Elsevier

Ageing Research Reviews

Volume 12, Issue 1, January 2013, Pages 316-328
Ageing Research Reviews

Review
Physiological and psychosocial age-related changes associated with reduced food intake in older persons

https://doi.org/10.1016/j.arr.2012.08.002Get rights and content

Abstract

Dietary intake changes during the course of aging. Normally an increase in food intake is observed around 55 years of age, which is followed by a reduction in food intake in individuals over 65 years of age. This reduction in dietary intake results in lowered levels of body fat and body weight, a phenomenon known as anorexia of aging. Anorexia of aging has a variety of consequences, including a decline in functional status, impaired muscle function, decreased bone mass, micronutrient deficiencies, reduced cognitive functions, increased hospital admission and even premature death. Several changes during lifetime have been implicated to play a role in the reduction in food intake and the development of anorexia of aging. These changes are both physiological, involving peripheral hormones, senses and central brain regulation and non-physiological, with differences in psychological and social factors. In the present review, we will focus on age-related changes in physiological and especially non-physiological factors, that play a role in the age-related changes in food intake and in the etiology of anorexia of aging. At the end we conclude with suggestions for future nutritional research to gain greater understanding of the development of anorexia of aging which could lead to earlier detection and better prevention.

Highlights

► Changes in peripheral hormones, senses and brain regulation are involved in anorexia of aging. ► Psychological and social changes can contribute to development of anorexia of aging. ► Future nutritional research in older persons should focus on physiological and non-physiological factors.

Introduction

Aging in humans is associated with a failure to maintain energy homeostasis in response to changes in physiological and non-physiological factors, resulting in a decrease in body fat and body weight in older individuals (above 60 years of age) (Steen, 1988, Shimokata et al., 1989). The changes in the maintenance of energy homeostasis have been elucidated in several epidemiological studies. A cross-sectional follow-up study in the USA, for example, reported a decline in average daily energy intake of 1165 kcal in males and 405 kcal in females when comparing individuals of 20 and 75 years of age (Briefel et al., 1995). A similar study performed in Mexico, reported a decrease of 19.3 kcal/day/year in women and 25.1 kcal/day/year in men who were above 60 years of age (Koehler, 1994). Furthermore, an Australian study revealed that older persons lost height (1.8 cm) and weight (1.9 kg) during the 84 months of the study which was related to a significant decrease in carbohydrate, fat and protein consumption (Zhu et al., 2010). Besides changes in the amount of food and type of food intake, it is also shown that older persons eat fewer snacks between meals (de Castro, 1993), that they experience less cravings for food (Pelchat and Schaefer, 2000) and that they feel less hungry and more satiated than younger individuals (Clarkson et al., 1997). These age-related changes in food consumption lead to decreased energy intake in older persons which is associated with a reduction in body fat and body weight. These reductions can lead to a variety of health-related consequences, including a decline in functional status, impaired muscle function, decreased bone mass, micronutrient deficiencies, reduced cognitive functions, increased hospital admission and even premature death (Roberts, 2000, Ahmed and Haboubi, 2010). Overall, the reduced food intake and the decreased body fat and body weight in older persons, is referred to as anorexia of aging (Morley, 1997, Hays and Roberts, 2006, Kmiec, 2010).

Anorexia of aging is a nationwide issue with currently 16% of individuals older than 65 years who are affected (Guigoz et al., 2002, Ahmed and Haboubi, 2010). It is especially a severe problem among institutionalized older persons of which 15% of the community-dwelling and home-bound older persons, 23–62% of the hospitalized patients and up to 85% of the nursing home residents suffer from malnutrition (Guigoz et al., 2002, Ahmed and Haboubi, 2010). The development of anorexia of aging is multifactorial, involving both physiological and non-physiological aspects (Hays and Roberts, 2006). Preceding reviews on anorexia of aging focused primarily on the physiological changes involved in the development of this type of anorexia. Here, we will outline both the physiological (peripheral hormones, senses and central brain regulation) and non-physiological (psychological and social) changes to show that both type of factors play a significant role in the development of anorexia of aging.

Section snippets

Physiological changes

There are several physiological factors associated with reduced food intake in older persons. Some of these factors are known to be associated with feelings of hunger or satiety while the effects of others remain unknown. Most of the physiological factors involved in lower dietary intake in elderly are related to changes in peripheral hormones, senses and central brain control. Here, we will discuss the most important age-related changes in these three aspects affecting energy intake regulation

Non-physiological changes

In addition to the age-related physiological changes, the nutritional status of older persons is affected by psychological and social factors. In this part of the review we will outline the most important age-related changes in these non-physiological factors and their involvement in decreasing food intake and the development of anorexia of aging.

Conclusion

Anorexia of aging is a major problem among persons older than 65 years of age. It involves reduced food consumption which is followed by lowered body fat and body weight. This reduction in body fat and body weight is associated with several consequences, including premature death. The development of anorexia of aging is influenced by both physiological and non-physiological age-related changes. Although most research on this type of anorexia has mainly focused on the physiological factors

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      Numerous dietary surveys have found that elderly individuals often do not eat adequately for their state of health—due, for example, to physical difficulties in meal preparation or swallowing (e.g., Bostic & McClain, 2017; Mann et al., 2013)—and follow a monotonous diet that is usually exacerbated by a lack of appetite. The latter can also be caused by the state of loneliness—the loss of a partner or estrangement from family (de Boer et al., 2013; Smith & Miller, 2011)—in which the elderly often lives and exaggerate the demand for carbohydrate-rich foods. Due to these protracted dietary errors, cases of malnutrition with weight loss or hypercaloric diets associated with overweightness and obesity often occur (Ford et al., 2014; Ledikwe et al., 2004).

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