Jan 20, 2018
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Unintended Weight Loss in the Elderly

Unexplained weight loss, or losing weight without trying, particularly if it’s significant or persistent, may be a sign of an underlying medical disorder (1).  The point at which unexplained weight loss becomes a medical concern is not exact. But many doctors agree a loss of approximately 5 to 10 percent of body weight in the previous one to 12 months may indicate a problem in an elderly patient. This degree of weight loss should not be considered a normal part of the aging process (2).  Significant weight loss has been associated with a decline in functional status, quality of life, and with increased morbidity and mortality (5).

The most commonly identified causes of elders’ unintentional weight loss are depression, cancer and gastrointestinal disorders (2,5).  Pulmonary disease, cardiac disorders (e.g., congestive heart failure), dementia, alcoholism and prescription medications have also been implicated in the problem (2,5).   Although acute and chronic physical and psychiatric disorders account for unexplained weight loss in most elderly patients, other psychologic and social factors may be involved (2,5).  No cause is found in about one quarter of patients (2,5).  Several tools have been developed to aid medical professionals in remembering the multiple etiologies of unintentional weight loss. These include the mnemonic Meals on Wheels (3).   Another tool is the 9 D’s of weight loss in the elderly (dementia, dentition, depression, diarrhea, disease [acute and chronic], drugs, dysfunction [functional disability], dysgeusia [taste changes], dysphagia) (3).

“Meals on Wheels”: A Mnemonic for Common Treatable Causes of Unintentional Weight Loss in the Elderly

M            Medication effects

E              Emotional problems, especially depression

A             Anorexia nervosa, alcoholism

L              Late-life paranoia

S              Swallowing disorders

O             Oral factors (e.g., poorly fitting dentures, caries)

N             No money

W            Wandering and other dementia-related behaviors

H             Hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoadrenalism

E              Enteric problems

E              Eating problems (e.g., inability to feed self)

L              Low-salt, low-cholesterol diet

S              Stones, social problems (e.g., isolation, inability to obtain preferred foods)

 

Inflammation is your body’s first line of defense against toxins, infections and injuries.  When your cells are in distress, they release chemicals to alert the immune system. The immune system sends its first responders, inflammatory cells, to trap the offending substance or heal the tissue.  These symptoms might be uncomfortable, but they are essential for the healing process.  The problem with inflammation is if it continues over time, you can end up with too much of a good thing. With chronic inflammation, your body is on high alert all the time.  This prolonged state of emergency can cause lasting damage to your heart, brain and other organs.  Several of the diseases listed in the MEALS ON WHEELS have an inflammation component.  Inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1 β and interleukin-6 have been implicated in cachexia and weight loss (4).   Historically termed cachectin, TNF-α is considered one of the more prominent cytokines and is thought to be a primary mediator of the muscle wasting of cachexia; it is also believed to act together with interleukin-1 β to promote cachexia.  Cytokines may act both centrally, by inhibiting feeding behavior, and peripherally, by slowing gastric movement, gastric emptying and intestinal motility and by modifying gastric secretion (4).  Tumor necrosis factor-α levels are increased in several human disease states associated with cachexia and weight loss, including malignancy, AIDS, heart failure, rheumatoid arthritis, and chronic obstructive pulmonary disease.

To help measure nutritional risk, and allow medical professionals to intervene more quickly, the Mini Nutritional Assessment was developed and validated (3).   This tool, which is available at http://www.mna-elderly.com/mna_forms.html  involves anthropometric measurements and general, dietary, and subjective assessments (3).  Scoring allows categorization of older adults as well-nourished (normal), at risk, or malnourished (3).  When categorized, the medical team can intervene more quickly, appropriately, and clearly.   Your Nutrition Care Systems dietitian has the resources and tools to communicate with the other team members and even incorporate the Mini Nutritional Assessment Tool into your facility’s documentation.

 

 

  1. Definition of Unexplained weight loss. Mayo Clinic online. https://www.mayoclinic.org/symptoms/unexplained-weight-loss/basics/definition/sym-20050700. Accessed 11/7/17
  2. G. Huffman. Evaluating and Treating Unintentional Weight Loss in the Elderly. Am Fam Physician.2002 Feb 15;65(4):640-651.
  3. H. Gaddey, K. Holder. Unintentional Weight Loss in Older Adults. Am Fam Physician.2014 May 1;89(9):718-722.
  4. S. Stajkovic, et al. Unintentional weight loss in older adults. Canadian Medical Assoc Journal. 2011 Mar 8; 183(4): 443–449.
  5. Karen L. Smith, MSc; Carol Greenwood, PhD; Helene Payette, PhD; Shabbir M.H. Alibhai, MD, MSc. An Approach to the Nonpharmacologic and Pharmacologic Management of Unintentional Weight Loss Among Older Adults. Geriatrics and Aging. 2007;10(2):91-98.

 

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