From the Guidelines
Increased satiety and nausea in geriatric patients should be promptly addressed by evaluating medication side effects and considering adjustments or alternatives, as these symptoms can lead to malnutrition and decreased quality of life. The most recent and highest quality study 1 highlights the importance of assessing the temporal relationship between medication changes and appetite or body weight changes. Many commonly prescribed medications in older adults, such as opioids, sedatives, and cholinesterase inhibitors, can cause increased satiety and nausea.
Key Considerations
- Evaluate for medication side effects, particularly those related to polypharmacy, as this can lead to adverse events and increased morbidity and mortality 1.
- Consider non-pharmacological approaches for nausea management, such as small, frequent meals and proper hydration.
- If medication is needed, start with low-dose antiemetics and use the lowest effective dose to minimize side effects.
- For early satiety, evaluate for gastroparesis using a gastric emptying study and consider prokinetic agents like low-dose metoclopramide.
- Always rule out serious underlying conditions such as malignancy, gastrointestinal obstruction, or cardiac issues.
Management Strategies
- Assess medication lists and consider alternatives or adjustments to minimize adverse effects on appetite and nutrition.
- Implement dietary counseling and support, such as meals on wheels or shared meals, to promote adequate nutrition.
- Monitor patients closely for signs of malnutrition, dehydration, or other complications related to increased satiety and nausea.
- Use verbal prompting and reminders to eat and drink, especially in patients with dementia or cognitive impairment 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
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 caused by various factors such as cerebrally caused, cerebrally controlled, or caused by gastrointestinal disease 2.
- The "anorexia of aging" refers to reduced appetite and energy intakes observed in some older adults, which can be related to altered satiation and satiety mechanisms 3.
- Factors that affect satiation and satiety in older adults include gastric emptying, levels of gut hormones, and sensory specific satiety, which can be targeted through dietary strategies to reduce satiety and encourage increased energy intake 3.
Management of Nausea and Satiety
- The diagnosis of nausea in the elderly is based on a detailed medical history and an in-depth physical examination, with further diagnostic steps customized to each patient 2.
- Therapy for nausea aims to treat the underlying cause, with symptom-oriented medication considered as a secondary measure 2.
- Metoclopramide, a dopamine receptor antagonist, can be used to treat nausea and vomiting, particularly in cases of diabetic gastroparesis, gastroesophageal reflux, and postoperative situations 4.
- Nutrition assessment and interventions, such as oral nutrition supplements, medical nutrition therapy, and nutrition education, can help prevent or treat malnutrition in older adults, which is often related to increased satiety and nausea 5.
Prevalence and Impact
- Chronic gastrointestinal symptoms, including nausea, vomiting, and constipation, are extremely common in the geriatric population and can have a profound impact on functional status, independence, and quality of life 6.
- Older adults living in the community or long-term residence are at increased risk for malnutrition due to factors such as depression and isolation, highlighting the need for effective nutrition assessment and interventions 5.