Managing Appetite Loss and Nausea in Elderly Patients After Injury

Loss of appetite after an injury?

The grandmother (95 years old) experienced gastric bleeding over two years ago and has been taking Nexium 1# HS and Amlodipine (for hypertension) for a long time.
She originally had a good appetite, able to eat a large bowl of porridge in one meal.
However, since her hip fracture, she has been unable to eat and swallow, as her attention is focused on the pain in her leg.
Recently, she underwent surgery for the fracture and had a myocardial infarction, requiring cardiac catheterization (three arteries were completely blocked, and a stent was placed in the RCA).
This has significantly increased her cardiovascular medications.
Due to her leg injury, she spends most of her time in bed.
Recently, she has been experiencing nausea and vomiting.
The cardiologist was informed, and her medications were changed from Aspirin and Clopidogrel to Ticagrelor (which is said to interact with Nexium).
She has some mild wheezing, so Acetylcysteine was added.
However, it is unclear if this is related to the medications, as her nausea and vomiting have become more pronounced and frequent.
Would it be better to switch Nexium to the morning? What recommendations can be made regarding her nausea and vomiting? Are there any tests that can assist in diagnosis (such as abdominal ultrasound or other non-invasive tests)?

CHUN, 30~39 year old female. Ask Date: 2022/03/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is necessary to change the medication to be taken at noon instead of on an empty stomach in the morning, and it may be advisable to schedule an appointment with a gastroenterologist.

Reply Date: 2022/03/04

More Info

Managing appetite loss and nausea in elderly patients, particularly those with complex medical histories, can be quite challenging. In your grandmother's case, her recent injuries and surgeries, along with the medications she is taking, may be contributing to her current symptoms of nausea and decreased appetite.

Understanding the Situation
1. Medical History: Your grandmother has a history of gastrointestinal issues, including a previous episode of gastric bleeding, which necessitated the use of Nexium (esomeprazole), a proton pump inhibitor (PPI). PPIs are effective in reducing stomach acid and preventing ulcers, but they can also lead to gastrointestinal side effects, including nausea, especially when combined with other medications.

2. Recent Surgeries and Medications: The recent hip fracture and subsequent surgery, along with her cardiovascular issues requiring medications like Aspirin, Clopidogrel, and now Ticagrelor, can complicate her overall health status. These medications can also have gastrointestinal side effects, including nausea and vomiting. The addition of Acetylcysteine (Acetin) may also contribute to gastrointestinal discomfort in some patients.

3. Physical Condition: Being mostly bedridden due to her injury can lead to decreased appetite and gastrointestinal motility, further exacerbating her nausea and vomiting.

Recommendations for Managing Nausea and Appetite Loss
1. Medication Review: It is crucial to have a thorough review of all medications your grandmother is taking. Since Ticagrelor may interact with Nexium, it would be wise to discuss with her healthcare provider whether adjusting the timing of these medications could alleviate some of her symptoms. Taking Nexium in the morning instead of at night might help, but this should be confirmed with her physician.

2. Dietary Adjustments: Encourage small, frequent meals rather than large ones. Soft, bland foods that are easy to digest may be more appealing and less likely to provoke nausea. Foods like applesauce, bananas, rice, and toast can be good options. Additionally, ensuring she stays hydrated is essential, even if she is not feeling hungry.

3. Nausea Management: If nausea persists, consider discussing the possibility of anti-nausea medications with her healthcare provider. Medications like ondansetron or metoclopramide can be effective in managing nausea, especially if it is medication-induced.

4. Non-Pharmacological Approaches: Non-drug interventions can also be beneficial. Ginger tea or ginger candies are known to help with nausea. Acupressure wristbands may also provide relief for some individuals.

5. Monitoring and Follow-Up: Regular follow-up with her healthcare team is essential. If her symptoms do not improve, further evaluation may be necessary. Non-invasive imaging, such as an abdominal ultrasound, can help assess for any underlying issues that may be contributing to her nausea and vomiting.

6. Physical Activity: If her condition allows, gentle physical activity, such as sitting up in bed or short walks, can help stimulate appetite and improve gastrointestinal function.

Conclusion
In summary, managing your grandmother's appetite loss and nausea involves a multifaceted approach that includes medication review, dietary adjustments, and possibly the introduction of anti-nausea medications. Close communication with her healthcare providers is essential to tailor her treatment plan effectively. Regular monitoring and adjustments based on her response to treatment will be key to improving her quality of life during her recovery.

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