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March 21, 2007

Frail Older Adults and Palliative Care—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(11):1193-1195. doi:10.1001/jama.297.11.1194-c

In Reply: Dr Finucane rightly points out that the evidence for megestrol benefit is very limited for older adults with weight loss. Unfortunately, in many cases appetite and weight loss are high-priority concerns of patients or their families. In this situation, it may be helpful for clinicians to explain that the cause of weight loss usually is not starvation or inadequate intake but poorly understood metabolic dysregulation. Clinicians may still feel pressured by patients or families to offer any weight loss antidote available, and megestrol may be appropriate to prescribe under these circumstances. Clinicians would be extrapolating from existing evidence of megestrol benefit in patients with cancer,1 many of whom are older, frail, and receiving palliative care.