David R. Thomas

The loss of appetite is termed ‘anorexia’. Dramatic and poorly understood alterations occur in the physiological regulation of appetite in older adults, who frequently exhibit less hunger and earlier satiety. Appetite regulation (and, therefore, food intake) is affected by a number of social, cultural and psychological factors, as well as by acute and chronic disease states, drugs, dementia or mood disorders. Self-reported anorexia has been reported by approximately one-third of older men and women. Recent development of validated measures of appetite aid in the approach to the problem. The differential diagnostic approach for appetite disturbances should follow from an understanding of the physiological, social, psychological and pathophysiological causes of anorexia. Emerging understanding of the association between proinflammatory cytokines and the anorexia/cachexia syndrome indicates that this process is the most commonly encountered underlying reason for anorexia in acute and chronically ill older persons. Despite the changes in appetite regulation in older persons, the response to social and psychological stimulants in this age group is similar to that in younger adults. Pharmacological stimulants of appetite appear to be a promising intervention for anorexia.