From the Guidelines
Appetite stimulants should not be used in elderly patients with dementia and decreased appetite, as the current evidence does not support their effectiveness and highlights potential harmful side effects. The most recent and highest quality study, published in 2024 1, recommends against the use of appetite stimulants in persons with dementia, citing a lack of consistent effects and potential harmful side effects. This recommendation is further supported by another study from 2024 1, which also advises against the use of appetite stimulants in dementia patients due to uncertain benefits and potential risks.
Some studies have investigated the use of specific appetite stimulants, such as mirtazapine, megestrol acetate, and dronabinol, in elderly patients with decreased appetite. However, the evidence for these agents is limited and inconsistent. For example, a small retrospective study found that mirtazapine may be beneficial in dementia patients with weight loss and depression 1, but its use cannot be recommended for weight loss without depression. Megestrol acetate has shown mixed results in nursing home residents with weight loss or at risk of weight loss, with only 41% of the samples having dementia 1.
Non-pharmacological approaches should be tried first, including:
- Offering smaller, more frequent meals
- Enhancing food flavor
- Addressing underlying causes like depression or medication side effects
- Ensuring proper oral health These approaches can help improve nutritional status and quality of life in elderly patients with decreased appetite, without the potential risks associated with appetite stimulants.
In summary, the current evidence does not support the use of appetite stimulants in elderly patients with dementia and decreased appetite, and non-pharmacological approaches should be prioritized. Treatment should be individualized based on the patient's medical history, with regular monitoring for effectiveness and side effects 1.
From the FDA Drug Label
In the clinical trials, the majority of patients were treated with 5 mg/day dronabinol capsules, although the dosages ranged from 2. 5 to 20 mg/day. For an adult: Begin with 2.5 mg before lunch and 2.5 mg before supper. Geriatrics: Caution is advised in prescribing dronabinol capsules in elderly patients because they may be more sensitive to the neurological, psychoactive and postural hypotensive effects of the drug. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range
The recommended appetite stimulant for elderly patients with decreased appetite is dronabinol, with a starting dose of 2.5 mg before lunch and 2.5 mg before supper. However, caution is advised when prescribing dronabinol to elderly patients due to potential neurological, psychoactive, and postural hypotensive effects. Dose selection should be cautious, usually starting at the low end of the dosing range 2.
From the Research
Appetite Stimulants for Elderly Patients
The use of appetite stimulants in elderly patients with decreased appetite is a topic of interest, with various studies examining their efficacy.
- Megestrol acetate and mirtazapine are two commonly used appetite stimulants, with some studies suggesting their effectiveness in promoting appetite and weight gain in elderly patients 3, 4.
- However, the evidence is limited, and the applicability of the data to elderly individuals is unclear, with conflicting results and concerns about adverse events 3.
- Dronabinol is another appetite stimulant that has been studied, but its efficacy in improving appetite and meal intake in hospitalized adults is limited 5.
- It is essential to assess and treat underlying causes of weight loss before considering pharmacotherapy, and to evaluate the use of appetite stimulants on an individual basis 3, 6.
Treatment Options
Treatment strategies for loss of appetite in older patients include:
- Managing GI disturbances
- Encouraging physical activity and socialization
- Reducing fatigue and food aversions
- Adding high-calorie supplements to the diet 6
- Using appetite stimulants such as megestrol acetate, mirtazapine, and dronabinol, under close supervision and monitoring 4
Importance of Proper Assessment and Diagnosis
Understanding the causes of reduced appetite and knowing how to measure it is crucial in identifying patients with impaired appetite 7.
- A comprehensive assessment, including physical exam, history of weight loss, and review of dietary intake, is necessary to diagnose and manage loss of appetite in older patients 6.