Anorexia Nervosa among

Older Adults Presented by: Edith Pastrana,

Windelyn Placencia and Marisol Maturino

Introduction● “Anorexia of aging”

● Highly prevalent

○ Present in 21.2% of persons over 65 years of age; occurs more in men than women

● Sarcopenia and frailty

○ Associated with poor outcomes

● Changes in lifestyle, disease conditions, and social and environmental

factors

Pathophysiology

● A highly complex process

● The central feeding pathway

regulates food ingestion

○ Signals leptin (hunger),

absorbed nutrients, and

circulating hormones

● Multi-level modification

Postulated factors

Risk Factors

Diagnosis● Screening tools are used for diagnosing the health issue or preventing it

● Visual analogue scale○ Decreased spontaneous food intake

● Questionnaires

○ Detail nutrition food intakes lower than 70% of estimated needs

1) Simplified Nutritional Assessment Questionnaire (SNAQ)

■ Successful predictive ability for future weight loss and protein-energy

malnutrition

2) Functional Assessment of Anorexia/Cachexia Therapy (FAACT)

■ Recognize anorexia related symptoms

■ Grading severity of symptoms from 0 (worse score) to 4 (better score)

■ 24 is the diagnostic number for anorexia Marisol (Landi et al., 2016). (Morley, J.E., 2012).

Marisol (Morley, J.E., 2012).

Treatment/Intervention● Change in prescriptions

○ could be causing the loss of appetite

● Supportive family

● Socialize● DO NOT FORCE FEED

○ could have more damaging effects

● Offer smaller meals● nutrition supplements

Interventions continue● Offer different texture of foods ● A solid dietary supplement in the form of a high-protein and high-energy cookie

designed for people with chewing difficulties ○ Increased weight gain and appetite increased○ Reduced pressure ulcer and diarrhea episodes

○ Fight against anorexia stimulation of touch and hearing could be valuable alternatives to sight smell and taste alterations

● Corticosteroids and Megestrol show improvement in appetite but no weight

gained

● Dronabinol,Growth hormone, and Thalidomide increase both however first

two are concerning.○ Risk of delirium with Dronabinol and Growth hormone increased mortality rate

Current Recovery Programs Combination of multi stimulus intervention strategies

● Food manipulation ○ Food texture and feeding assistance

● Environmental adaptation○ Decreasing social isolation, increasing conviviality, provide

financial assistance if needed

● Medical diagnosis○ All possible medical causes that contribute to weight loss

○ Swallowing disorders, neurological, psychiatric, respiratory, cardiovascular, and more

Marisol (Landi et al., 2016).

Current Recovery Programs(Santa Clara County)

● City of San Jose Active Adults Program - Senior Nutrition Program

● Second Harvest Food Bank (SHFB) Brown Bag

Program

● Seniors Farmers’ Market Nutrition Program

Marisol (City of San Jose, 2020). (SHFB, 2018). (USDA, 2020).

ReferencesBrown Bag Program Free Food for Seniors. (2018). Second Harvest Food Bank. Retrieved February 24, 2020 from

https://www.shfb.org/docs/getfood/brownbag.pdf

Dudricks, S. J. (2013). Older clients and eating disorders. Retrieved From https://www.todaysdietitian.com/newarchives/110413p44.shtml

Landi, F., Calvani, R., Tosato, M., Martone, A. M., Ortolani, E., Savera, G., Sisto, A., & Marzetti, E. (2016). Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients, 8(2), 69. https://doi.org/10.3390/nu8020069

J E Morley, Anorexia of aging: physiologic and pathologic, The American Journal of Clinical Nutrition, Volume 66, Issue 4, October 1997, Pages 760–773, https://doi.org/10.1093/ajcn/66.4.760

Morley, J.E. (2012). Undernutrition in older adults. Oxford Academy. 29(1), pp. 89-93. https://doi.org/10.1093/fampra/cmr054

Senior Farmers’ Market Nutrition Program. (2020). United States Department of Agriculture (USDA). Retrieved February 24, 2020from https://www.fns.usda.gov/sfmnp/senior-farmers-market-nutrition-program

References cont’d.Thomas, D. R. (2009). Anorexia. Drugs & Aging, 26(7), 557–570. doi:10.2165/11316360-000000000-00000

Pouyssegur, V., Brocker, P., Schneider, S. M., Philip, J. L., Barat, P., Reichert, E., … Lupi-Pegurier, L. (2014). An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised,malnourished older adults. Age and Ageing, 44(2), 245–251. doi:10.1093/ageing/afu150

Programs for Active Adults 50+. (2020). City of San Jose Parks, Recreation, and Neighborhood Services Department. Retrieved February 24, 2020 from https://www.sanjoseca.gov/your-government/departments/parks-recreation-neighborhood-services/your-programs/active-adults-50