Evaluating and treating unintentional weight loss in the elderly,healthy crash diets to lose weight fast vegetarian,2 month exercise plan to lose weight - Try Out

Sudden, unintentional weight loss in the elderly can signify a number of underlying medical concerns. It can be difficult to determine which came first, the medical complications or the weight loss. A sudden weight loss of more than 10 percent of a person's body weight can signal more serious complications. Metabolism slows down with age, meaning seniors don't need to eat as many calories as they previously consumed.
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In her article Evaluating and Treating Unintentional Weight Loss in the Elderly, medical doctor Grace Brooke Huffman warns that elderly patients who lose weight suddenly are at greater risk of developing other conditions as well. Grace Brooke Huffman explains that there is a strong correlation between the quality of life and quick, unintentional weight loss.
While sudden weight loss can lead to depression, for example, an altered state of mind can reduce appetite and the desire to eat. Caregivers should watch for signs of quick weight loss that could signify cancer, hyperthyroidism or liver disease. The leading causes of involuntary weight loss are depression (especially in residents of long-term care facilities), cancer (lung and gastrointestinal malignancies), cardiac disorders and benign gastrointestinal diseases. In evaluating weight loss in the patient who resides in a long-term care facility, the physician may have to address some issues that can be unique to institutional care.Interviews with the caregivers and the dietary staff of the facility are crucial to understanding the problem.
While the work-up is proceeding or if a cause is not well defined, the goal is to prevent further weight loss. Reprints are not available from the author.The authors indicate that they do not have any conflicts of interest.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Decreased mobility, medications, state of mind and financial difficulties can all contribute to sudden weight loss. The psychological state can be directly caused by medication or other illness or may be due to feelings of uselessness and fear of death. According to the AGS Foundation for Health in Aging, caretakers and family members can reduce the impact of the decrease in appetite and avoid sudden weight loss by monitoring a senior's diet.


Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. The risk of mortality was significantly higher in the men who lost weight than in those whose weight did not decrease.
The staff should have a good grasp of the patient's ability to chew foods of various consistencies, to feed himself or herself, and to attend to the various tasks involved in eating.Many facilities have high rates of staff turnover or inconsistent staffing levels, and mealtimes may be affected.
Initiating nutritional support early may help to avoid some of the complications related to weight loss.28The contributions of dietitians, speech therapists (for oropharyngeal and swallowing evaluations) and social services personnel cannot be overestimated because the efforts of these staff can improve many strategies to increase food intake.
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Lack of social interaction, loneliness and inability to participate in regular activities can also lead to depression. Their immune systems can become severely compromised, making them more at risk for developing infections.
High calorie supplements such as milkshakes, cheese and whole grains can help maintain proper weight. The staff may feel pressure from regulatory agencies to feed residents within a certain amount of time. For women, healthy weight is considered to be 100 pounds for the first 5 feet and 5 pounds for every inch over that. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss.
Consequently, the total caloric intake of a patient may be compromised.Creative strategies are often needed when weight loss is due to environmental issues. A reasonable work-up includes tests dictated by the history and physical examination, a fecal occult blood test, a complete blood count, a chemistry panel, an ultrasensitive thyroid-stimulating hormone test and a urinalysis. In some instances, weight loss in these patients with diabetes mellitus may reflect overzealous blood glucose control. One strategy would be to have the patient's meals served in a quieter room, or at a slightly different time, to minimize confusing situations. Also, family members may sometimes be more successful than nursing assistants in encouraging a patient to eat.Although the setting may be contributory, the physician should not simply assume that environmental factors are responsible for unintentional weight loss in an institutionalized elderly patient. Large portions may be overwhelming and may actually discourage intake.When possible, physical exercise and even physical therapy should be encouraged because increased activity has been shown to promote appetite and food intake. Consideration should be given to the patient's environment and interest in and ability to eat food, the amelioration of symptoms and the provision of adequate nutrition. One study30 found that caloric intake was greater in patients who received both nutritional supplements and exercise than in patients who received only supplements.When liquid calorie supplements are used, they should not be given with meals. Food and Drug Administration has labeled no appetite stimulants for the treatment of weight loss in the elderly.
It should be possible to determine if the patient is predominantly not hungry or is feeling nauseated (or even vomiting) after meals, if the patient is having difficulty eating or swallowing, or if the patient is having functional or social problems that may be interfering with the ability to obtain or enjoy food.
Food and Drug Administration has not labeled any of these drugs for use in elderly patients with weight loss.Treatment of depression may, in and of itself, cause weight gain. Accurate evaluation is essential, however, because this problem is associated with increased morbidity and mortality.1,2 When a patient has multiple medical problems and is taking several medications, the differential diagnosis of unintentional weight loss can be extensive.
A combination of these factors may be present.An interview with a knowledgeable care-giver is essential because the elderly patient may deny or be unaware of the weight loss or the aforementioned difficulties. Mirtazapine (Remeron) has been shown to increase appetite and promote weight gain while also treating the underlying depression.33Dronabinol (Marinol) is a cannabinoid indicated for the treatment of anorexia with weight loss in patients with acquired immunodeficiency syndrome (AIDS).


If the patient's measured weights over time are not available, the caregiver may be able to estimate the amount of weight that the patient has lost through changes in the patient's clothing size.A nutritional assessment should be performed.
The dietary history includes the availability of food, the patient's use of nutritional (and herbal) supplements, the adequacy of the patient's diet (amount of food consumed, balance of nutrients, etc.) and the patient's daily caloric intake. Lower dosages may be effective for stimulating weight gain in frail elderly patients, although this approach needs to be tested in randomized controlled trials.
In one study,37 patients (median age: 65 years) who received cyproheptadine had a decrease in their rate of weight loss but no weight gain. Functional and mental status should be reviewed with the patient and family members and other caregivers. However, this hormone is extremely expensive, and its adverse effects include carpal tunnel syndrome, headache, arthralgias, myalgias and gynecomastia.41Although medications may help promote appetite and weight gain in an elderly patient with unintentional weight loss, drugs should not be considered first-line treatment.
Even if drugs are successful in inducing weight gain, long-term effects on quality of life are unknown.FEEDING TUBESContinued weight loss necessitates a discussion with the patient or family members about whether long-term tube feeding is desired. The physician needs to understand the patient's wishes about prolonging life and maximizing function and comfort.
For the missing item, see the original print version of this publication.A review of systems can reveal problems with specific organ systems.
Questions directed at identifying symptoms related to the pulmonary and digestive systems are important because lung and gastrointestinal cancers are the malignancies most likely to be implicated in unexpected weight loss. One study,26 although not performed in the elderly, found that simply asking the patient if he or she is depressed and has recently lost pleasure in doing things can reliably screen for depression.PHYSICAL EXAMINATIONThe physical examination of an elderly patient with unintentional weight loss is directed by the information gathered during the history-taking process.
It is particularly important to evaluate the oral cavity and the respiratory and gastrointestinal systems.Anthropometric measurements, specifically height and weight, are of prime importance and should be compared to minimum and maximum adult weights.
The patient's body mass index (BMI) can be calculated by dividing the patient's weight in kilograms by the square of the patient's height in meters. In one study27 it was found that a BMI of less than 22 kg per m2 in women and less than 23.5 in men is associated with increased mortality. As mentioned previously, formal assessment of mood may be necessary,25 particularly if the initial screen for depression is positive.Often, clues to the etiology of unintentional weight loss can be obtained by watching a patient eat part of a meal. For example, the patient may be distracted by stimuli in the room or by too many items of food on the plate. Initial targeted studies can determine the cause in many patients.1,17The findings of the history and physical examination guide the initial diagnostic assessment. Some diagnostic modalities, such as computed tomographic (CT) scanning, have particularly low yields. In one series,14 CT scanning provided no new information beyond confirming one cancer that was already suspected.
Hence, a patient with a low albumin level is not necessarily malnourished or losing weight.
Similarly, prealbumin and transferrin levels may reflect nutritional status, but they can also be abnormal in elderly patients with chronic illnesses.29If the decision is made to provide nutritional supplementation in a patient with unintended weight loss, the serum prealbumin, transferrin or albumin level can be used to guide supplement selection.



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