92ANOREXIA IN OLDER PEOPLE AND ITS TREATMENT: A SYSTEMATIC REVIEW

Abstract

Introduction: appetite loss in older people, often termed ‘Anorexia of Ageing’ (AA), is common. Recognised consequences include undernutrition, sarcopenia, frailty, and in-hospital increased length of stay, morbidity and mortality. Identification and management of AA is important to optimise care of older people.This systematic review aimed to identify interventions for AA with reported effects on appetite. Methods: the review followed PRISMA recommendations. Study inclusion criteria were participants aged >65, appetite measurement and an intervention for AA or undernutrition. Studies on specific health cohorts e.g. cancer were excluded. Searches were performed in MEDLINE, EMBASE, and CINAHL databases. Reference lists of included articles and relevant reviews were hand-searched. Two researchers independently screened for eligibility and assessed study quality. Results: authors screened 8729 titles, 402 abstracts and 42 full texts. 16 studies were included. The quality of included studies was largely good with one study rated poor. Settings included own home (n = 7), care home (n = 5), rehabilitation (n = 2) and acute hospital (n = 5). Three studies had combinations of settings. Appetite was measured by multiple different methods, predominantly utilising Likert scales (n = 8), or visual analogue scales (n = 5).Interventions were categorised into education (n = 2), exercise programmes (n = 2), supplementation (fortified food, oral nutritional supplement (ONS), amino acid pre-cursor) (n = 9), drug therapy (megestrol acetate, nandrolone decanoate) (n = 3) and meal adjustments (n = 3). Three studies included combinations of categories.Education had no effect on appetite. Exercise showed no effect alone or combined with education or ONS. Supplementation gave mixed results with transient appetite depression (n = 2), no effect (n = 4) or increases (n = 3). Drug therapies were mixed: megestrol acetate increased appetite (n = 2), nandrolone decanoate had no effect (n = 1). Flavour enhancement increased appetite whilst other meal adjustments (mealtime assistance, increased variety) had no effect. Discussion: few studies have measured appetite with an intervention for AA or undernutrition. The lack of consensus on how to measure appetite and the heterogeneity of interventions and methodologies makes pooling of results unachievable and it is difficult to draw meaningful conclusions about effects. AA warrants further research as an avenue to treating undernutrition, with its importance in the trajectory to sarcopenia, frailty and ultimately poor outcomes.