The cause of anorexia and proportion of its recovery in older adults without underlying disease: Results of a retrospective study

Autoři: Nobuyuki Maki aff001;  Eiji Nakatani aff002;  Toshiyuki Ojima aff004;  Tomoka Nagashima aff005;  Takane Harada aff001;  Fumiko Koike aff005;  Naoki Tosaka aff001;  Hiroshi Yoshida aff001;  Toshio Shimada aff006
Působiště autorů: Department of Emergency Medicine, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan aff001;  Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan aff002;  Division of Medical Statistics, Translational Research Center for Medical Innovation on Foundation for Biomedical Research and Innovation at Kobe, Kobe City, Hyogo, Japan aff003;  Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan aff004;  Community Medicine Network Center, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan aff005;  Clinical Research Center, Shizuoka General Hospital, Shizuoka City, Shizuoka, Japan aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224354



It 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.


Retrospective 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.


Eighty-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.


Older 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.

Klíčová slova:

Anorexia nervosa – Cancer detection and diagnosis – Cancer treatment – Computed axial tomography – Critical care and emergency medicine – Diagnostic medicine – Elderly – Prognosis


1. La Puma J, Lawlor EF. Quality-adjusted life-years: Ethical implications for physicians and policymakers. JAMA. 1990;263: 2917–2921. doi: 10.1001/jama.263.21.2917 2110986

2. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362: 1211–1218. doi: 10.1056/NEJMsa0907901 20357283

3. Maki N, Kosugi K, Nagashima T, Nakamura M. Elderly people’s thoughts about surrogate decision making in end-of-life care: increasing trust through communication in the primary care. Nihon Primary Care Rengōgakkai Zasshi. 2016;39: 150–156 (written in Japanese, abstract in English).

4. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S, Kreling B, et al. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330: 545–549. doi: 10.1056/NEJM199402243300807 8302322

5. Fagerlin A, Ditto PH, Danks JH, Houls RM, Smucker WD. Projection in surrogate decisions about life-sustaining medical treatments. Health Psychol. 2001;20: 166–175. 11403214

6. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, et al. A systematic review of physician’s survival predictions in terminally ill cancer patients. BMJ. 2003;327: 195–198. doi: 10.1136/bmj.327.7408.195 12881260

7. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med. 2010;362: 1173–1180. doi: 10.1056/NEJMoa0909087 20357280

8. Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999;7: 128–133. 10335930

9. Hamaguchi S, Kinugawa S, Goto D, Tsuchihashi-Makaya M, Yokota T, Yamada S, et al. Predictors of long-term adverse outcomes in elderly patients over 80 years hospitalized with heart failure. ─A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) ─. Circ J. 2011;75: 2403–2410. doi: 10.1253/circj.cj-11-0267 21778592

10. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330: 1007–1011. doi: 10.1136/bmj.330.7498.1007 15860828

11. Ross DD, Alexander CS. Management of common symptoms in terminally ill patients: part I. fatigue, anorexia, cachexia, nausea and vomiting. Am Fam Physician. 2001;64: 807–814. 11563572

12. Martone AM, Onder G, Vetrano DL, Orolani E, Tosato M, Marzetti E, et al. Anorexia of aging: a modifiable risk factor for frailty. Nutrients. 2013;5: 4126–4133. doi: 10.3390/nu5104126 24128975

13. Landi F, Picca A, Calvani R, Marzetti E. Anorexia of aging assessment and management. Clin Geriatr Med. 2017;33: 315–323. doi: 10.1016/j.cger.2017.02.004 28689565

14. Ministry of Health, Labour and Welfare. Overview of population survey report (fixed). 2016. Available from:

15. Kameyama M. Old age syndrome ─ clinical and pathological considerations. Nihon Ronen Igakkai Zasshi. 1974;11: 71–81 (written in Japanese). 4475243

16. Sanford AM. Anorexia of aging and its role for frailty. Curr Opin Clin Nutr Metab Care. 2017;20: 54–60. doi: 10.1097/MCO.0000000000000336 27749690

17. O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96: 1420–1425. doi: 10.1093/jnci/djh275 15467030

18. Okada K, Fujisaki J, Yoshida T, Ishikawa H, Suganuma T, Kasuga A, et al. Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy. 2012;44: 122–127. doi: 10.1055/s-0031-1291486 22271022

19. Wyskiński A, Sobów T, Kłoszewska I, Kostika T. Mechanisms of the anorexia of aging-a review. Age (Dordr). 2015;37: 9821.

20. Okada A. Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder. BMJ Case Rep. 2014 May 16;2014. pii: bcr2013203422. doi: 10.1136/bcr-2013-203422 24835805

21. Hendi K, Leshem M. Salt appetite in the elderly. Br J Nutr. 2014;112: 1621–1627. doi: 10.1017/S0007114514002803 25287294

22. Kanda Y. Investigation of the freely available east-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48: 452–458. doi: 10.1038/bmt.2012.244 23208313

23. Malafarina V, Uriz-Otano F, Gil-Guerrero L, Iniesta R. The anorexia of ageing: physiopathology, prevalence, associated comorbidity and mortality. a systematic review. Maturitas. 2013;74: 293–302. doi: 10.1016/j.maturitas.2013.01.016 23415063

24. Donini LM, Poggiogalle E, Piredda M, Pinto A, Barbagallo M, Cucinotta D, et al. Anorexia and eating patterns in the elderly. PLoS One. 2013;8: e63539. doi: 10.1371/journal.pone.0063539 23658838

25. Donini LM, Savina C, Piredda M, Cucinotta D, Fiorito A, Inelmen EM, et al. Senile anorexia in acute-ward and rehabilitations settings. J Nutr Health Aging. 2008;12: 511–517. 18810297

26. Wilson MG, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005;82: 1074–1081. doi: 10.1093/ajcn/82.5.1074 16280441

27. Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, et al. The association between anorexia of aging and physical frailty: results from the national center for geriatrics and gerontology’s study of geriatric syndromes. Maturitas. 2017; 97: 32–37. doi: 10.1016/j.maturitas.2016.12.005 28159059

28. Nakatsu N, Sawa R, Misu S, Ueda Y, Ono R. Reliability and validity of the Japanese version of the simplified nutritional appetite questionnaire in community-dwelling older adults. Geriatr Gerontorol Int. 2015;15: 1264–1269.

29. Cornali C, Franzoni S, Frisoni GB, Trabucchi M. Anorexia as an independent predictor of mortality. J Am Geriatr Soc. 2005;53: 354–355. doi: 10.1111/j.1532-5415.2005.53126_4.x 15673368

30. Landi F, Liperoti R, Lattanzio F, Russo A, Tosato M, Barillaro C, et al. Effects of anorexia on mortality among older adults receiving home care: an observation study. J Nutr Health Aging. 2012;16: 79–83. 22238005

31. Gazewood JD, Mehr DR. Diagnosis and management of weight loss in the elderly. J Fam Pract. 1998;47: 19–25. 9673603

32. Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65: 640–650. 11871682

33. Thompson MP, Morris LK. Unexplained weight loss in the ambulatory elderly. J Am Geriatr Soc. 1991;39: 497–500. doi: 10.1111/j.1532-5415.1991.tb02496.x 2022802

34. Morley JE, Kraenzle D. Causes of weight loss in a community nursing home. J Am Geriatr Soc. 1994;53: 583–585.

35. Rabinovitz M, Piklik SD, Leifer M, Garty M, Rosenfeld JB. Unintentional weight loss. A retrospective analysis of 154 cases. Arch Intern Med. 1986;146: 186–187. doi: 10.1001/archinte.146.1.186 3942450

36. Marton KI, Sox HC Jr, Krupp JR. Involuntary weight loss: diagnostic and prognostic significance. Ann Intern Med. 1981;95: 568–574. doi: 10.7326/0003-4819-95-5-568 7294545

37. Visvanathan R. Anorexia of aging. Clin Geriatr Med. 2015; 31: 417–427. doi: 10.1016/j.cger.2015.04.012 26195100

38. Morley JE. Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia. J Cachexia Sarcopenia Muscle. 2017;8: 523–526. doi: 10.1002/jcsm.12192 28452130

39. Kawashiro N, Kasanuki H, Ogawa H, Matsuda N, Hagiwara N, The Heart Institute of Japan-Department of cardiology (HIJC) Investigators. Characteristics and outcome of hospitalized patients with congestive heart failure ─ results of the HIJC-HF registry ─. Circ J. 2008;72: 2015–2020. doi: 10.1253/circj.cj-08-0323 18931450

40. Oshitani Y, Nagai H, Matsui H, Aoshima M. Reevaluation of the Japanese guideline for healthcare-associated pneumonia in a medium-sized community hospital in Japan. J Infect Chemother. 2013;19: 579–587. doi: 10.1007/s10156-012-0517-1 23179959

41. Mcllvennan CK, Allen LA. Palliative care in patients with heart failure. BMJ. 2016;353: i1010. doi: 10.1136/bmj.i1010 27079896

42. Lum HD, Sudore RL, Bekelman DB. Advance care planning in the elderly. Med Clin North Am. 2015;99: 391–403. doi: 10.1016/j.mcna.2014.11.010 25700590

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2019 Číslo 10