PDF(Pubmed)
Abstract：
Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of \'normal\' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes.
This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations.
A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n = 1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%).
Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.
This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations.
A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n = 1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%).
Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.
摘要：
背景：衰老厌食症是一种常见的老年综合征，包括食欲不振和/或食物摄入减少，伴随着相关的营养不良，意外的减肥，少肌症,功能衰退，丧失独立性和其他不良健康结果。衰老的厌食症可能会产生多种严重的后果，并且经常被医疗保健专业人员（HCP）忽略。更令人担忧的是,临床医生通常认为衰老的厌食症是“正常衰老”不可避免的一部分。这项评估的目的是确定目前在识别和管理厌食症老年人方面的专业知识和实践方面的差距。结果可以指导教育计划来填补所发现的空白，从而改善患者的预后。
方法：这项国际评估是使用混合方法进行的，包括与主题专家的焦点小组访谈以及对实践HCP的电子调查。这项评估是由肌肉减少症协会领导的，恶病质和浪费性疾病（SCWD），并得到了国内合作组织的支持。
结果：医生完成了对26个多项选择题的定量调查，营养师和其他HCPs(n=1545)。大多数HCP（56.8％）将衰老的厌食症定义为食欲不振和/或食物摄入不足。认知改变/痴呆(91%)和吞咽困难(87%)被视为最大的危险因素。大多数受访者有信心提供营养(62%)和体力活动(59.4%)建议，并让家庭成员等护理人员支持患有厌食症的老年人(80.6%)。大多数临床医生在每次就诊时评估食欲（66.7％），尽管并非每次就诊时都会测量体重（41.5%）。除了迷你营养评估简短表格(39%)，其他筛查食欲减退的工具不经常使用或根本不使用任何工具(29.4%).大量受访者（38.7％）认为厌食症是衰老的正常部分。结果显示，治疗集中在吞咽障碍（78％），牙列问题（76％）和增加口服摄入量（强化食品[75％]和口服营养补充剂[74％]）。然而，缺乏高质量证据被认为是最佳治疗的障碍(49.2%).
结论：这项国际评估的结果强调了老年人在护理方面面临的挑战。确定个人HCP之间的专业实践差距和基于团队的差距可以为解决根本原因的医疗保健教育提供基础。针对特定受众，并开发以改善个人和团队实践，有助于改善患者的治疗效果。
方法：这项国际评估是使用混合方法进行的，包括与主题专家的焦点小组访谈以及对实践HCP的电子调查。这项评估是由肌肉减少症协会领导的，恶病质和浪费性疾病（SCWD），并得到了国内合作组织的支持。
结果：医生完成了对26个多项选择题的定量调查，营养师和其他HCPs(n=1545)。大多数HCP（56.8％）将衰老的厌食症定义为食欲不振和/或食物摄入不足。认知改变/痴呆(91%)和吞咽困难(87%)被视为最大的危险因素。大多数受访者有信心提供营养(62%)和体力活动(59.4%)建议，并让家庭成员等护理人员支持患有厌食症的老年人(80.6%)。大多数临床医生在每次就诊时评估食欲（66.7％），尽管并非每次就诊时都会测量体重（41.5%）。除了迷你营养评估简短表格(39%)，其他筛查食欲减退的工具不经常使用或根本不使用任何工具(29.4%).大量受访者（38.7％）认为厌食症是衰老的正常部分。结果显示，治疗集中在吞咽障碍（78％），牙列问题（76％）和增加口服摄入量（强化食品[75％]和口服营养补充剂[74％]）。然而，缺乏高质量证据被认为是最佳治疗的障碍(49.2%).
结论：这项国际评估的结果强调了老年人在护理方面面临的挑战。确定个人HCP之间的专业实践差距和基于团队的差距可以为解决根本原因的医疗保健教育提供基础。针对特定受众，并开发以改善个人和团队实践，有助于改善患者的治疗效果。
