David R. Thomas, MD, FACP, FAGS
John E. Morley, MB, ChB
Division of Geriatric Medicine
Saint Louis University Health Sciences Center and
GRECC, Veterans Administration Center
Saint Louis, MO, USA.

Abstract
Unintentional weight loss is a common problem among older adults, especially those in institutional settings. Physicians respond by prescribing increased oral calories, prescribing nutritional supplements or by considering enteral feeding. The response of patients to these interventions is often poor. For this reason, pharmacological agents that stimulate appetite or produce weight gain have attracted considerable attention. Should these agents be used? This review focuses on the benefits and risks of these orexigenic agents.

Introduction
Malnutrition is a major problem among residents in long-term care facilities.^1-4 The prevalence of protein-energy malnutrition in nursing home residents ranges from 23-85%.5,6 By comparison, the prevalence of protein-energy malnutrition ranges from 32-50% in acutely hospitalized patients.^7,8 The high prevalence of malnutrition in nursing homes may reflect a unique problem in elderly persons, the presence of chronic conditions, failure to address specific nutritional problems in this setting, or transfer of malnourished patients from acute care hospitals to long-term care facilities following an acute illness.