Original Study Prevalence and Potentially Reversible Factors Associated With Anorexia Among Older Nursing Home Residents: Results from the ULISSE Project Francesco Landi MD, PhD a, *, Fabrizia Lattanzio MD, PhD b , Giuseppina Dell’Aquila MD c , Paolo Eusebi PhD d , Beatrice Gasperini MD e , Rosa Liperoti MD, MPH a , Andrea Belluigi MD c , Roberto Bernabei MD a , Antonio Cherubini MD, PhD c, e a Department of Gerontology and Geriatric, Catholic University of Sacred Heart, Rome, Italy b Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy c Geriatric Hospital, Italian National Research Centers on Aging (INRCA), Ancona, Italy d Epidemiology Department, Regional Health Authority of Umbria, Italy e Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Italy Keywords: Anorexia correlated factors mortality geriatric assessment nursing home Minimum Data Set abstract Objective: The principal aims of the present study were to explore the prevalence of anorexia and the factors correlated to anorexia in a large population of older people living in nursing home. Secondary, we evaluated the impact of anorexia on 1-year survival. Methods: Data are from baseline evaluation of 1904 participants enrolled in the Un Link Informatico sui Servizi Sanitari Esistenti per l’Anziano study, a project evaluating the quality of care for older persons living in an Italian nursing home. All participants underwent a standardized comprehensive evaluation using the Italian version of the inter Resident Assessment Instrument Minimum Data Set (version 2.0) for Nursing Home. We defined anorexia as the presence of lower food intake. The relationship between covariates and anorexia was estimated by deriving ORs and relative 95% CIs from multiple logistic regression models including anorexia as the dependent variable of interest. Hazard ratios and 95% CIs for mortality by anorexia were calculated. Results: More than 12% (240 participants) of the study sample suffered from anorexia, as defined by the presence of decreased food intake or the presence of poor appetite. Participants with functional impairment, dementia, behavior problems, chewing problems, renal failure, constipation, and depres- sion, those treated with proton pump inhibitors and opioids had a nearly 2-fold increased risk of anorexia compared with participants not affected by these syndromes. Furthermore, participants with anorexia had a higher risk of death for all causes compared with nonanorexic participants (hazard ratio 2.26, 95% CI: 2.14e2.38). Conclusions: The major finding is that potentially reversible causes, such as depression, pharmacologic therapies, and chewing problems, were strongly and independently associated with anorexia among frail older people living in nursing home. Furthermore, anorexia was associated with higher rate of mortality, independently of age and other clinical and functional variables. Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc. Introduction Anorexia is not an inevitable consequence of aging but many changes associated with the process of aging can promote it. Age- related diseases, lifestyle, and social and environmental factors may have considerable effects on nutritional habits and status. Nevertheless, nutritional problems are frequently unrecognized or disregarded, 1,2 and too often an “ageist” perspective of physicians toward geriatric patients could unjustifiably restrict diagnostic and therapeutic efforts. Scientific evidence indicates that a significant number of older persons fail to get adequate amount of food to meet essential energy and nutrient needs. Weight loss because of anorexia of aging has been mentioned as one of the most prevalent problem in older popula- tions 3,4 and is acknowledged as an independent predictor of morbidity and mortality among adult and geriatric patients in various clinical settings. 5,6 In most of the cases, anorexia is associated with The authors have no conflicts of interest relating to this article. * Address correspondence to Francesco Landi, MD, PhD, Centro Medicina, del- l’Invecchiamento, (CEMI), Istituto di Medicina Interna e Geriatria,Università Cat- tolica, del Sacro Cuore, Largo Agostino Gemelli, 8,00168 Rome, Italy. E-mail address: Francesco.landi@rm.unicatt.it (F. Landi). JAMDA journal homepage: www.jamda.com 1525-8610/$ - see front matter Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc. http://dx.doi.org/10.1016/j.jamda.2012.10.022 JAMDA 14 (2013) 119e124