Unintentional Weight Loss in Older Adults - 2014 review of Am Fam Physician

Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality.

What are the causes?

The most common etiologies are:

- malignancy
- nonmalignant gastrointestinal (GI) disease
- psychiatric conditions

Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy.

Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Social factors may contribute to unintentional weight loss.

A readily identifiable cause is not found in 16% to 28% of cases.

What tests may be done?

Recommended tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis.

Chest radiography and fecal occult blood testing should be performed. Abdominal ultrasonography may also be considered.

When baseline evaluation is unremarkable, a three- to six-month observation period is justified.

What are the treatment options?

Treatment focuses on the underlying cause. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. Appetite stimulants may increase weight but have serious adverse effects and no evidence of decreased mortality.

References:

Unintentional Weight Loss in Older Adults. Gaddey HL1, Holder K2. Am Fam Physician. 2014 May 1;89(9):718-722.
http://www.ncbi.nlm.nih.gov/pubmed/24784334

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