A Synopsis of:
Unintentional Weight Loss in Older Adults
HEIDI L. GADDEY, MD, Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, Nebraska KATHRYN HOLDER, MD, David Grant Medical Center, Travis Air Force Base, California
Am Fam Physician. 2014 May 1;89(9):718-722.
http://www.aafp.org/afp/2014/0501/p718.pdf
Unintentional weight loss is defined as a 5% weight reduction within 6-12 months. It is associated with a decline in ADLs, increased hip fractures, and elevated morbidity and mortality. Since it is nonspecific, it is difficult to determine the etiology. Causes include malignancy, GI disease, medication side effect, polypharmacy, or psychiatric issues. Social factors include alcoholism, financial problems. poverty, isolation, and problems obtaining/ preparing food. A mnemonic is the 9 D's of weight loss in the elderly (dementia, dentition, depression, diarrhea, disease, drugs, dysfunction dysgeusia, and dysphasia). A nutritional evaluation can be completed using the nutritional health checklist found HERE. Depression and dementia questionnaires are also helpful. Recommended test to order include CBC, BMP, LFTs, thyroid function tests, CRP, ESR, glucose, UA, and LDH (CRP, hemoglobin, LDH and albumin are particularly high yield). If these baseline tests are normal then further workup is unnecessary. In this case, a close follow up is all that is required.
Treatment consists of treating the underlying problem. Diet modification including softer food, assisted feeding, or nutritional supplementation may help. Medications that stimulate appetite include megestrol, mirtazapine, cyproheptadine and dronabinol, which may be beneficial.
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