Original Study| Volume 11, ISSUE 4, P268-274, May 2010

Anorexia, Physical Function, and Incident Disability Among the Frail Elderly Population: Results From the ilSIRENTE Study


      Increasing evidence suggests that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia of aging and measures of physical performance, muscle strength, and functional status in older persons aged 80 years or older.


      Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on 3 timed tests: 4-meter walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. We defined anorexia as the presence of loss of appetite and/or lower food intake. Analyses of covariance were performed to evaluate the relationship of anorexia with physical function.


      In the unadjusted model, all the physical performance, muscle strength, and functional measures showed significant associations with the presence of anorexia. After adjustment for potential confounders (age, gender, BMI, number of diseases, depression, congestive heart failure, lung diseases) these associations were weaker but still statistically significant (physical performance battery score: subjects without anorexia 6.8, SE 0.2, subjects with anorexia 5.8, SE 0.4, P = .03; 4-meter walking speed: subjects without anorexia 0.5 m/s, SE 0.1, subjects with anorexia 0.3 m/s, SE 0.1, P = 5.001 hand grip strength: subjects without anorexia 30.8 kg, SE 0.7, subjects with anorexia 27.9 kg, SE 1.5, P = .03). Furthermore, relative to participants without anorexia, those subjects with anorexia showed a significantly higher risk of developing disability after 2 years of follow-up (hazard ratio 2.25; 95% confidence intervals 1.15–4.39).


      Anorexia is common among community older subjects in Italy. Our results suggest that among old-old subjects, the presence of anorexia is associated with impaired physical performance and with a significant increased risk of incident disability, irrespective of potential confounders.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Guralnik J.M.
        • Fried L.P.
        • Salive M.E.
        Disability as a public health outcome in the aging population.
        Annu Rev Public Health. 1996; 17: 25-46
        • Fried T.R.
        • Bradley E.H.
        • Williams C.S.
        • Tinetti M.E.
        Functional disability and health care expenditures for older persons.
        Arch Intern Med. 2001; 161: 2602-2607
        • Landi F.
        • Russo A.
        • Cesari M.
        • et al.
        Walking one hour or more per day prevented mortality among older persons: Results from ilSIRENTE study.
        Prev Med. 2008; 47: 422-426
        • Morley J.E.
        Weight loss in the nursing home.
        J Am Med Dir Assoc. 2007; 8: 201-204
        • Landi F.
        • Onder G.
        • Gambassi G.
        • et al.
        Body mass index and mortality among hospitalized patients.
        Arch Intern Med. 2000; 160: 2641-2644
        • Landi F.
        • Laviano A.
        • Cruz-Jentoft A.
        The anorexia of aging: Is it a geriatric syndrome?.
        J Am Med Dir Assoc. 2010; 11: 153-156
        • Kuh D.
        A life course approach to healthy aging, frailty, and capability.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 717-721
        • Cartwright J.C.
        • Hickman S.
        • Perrin N.
        • Tilden V.
        Symptom experiences of residents dying in assisted living.
        J Am Med Dir Assoc. 2006; 7: 219-223
        • Morley J.E.
        Anorexia, sarcopenia, and aging.
        Nutrition. 2001; 17: 660-663
        • Landi F.
        • Russo A.
        • Cesari M.
        • et al.
        The ilSIRENTE study: A prospective cohort study on persons aged 80 years and older living in a mountain community of Central Italy.
        Aging Clin Exp Res. 2005; 17: 486-493
        • Morris J.N.
        • Fries B.E.
        • Bernabei R.
        • et al.
        RAI - Home Care Assessment Manual.
        InterRAI Coporation, Washington, DC1996
        • Morris J.N.
        • Fries B.E.
        • Steel K.
        • et al.
        Comprehensive clinical assessment in community setting: Applicability of the MDS-HC.
        J Am Geriatr Soc. 1997; 45: 1017-1024
        • Ferrucci L.
        • Bandinelli S.
        • Benvenuti E.
        • et al.
        Subsystems contributing to the decline in ability to walk: Bridging the gap between epidemiology and geriatric practice in the InCHIANTI study.
        J Am Geriatr Soc. 2000; 48: 1618-1625
        • Hawes C.
        • Morris J.N.
        • Phillips C.D.
        • et al.
        Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).
        Gerontologist. 1995; 35: 172-178
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • et al.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the Short Physical Performance Battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55A: M221-M231
        • Al Snih S.
        • Markides K.S.
        • Ray L.
        • et al.
        Handgrip strength and mortality in older Mexican Americans.
        J Am Geriatr Soc. 2002; 50: 1250-1256
        • Rantanen T.
        • Guralnik J.M.
        • Foley D.
        • et al.
        Midlife hand grip strength as a predictor of old age disability.
        JAMA. 1999; 281: 558-560
        • MacIntosh C.
        • Morley J.E.
        • Chapman I.M.
        The anorexia of aging.
        Nutrition. 2000; 16: 983-995
        • Morley J.E.
        Anorexia of aging: Physiologic and pathologic.
        Am J Clin Nutr. 1997; 66: 760-773
        • Morley J.E.
        • Thomas D.R.
        Anorexia and aging: Pathophysiology.
        Nutrition. 1999; 15: 499-503
        • Wilson M.M.
        • Morley J.E.
        Invited review: Aging and energy balance.
        J Appl Physiol. 2003; 95: 1728-1736
        • Chapman I.M.
        • MacIntosh C.G.
        • Morley J.E.
        • Horowitz M.
        The anorexia of ageing.
        Biogerontology. 2002; 3: 67-71
        • Bostick J.E.
        • Rantz M.J.
        • Flesner M.K.
        • Riggs C.J.
        Systematic review of studies of staffing and quality in nursing homes.
        J Am Med Dir Assoc. 2006; 7: 366-376
        • White H.K.
        • McConnell E.S.
        • Bales C.W.
        • Kuchibhatla M.A.
        6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects.
        J Am Med Dir Assoc. 2004; 5: 89-97
        • Donini L.M.
        • Savina C.
        • Piredda M.
        • et al.
        Senile anorexia in acute-ward and rehabilitation settings.
        J Nutr Health Aging. 2008; 12: 511-517
        • Sloane P.D.
        • Ivey J.
        • Helton M.
        • et al.
        Nutritional issues in long-term care.
        J Am Med Dir Assoc. 2008; 9: 476-485
        • Cabrera M.A.
        • Mesas A.E.
        • Garcia A.R.
        • de Andrade S.M.
        Malnutrition and depression among community-dwelling elderly people.
        J Am Med Dir Assoc. 2007; 8: 582-584
        • Simmons S.F.
        • Schnelle J.F.
        A continuous quality improvement pilot study: Impact on nutritional care quality.
        J Am Med Dir Assoc. 2006; 7: 480-485
        • Simmons S.F.
        • Walker K.A.
        • Osterweil D.
        The effect of megestrol acetate on oral food and fluid intake in nursing home residents: A pilot study.
        J Am Med Dir Assoc. 2005; 6: S5-11
        • Raney M.S.
        • Anding R.
        • Fay V.
        • Polk G.
        A pilot study to assess the use of megesterol acetate to promote weight gain in frail elderly persons residing in long-term care.
        J Am Med Dir Assoc. 2000; 1: 154-158
        • Nijs K.
        • de Graaf C.
        • van Staveren W.A.
        • de Groot L.C.
        Malnutrition and mealtime ambiance in nursing homes.
        J Am Med Dir Assoc. 2009; 10: 226-229