From the Guidelines
Increased satiety and nausea in geriatric patients should be evaluated promptly, and the first step is to review all medications, as many commonly prescribed drugs in older adults can cause these symptoms, including cholinesterase inhibitors, opioids, antibiotics, and some antidepressants 1. When managing increased satiety and nausea in geriatric patients, it is crucial to consider the potential impact of medications on nutritional intake and nutritional status. The evidence suggests that polypharmacy is associated with malnutrition in the general older population 1. Some key considerations include:
- Reviewing medications to identify potential causes of increased satiety and nausea, such as opioids, sedatives, digoxin, metformin, antibiotics, and nonsteroidal anti-inflammatory drugs 1
- Considering non-pharmacological approaches, including eating smaller, more frequent meals, avoiding strong odors, and ensuring adequate hydration
- Using low-dose antiemetics like ondansetron or metoclopramide for persistent nausea, while being cautious of potential side effects 1
- Avoiding medications with anticholinergic properties, which can cause confusion in older adults
- Monitoring for weight loss, dehydration, and malnutrition, which can quickly develop in geriatric patients with persistent satiety and nausea The use of appetite stimulants, such as dronabinol and megestrol acetate, is not generally recommended due to limited evidence and potential side effects 1. In specific clinical situations, the choice of medication might be important, and medications like mirtazapine, which can stimulate appetite, might be considered 1. Overall, a comprehensive approach that takes into account the complex interplay of factors contributing to increased satiety and nausea in geriatric patients is essential for effective management.
From the Research
Increased Satiety and Nausea in Geriatrics
- Increased satiety and nausea are common issues in the geriatric population, with approximately every 2nd to 3rd elderly person affected by nausea 2.
- The physiological aging of the gastrointestinal tract does not cause nausea, but rather it is often a symptom of an underlying disease or condition 2.
- Factors that affect satiation and satiety in older adults include gastric emptying and levels of gut hormones, which can lead to reduced appetite and energy intake 3.
- Sensory specific satiety also appears to be reduced in older subjects, which may contribute to the anorexia of aging 3.
Management of Nausea and Vomiting
- Ondansetron has been shown to be an effective antiemetic in patients receiving cisplatin chemotherapy, with significantly fewer treatment failures compared to metoclopramide 4.
- Ondansetron is also effective in controlling nausea and vomiting in uremic patients, with a greater efficacy compared to metoclopramide 5.
- However, the use of ondansetron and metoclopramide as second-line antiemetics in women with nausea and vomiting in pregnancy is still being studied, with a pilot trial failing to achieve recruitment targets due to unforeseen changes in prescribing practice 6.
Treatment Options
- Treatment of nausea and vomiting in the geriatric population should aim to address the underlying cause, with symptom-oriented medication considered as a secondary measure 2.
- Ondansetron and metoclopramide may be considered as treatment options, but their use should be tailored to the individual patient's needs and medical history 4, 5.
- Further research is needed to determine the most effective treatment strategies for managing nausea and vomiting in the geriatric population, particularly in relation to increased satiety and appetite regulation 3.