Weight loss in elderly patients is a common clinical problem. Wasting and
cachexia are associated with severe physiologic, psychologic, and immunologic consequences, regardless of the underlying causes.
Cachexia has been associated with
infections,
decubitus ulcers, and even death. Multivariate analyses of risk and prognostic factors in community-acquired
pneumonia in the elderly have found that age by itself is not a significant factor related to prognosis. Among the significant risk factors, only nutritional status is amenable to medical intervention.
Cachexia in the elderly may have profound consequences: medical, cognitive, and
psychiatric disorders may diminish self-reliance in
activities of daily living, thus reducing quality of life and increasing the frequency of secondary procedures, hospitalizations, and the need for skilled care.
Cachexia is associated with higher-than-normal concentrations of
tumor necrosis factor alpha (
TNF-alpha),
interleukin (IL) 1,
IL-6,
serotonin, and
interferon gamma. The role of these proinflammatory
cytokines has been established in the
cachexia seen in
cancer and
AIDS patients. Reduction in the concentrations of these
cytokines is associated with
weight gain. Drugs that promote appetite stimulation and
weight gain, such as
progestational agents, cyproheptadines,
pentoxifylline, and
thalidomide may work by down-regulating these proinflammatory
cytokines. An understanding of the relation between
cachexia and negative regulatory
cytokines may point to effective treatment of geriatric
cachexia as well.