A recent review published in the Clinical Interventions in Aging journal highlights the severe and often overlooked consequences of anorexia of ageing (AA) in hospital settings. Conducted by Natalie J. Cox from the University of Southampton, the study underscores the urgent need for standardised assessments and evidence-based management strategies to address this prevalent issue among older hospitalised patients.
The anorexia of ageing (AA) refers to appetite loss in older individuals that is linked to the natural ageing process rather than specific diseases. In hospital settings, the prevalence of AA ranges between 30–60%, significantly higher than the 11% to 28% observed in the community. Despite its common occurrence, AA often goes undiagnosed in hospitals due to a lack of standardised assessment tools and limited awareness of its severe health consequences.
Several factors contribute to the development of AA in hospitalised older adults. Poor oral health is a significant physical factor, with studies indicating that patients with AA have poorer oral cleanliness and a higher presence of dentures. Additionally, difficulty in chewing and swallowing, along with the use of texture-modified diets, exacerbates the condition.
Inflammation also plays a crucial role, with higher levels of inflammatory markers like C-reactive protein (CRP) being associated with reduced food intake. Psychological factors such as low mood and depression are closely linked to diminished appetite. Hospitalised patients often experience lower mood levels, which, while not necessarily reaching clinical depression, can still negatively impact their desire to eat.
Physical activity is another critical factor. Hospitalised older adults with higher levels of physical activity prior to admission tend to have better appetites. This relationship suggests that maintaining physical activity can help regulate appetite, though the dynamics change with age-related physiological alterations.
The implications of AA in hospital settings are profound and multifaceted. One of the most significant consequences is malnutrition, which affects 20% to 50% of hospitalised older adults. A lower body mass index (BMI), fewer nutritional biomarkers, and deficiencies in crucial vitamins like B12 are signs of malnutrition, which is more likely to occur as a result of AA. Malnutrition, in turn, increases the risk of poor health outcomes, including higher rates of hospital readmission and mortality.
Sarcopenia, or the loss of muscle mass and strength, is another severe consequence. Hospitalised patients with AA often exhibit reduced hand grip strength, a key indicator of muscle function. This reduction in muscle strength can persist post-discharge, indicating long-term impacts on physical health.
The review also highlights the uncertain relationship between AA and healthcare utilisation. While some studies suggest that AA leads to longer hospital stays and higher rates of hospital-acquired infections, others do not find significant differences. This discrepancy underscores the need for more comprehensive research to understand the full impact of AA on healthcare resources.
The effects of AA on functional status are also negative. Patients with AA typically show lower scores on functional independence measures, indicating higher degrees of dependence. This decrease in functional ability can extend beyond basic daily activities, affecting more complex tasks and overall quality of life.
Perhaps the most alarming consequence of AA is its association with increased mortality. Studies have shown that hospitalised older adults with AA have twice the risk of dying within six months post-discharge compared to those without AA. This elevated risk persists even when accounting for other factors like comorbidities and length of hospital stay. The connection between AA and mortality highlights the critical need for timely identification and intervention.
Given the high prevalence and severe consequences of AA, the review calls for urgent action to improve diagnosis and management in hospital settings. Implementing standardised assessment tools, such as the Council on Nutrition Appetite Questionnaire (CNAQ) and its shortened version, the Simplified Nutritional Appetite Questionnaire (SNAQ), could enhance the detection of AA. Additionally, raising awareness about the health impacts of AA among healthcare professionals is crucial.
The review also emphasises the need for more research to develop effective interventions. Understanding the pathways of causality and exploring the role of factors like inflammation and physical activity could lead to better management strategies. Addressing AA not only improves the health outcomes of older adults but also reduces the burden on healthcare systems.
