION

Francesco Landi, Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments , Nutrients 2016
 MECHANISM OF ANOREXIA OF
AGING
• Smell and Taste
• Hormones
• Gastrointestinal Function
• Inflammation
Smell and Taste
• The sense of smell and taste decreases with age,
• The number & function of taste buds decreases:
aging process diseases, medications, smoking, and
some environmental exposures
• Older persons frequently lose salty and sweet tastes
first.
• Decline in saliva secretion
Hormones
• Ghrelin or “hunger hormone” release from mucosal
in stomach
• Increase in leptin and insulin  low sensitive of
ghrelin
• Cholecystokinin (CCK)  proximal intestinal
• Peptide YY (PYY) late postprandial in elderly
Gastrointestinal Function
• Abnormalities in gastric motility
• Delayed gastric emptying
• Chronic gastritis and some drugs (e.g., proton-
pomp inhibitors) may cause hypochlorhydria
Inflammation
• Chronic low-grade inflammation, a hallmark of the aging
process
• Cytokines reduce food intake and, hence, body weight by
several means, contributing to delayed gastric emptying and
clampdown of small intestinal motility.
• These cytokines directly stimulate leptin mRNA expression
and enhance circulating leptin levels,
• Pro-inflammatory cytokines also stimulate the production of
hypothalamic corticotropin releasing factor (CRF), a
mediator of the anorexigenic effect of leptin
RISK FAKTOR

• Physical Factors : Functional impairments in the

basic and instrumental activities of daily living (ADL
and IADL)  difficult getting food, cooking, shop,
else
• Medical Factors: GI disease, acute/chronic infection,
hypermetabolism, CHF, COPD, Parkinson, stroke
• Medications: polypharmacy, drug-drug interaction
• Social Factors: sosial isolation. Living alone
ASSESSMENT
 CONSEQUENCES OF ANOREXIA OF
AGING
1. Malnutrition :
• protein-energy malnutrition,
• in the early stages, anorexia increases the risk of qualitative
malnutrition, due to suboptimal intake of single nutrients, like
proteins and vitamins
2. Frailty and Sarcopenia:
• reduced physical activity and declining muscle mass and
strength
3. Mortality :
• ULISSE) project, a study designed to assess the quality of care
in nursing home residents.
• Anorexia had an almost two-fold higher risk of death for all
causes compared with subjects without anorexia.
TREATMENT ANOREXIA OF AGING

Multi-stimulus interventions

• Food Manipulation
• Environmental Adaptation
• Medication
• Medical Diagnoses
• Specific Treatments
Food Manipulation
The enhancement of food texture and palatability,
flavor improvement, provision of dietary variety, and
feeding assistance as needed.
Environmental Adaptation
• Preventing social isolation
• Living alone
Medication
1. Cardiovascular drugs such as digoxin, amiodarone
and spironolactone;
2. Psychiatric drugs such as phenotiazines, lithium,
amitriptyline, fluoxetine and other selective
serotonin reuptake inhibitors; and
3. Anti-rheumatic drugs such as non-steroidal anti-
inflammatory agents.
4. Other medications can contribute to weight loss by
causing malabsorption (e.g., laxatives) or increasing
metabolism (e.g., theophylline).
Medical Diagnoses
• Swallowing disorders (e.g., dry mouth, tooth loss, lesions or
sores in the mouth),
• Dyspepsia (e.g., gastritis and ulcers),
• Malabsorption syndromes (e.g., bacterial overgrowth, gluten
enteropathy, pancreatic insufficiency),
• Neurological causes (e.g., stroke with residual swallowing
deficits),
• Endocrine disorders (e.g., hypercalcemia),
• Psychiatric disorders (e.g., depression, delirium),
• Respiratory diseases (e.g., COPD), and
• Cardiovascular diseases (e.g., CHF)
 Specific Treatments
• No specific therapeutic agents have shown to be clearly effective in
treating anorexia of aging.
• Nutritional supplementations do not directly cure anorexia of aging
but only its consequences, such as weight loss and energy-protein
malnutrition.
• PROT-AGE Study Group : a daily intake in the range of at least 1.0–
1.2 g protein per kilogram of body weight is required to reduce the
loss of muscle mass and strength and prevent the development of
frailty.
• Several medications: Corticosteroids, Growth hormone, Anabolic
steroids (e.g., testosterone and oxandrolone), Metoclopramide,
appetite-stimulating medications (e.g., megesterol, meclobemide,
tetrahydrocannabinol, cyproheptadine, CCK antagonists such as
loxiglumide).
MEGESTROL ACETATE (MA)

• MA should be considered appetite stimulant. Because the role of

nutritional support and appetite stimulants remains fundamental.
• Patients will typically improve their appetite within the first few
weeks after starting the drug. Weight gain, often in the form of fat,
may take longer.
• Resistance exercise training coupled with the weight gain may lead to
improved lean muscle mass. A typical treatment duration may be 12
weeks. Patients should be monitored for signs and symptoms of
adrenal suppression.
• The newer MA nanocrystal oral suspension (Megace ES) can be given
in a smaller volume and depends less on a patient taking it in the fed
state to achieve a clinical benefit.
 CONCLUSION
• Anorexia of aging, with its high prevalence and negative impact on
quality of life, morbidity and mortality,
• The first step is the identification of persons that are at risk of
anorexia of aging
• Potentially reversible factors that promote loss of appetite and
diminish food intake should be eliminated in order to prevent the
development of anorexia
• Specific individualized care plans should consequently be
implemented to guarantee the provision of adequate amounts of
food and limit weight loss
• Finally, multi-stimulus interventions and specific strategies,
including food texture adjustments, flavor enhancements and
feeding assistance, may be effective in the management of
anorexia
THANK YOU