Abstract
AimIt is difficult to determine whether or not end-of-life care is necessary for frail older adults complaining of anorexia without underlying disease, such as cancer or organ failure. The main reason for this is the lack of the specification of the anorexia cause and no understanding of the cause-providing factor and the prognostic factor. This study aimed to clarify the cause of anorexia, and the determinant of the cause and recovery from anorexia.MethodsRetrospective chart reviews were conducted on patients with anorexia without an underlying disease who were aged ≥65 years and visited the emergency department of a single tertiary care center between 2016 and 2017. Patient characteristics at hospital visit, the cause of anorexia, and diagnostic modalities were summarized. The diagnosis-providing rate, recovery rate, and the association between them were analyzed.ResultsEighty-three patients (mean age 82.3 years; 50.6% male) were investigated. In 67 patients (81%), the causes of anorexia were identified, including 18 patients (22%) with infection, 13 (16%) with benign gastrointestinal diseases, and 7 (8%) with cardiovascular diseases. In 16 patients (19%), the causes of anorexia were not identified despite examinations. The modality that most contributed to diagnosis was plain computed tomography followed by blood tests. The value regarding information in history-taking and physical examinations was limited. Sixty-five patients (78%) recovered. Only 73% of patients with a definite cause recovered; all patients with an unknown cause recovered.ConclusionsOlder adults with anorexia are not always at the end of life, and efforts to identify the cause are crucial. Moreover, it is vital to realize the limitations associated with the treatment of infections and cardiovascular diseases.
Highlights
Decision-making with regards to end-of-life care for older adults is an important and challenging process in developed countries [1]
In 67 patients (81%), the causes of anorexia were identified, including 18 patients (22%) with infection, 13 (16%) with benign gastrointestinal diseases, and 7 (8%) with cardiovascular diseases
In 16 patients (19%), the causes of anorexia were not identified despite examinations
Summary
Decision-making with regards to end-of-life care for older adults is an important and challenging process in developed countries [1]. Forty-three percent of all older adults aged 60 years require decision-making on end-of-life care [2]. This is often difficult because of several factors; we showed that one of the reasons is a lack of adequate data to predict the prognosis accurately [3]. In both the patients’ own and surrogate decision-making, preferences for or against treatments are greatly affected by the predicted prognosis [4, 5]. Prediction of prognosis is difficult in frail older adults without underlying diseases because they already have lowlevel function at baseline, and even minor physical events can be fatal [10]
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