EpistemisSenile cachexia
Specialty: Geriatrics.
Why it occurs
- Severe underlying chronic inflammatory syndrome associated with advanced stages of chronic diseases (advanced congestive heart failure, severe COPD, end-stage renal disease)
- Occult malignant neoplasms of larval growth frequent in the elderly (colorectal, gastric cancer, hematological tumors)
- Advanced dementia of any etiology (FAST stage 7 or GDS 7) with swallowing apraxia, dysphagia and food refusal
- Chronic adrenal insufficiency or progressive hypopituitarism with an overlapping course in the frail patient
- Senile intestinal malabsorption syndrome secondary to bacterial overgrowth in the small intestine (SIBO) or villous atrophy
Initial workup
Detailed blood analysis with nutritional and inflammation markers (complete blood count, albumin, prealbumin, transferrin, ultrasensitive C-reactive protein, ferritin, erythrocyte sedimentation rate [ESR]); basic oncological screening adapted to the patient's life expectancy (occult blood in feces, chest x-ray, abdominal ultrasound or CT depending on baseline status); evaluation of digestive transit through ultrasound of the bile ducts or esophago-gastro-duodenal transit; evaluation of 72-hour stool fat excretion if malabsorption is suspected.
red flags
Loss of body mass greater than 15% in a period of less than 6 months without justified cause, absolute inability to maintain minimal oral caloric or water intake with severe clinical signs of cellular dehydration, generalized edema in the lower limbs or anasarca secondary to severe hypoalbuminemia (less than 2.5 g/dl) that compromises lung function, or development of multiple and progressively infected pressure ulcers torpid
Standard management
- Mirtazapine — 7.5 mg to 15 mg orally at night, prescribed to stimulate appetite, improve sleep quality and treat concomitant depressive symptoms, being the drug of choice in geriatrics due to its safety profile compared to other options
- Use of high-protein and high-calorie enteral nutritional supplements enriched with immunonutrients and omega-3 fatty acids — that help counteract the systemic inflammatory cascade responsible for muscle catabolism
- Megestrol Acetate (80 mg to 160 mg orally per day, used with exclusively palliative criteria in advanced stages, informing of the risks of deep vein thrombosis, fluid retention and cardiovascular decompensation).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Geriatrics
- Listed causes
- 5
- Treatment options
- 3