Presbyorexia

Specialty: Geriatrics.

• anorexia of aging
• senile physiological hyporexia
• loss of appetite in the elderly
• senile food disinterest

Why it occurs

• Physiological reduction in plasma ghrelin secretion and persistent increase in cholecystokinin and leptin, which induce early satiety
• Degenerative alteration of the olfactory receptors and taste buds (presbyosmia and presbiogeusia) that reduces the palatability of foods
• Delayed gastric emptying secondary to physiological antral hypomotility of advanced age
• Late-onset major depressive disorder with apathy and general disinterest in self-care
• Oral pathology (poorly adapted prostheses, cavities, periodontitis) or severe xerostomia that makes chewing and the formation of the bolus difficult

Initial workup

Application of the Mini Nutritional Assessment (MNA) scale to categorize nutritional status; blood analysis with complete blood count, acute phase reactants (CRP, ESR), albumin, prealbumin, transferrin, ferritin, serum iron, total iron binding capacity (TIBC), electrolytes, kidney and liver function; upper digestive endoscopy if there is dysphagia or clinical suspicion of esophageal or gastric neoplasia; comprehensive dental examination of the oral cavity.

Standard management

• Mirtazapine — 7.5 mg to 15 mg orally at night, an excellent option in geriatrics due to its dual antidepressant profile that effectively stimulates appetite at low doses and improves sleep architecture
• Megestrol acetate — 160 mg to 400 mg orally per day, used only in selected cases of refractory cachexia in palliative care due to its high risk of thromboembolic events and fluid overload in the elderly
• Pilocarpine (5 mg orally three times a day if there is documented severe xerostomia due to salivary gland atrophy, monitoring the appearance of cholinergic adverse effects).