Plain language summary
The loss of appetite experienced by older people has been largely attributed to the aging process and is often termed the ‘anorexia of aging’. The aims of the study were (1) to describe current interventions for anorexia of aging and their reported effectiveness in the older population, and (2) to identify the methods of the appetite assessment used. The study is a systemic review with 18 studies meeting inclusion criteria (17 journal articles and 1 conference abstract), which were carried out in different settings including hospital, rehabilitation, care homes, and own home. From these studies, 9 different types of intervention for anorexia of aging were identified. Results indicate that five of the nine different types of interventions exhibited some favourable effects on appetite (flavour enhancement, oral nutritional supplement, an amino acid precursor [compounds that give amino acids after some reactions], fortified food, and megestrol acetate [type of hormone treatment] medication) when compared to controls or from baseline. Appetite was assessed in a number of different ways, predominantly using Likert or visual analogue scale methods. Authors conclude that flavour enhancement and supplementation particularly in the form of fortified food could be potential avenues of interest, together with a more rigorous assessment of the impact of lifestyle measures.
Abstract
(1) Background: Appetite loss in older people, the 'Anorexia of Aging' (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored.
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