Alessandra Imoscopi

Taste loss in the elderly: epidemiology, causes and consequences

Taste disorders are common among older people and may have serious consequences on their health status: each of the five main flavors (salty, sweet, sour, bitter and umami) has a specific function and a declining taste acuity or taste loss predisposes the elderly to a higher risk of developing certain diseases. Taste disorders often go unrecognized or underestimated in elderly people, however, and there is little medical literature on this issue. This study focused on analyzing the existing literature, paying particular attention to the causes of taste disorders in the elderly and their potential consequences. The most common causes of taste disorders are drug use (21.7%), zinc deficiency (14.5%) and oral and systemic diseases (7.4% and 6.4%, respectively). All these factors can have a negative effect on gustatory system deficiencies due to physiological changes associated with aging. Elderly people are liable to have several chronic diseases and to routinely need multiple medications, and this carries a particular risk of taste disorders or severe loss of the ability to taste the five basic flavors. It is noteworthy that the most useful drugs for treating chronic diseases typical of the elderly are also a potential cause of taste disorders, so periodically reviewing pharmacological therapies is not just a matter of good clinical practice, but also helps to prevent or contain taste disorders. Assessing gustatory function should be a part of any comprehensive geriatric assessment, especially in elderly hospital outpatients or inpatients, or institutionalized cases, with severe conditions that require multiple pharmacological therapies, as well as in elderly patients who are malnourished or at risk of malnutrition, with a view to limiting the modifiable causes of taste disorders.

Taste loss in hospitalized multimorbid elderly subjects

Background Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss. Methods The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively), and taste recognition thresholds were measured in both groups. Results In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P < 0.05). Low citric acid sensitivity was independently associated with advanced age (≥75 years; odds ratio [OR] 3.01, 95% confidence interval [CI] 1.01–9.82), polypharmacy (number of prescribed drugs ≥ 4; OR 2.74, 95% CI 1.01–7.72), and poor nutritional status (as assessed by Mini Nutritional Assessment score < 23.5; OR 5.08, 95% CI 1.76–14.6). Conclusion Because gustatory impairment may reduce a person’s appetite and lead to inadequate dietary intake, compensatory nutritional measures, such as the use of flavor-enhanced foods, should be strongly encouraged, particularly in the hospital setting.

Changes in healthy elderly women's physical performance: A 3-year follow-up

BACKGROUND Inflammatory states, hypovitaminosis D and secondary hyperparathyroidism may have a role in the age-related loss of muscle mass, and physical performance in healthy old people. The aim of this study is to investigate changes in muscle mass, strength and physical performance in healthy, active elderly females over a 3-year follow-up, correlating them with any inflammatory states and PTH and 25-hydroxyvitamin D (25-OHD) levels. METHODS One hundred healthy females over 65 years of age routinely attending a twice-weekly mild fitness program were eligible for the study. Clinical history, serum parameters, body composition by DEXA, handgrip strength, knee extensor isometric/isotonic strength and functional performance measured using the Short Physical Performance Battery (SPPB) were evaluated at the baseline and after 3 years. RESULTS After 3 years, the women had a significant decrease in weight (∆:-0.8±3.1 kg; p<0.05) and height (∆:-0.4±0,6 cm; p<0.001), while their BMI and body composition parameters did not change. Only IL-6 (∆: 0.6±2.0; p<0.01) and PTH (∆: 30.7±29.2 ng/L; p<0.001) increased significantly, while there were no changes in 25-OHD levels. There was a significant decrease in all the SPPB results and in muscle strength. ∆ PTH only correlated with the variation in 4-meter walking speed (r: 0.41; p<0.01). CONCLUSIONS With advancing age, physical performance declines even in healthy, active females despite a spare of muscle mass. The increase in PTH seems to have a role in this decline, that could be clarified by further investigations.

Association Between Serum 25-Hydroxyvitamin D Levels, Bone Geometry, and Bone Mineral Density in Healthy Older Adults

PURPOSE The association between serum 25-hydroxyvitamin D values and cortical/trabecular bone parameters in older adults has been incompletely explored. This study was designed to investigate the relationship between serum 25-hydroxyvitamin D levels and bone parameters for the tibia and radius using peripheral quantitative computed tomography in free-living healthy older adults. METHODS The study involved 134 older adults attending a twice-weekly low-intensity fitness program. In addition to clinical history and serum parameters, we assessed fat-free mass using dual-energy X-ray absorptiometry, total bone and cortical bone cross-sectional areas, and trabecular and cortical bone mineral density for the tibia and radius by peripheral quantitative computed tomography. RESULTS After applying multivariate linear regression models, adjusting for sex, age, body mass index, fat mass and fat-free mass, and creatinine, the association between 25-hydroxyvitamin D and bone parameters was significant for total bone and cortical bone cross-sectional areas in the radius (partial R (2) = 0.05 and 0.09, respectively) and for trabecular bone mineral density and cortical bone cross-sectional area in the tibia (partial R (2) = 0.11 and 0.02, respectively). CONCLUSION These findings support the idea that serum 25-hydroxyvitamin D levels and bone parameters are linked in older adults. Longitudinal studies are needed to establish whether vitamin D levels over time are associated with changes in these parameters.

A retrospective pilot study on the development of cognitive, behavioral and functional disorders in a sample of patients with early dementia of Alzheimer type.

This pilot study retrospectively analyzes the evolution of cognitive-behavioral symptoms and functional autonomy in a sample of patients with early diagnosis of probable Alzheimers disease (AD). One hundred patients with early mild cognitive impairment (MCI) were considered and submitted to a multidimensional evaluation: the 53% presented probable AD. These 53 subjects were evaluated for cognitive performance by using the mini mental examination (MMSE), behavioral functions by the neuropsychiatric inventory (NPI) and functional dependence by the activities of daily living (ADL) and the instrumental ADL (IADL) scales at basal time and after 6-12 months. Results were analyzed according to the duration of therapy with acetyl-cholinesterase inhibitors (ACHEI) and to the timing of the beginning with respect to the diagnosis. AD patients treated with ACHEI at the moment of the diagnosis, showed a statistically significant improvement in MMSE (2.7+/-1.5) after 6 months (p=0.012) which was maintained even after 12 months. Subjects beginning ACHEI at the visit of 6 months showed a statistically worsened MMSE, even after 6 months of therapy (-2.8+/-1.7, p=0.026). We conclude that the timing of administration of ACHEI therapy in mild AD is essential to obtain beneficial effects on cognitive decline.