'Wasting away' of the old old: can it--and should it--be treated?

Asthenia/cachexia, a syndrome which may manifest as a "wasting away," is growing in importance as the number of those ages 75 to 85 and over 85 increases. The syndrome has clearly identifiable laboratory abnormalities, a multitude of etiologic factors, and serious consequences. Accurate diagnosis of the causative agent is often difficult, since asthenia/cachexia is associated with aging, acute disease, and chronic disease. In addition, empiric treatment is often unpleasant and causes grief to families attempting to provide humane care for parents and grandparents at the end of life. The goal of the practitioner is to identify and intervene judiciously in the progressive deterioration of individuals who develop asthenia/cachexia and its complications.