Upper gastrointestinal studies (radiography or endoscopy) may be warranted in patients with symptoms referable to the gastrointestinal system or in patients with persistent weight loss. Though some weight loss can be a normal part of aging, losing a substantial amount of weight over a short period of time can be a sign of an underlying condition. 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. A Mayo Clinic expert explains. The medical and surgical histories should specifically focus on the role of the following: previous gastrointestinal conditions or surgeries (looking for evidence of malabsorption), renal, hepatic, cardiac and respiratory diseases (looking for evidence of organ failure), rheumatologic diseases (chronic inflammation), recurrent infections and previous major psychiatric illnesses. Evaluation of the oral cavity and dentition may indicate difficulty with chewing or swallowing. Rheumatoid arthritis: Can it affect the eyes? If so, be sure to tell your health care provider about these symptoms as well. In: Ferri's Clinical Advisor 2022. Thyroid disease: Can it affect a person's mood? Diabetes diet: Create your healthy-eating plan. other information we have about you. Consistent findings from multiple prospective cohort studies with good follow-up. Interviews with the caregivers and the dietary staff of the facility are crucial to understanding the problem. Here are some critical questions doctors may ask: Its helpful for doctors to understand psychological and social factors in the patients life, such as dementia, depression, social isolation, and income status. However, this hormone is extremely expensive, and its adverse effects include carpal tunnel syndrome, headache, arthralgias, myalgias and gynecomastia.41. Mayo Clinic; 2021. Changes to your body can affect your ability to feel hunger and could cause a loss of appetite. Tricyclic antidepressants and tetracyclic antidepressants, Ulcerative colitis flare-ups: 5 tips to manage them. The 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. All rights reserved. The use of formal screening instruments for depression, such as the Geriatric Depression Scale,25 may be necessary in the elderly patient with unintentional weight loss. This content is owned by the AAFP. Find out when losing weight without trying calls for a medical evaluation. What is cirrhosis? This content does not have an Arabic version. Dr. Danny Branstetter, Chief Medical Officer at . Vegetarian diet: Can it help me control my diabetes? Diabetes management: How lifestyle, daily routine affect blood sugar, Diabetes prevention: 5 tips for taking control. MAOIs and diet: Is it necessary to restrict tyramine? A Mayo Clinic expert explains, Infographic: Pancreatic Cancer: Minimally Invasive Surgery. Does stress make rheumatoid arthritis worse? A review of systems to detect acute illness or worsening chronic conditions is important and should pay particular attention to cardiovascular, respiratory, and gastrointestinal symptoms (Table 3). Unintentional weight loss in older adults. Rheumatoid arthritis: Does pregnancy affect symptoms? Gastrointestinal disorders. That can cause many symptoms, such as weight loss, hand tremors, and rapid or irregular heartbeat. Copyright 2023 American Academy of Family Physicians. J Am Geriatr Soc. Key terms: unintentional, involuntary, weight loss, geriatric, elderly, appetite stimulants, cachexia/drug therapy, and nutrition. If 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. You may opt-out of email communications at any time by clicking on Natural remedies for depression: Are they effective? A Mayo Clinic expert explains. All rights reserved. If so, the first thing to do is to learn about the causes of rapid weight loss in the elderly. [1] It is a diagnostic challenge because, while an underlying illness may be found after a thorough history and . Potential causes of unexplained weight loss include. Male depression: Understanding the issues. Im also concerned about weight loss that is slow and progressive.. Get useful, helpful and relevant health + wellness information. Whatever approach is used, the initial evaluation can yield a reason for weight loss in a large number of patients.17. A loss or reduction of taste or smell. Blood sugar levels can fluctuate for many reasons, Bone and joint problems associated with diabetes, Dr. Mark Truty (surgery, MN) better outcomes with chemo, Infographic: Cancer Clinical Trials Offer Many Benefits, Cancer survivors: Care for your body after treatment, Cancer survivors: Late effects of cancer treatment, Cancer survivors: Managing your emotions after cancer treatment, Cancer treatment decisions: 5 steps to help you decide. Consequently, the total caloric intake of a patient may be compromised. Thyroid disease: Can it affect a person's mood? Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Australian researchers found an unintentional weight loss of 5% to 10% body weight in seniors age 70 and older raised a person's risk of dying. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091909/), (http://www.alzbrain.org/pdf/handouts/2023.%20%20WEIGHT%20LOSS%20IN%20THE%20DEMENTIA%20PATIENT.pdf), Dental issues, including poorly fitting dentures, bad teeth, mouth sores/ulcers. Let our care assessment guide you Our free tool provides options, advice, and next steps based on your unique situation. However, none are specifically indicated for the treatment of weight loss in elderly patients, and few have been studied in this population.32 The U.S. Food and Drug Administration has not labeled any of these drugs for use in elderly patients with weight loss. Copyright 2023 American Academy of Family Physicians. Diabetes diet: Create your healthy-eating plan. information and will only use or disclose that information as set forth in our notice of Ferri FF. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. The differential diagnosis of unintended weight loss in the elderly can be extensive. Seasonal affective disorder treatment: Choosing a light box, Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), Small cell, large cell cancer: What this means, What is stomach cancer? Human growth hormone has been associated with increased mortality.17. 2 This would mean a 10-pound loss in a 200-pound man, or losing between 6 and 7 pounds for a 130-pound woman. Also, family members may sometimes be more successful than nursing assistants in encouraging a patient to eat. The digestive system receives less blood, causing problems with digestion. Copyright 2002 by the American Academy of Family Physicians. Adding flavor enhancers that amplify the intensity of food odor may be useful in patients with hyposmia.13 Pureed foods and thickened liquids may be needed in patients with dysphagia. Our advisors help 300,000 families each year find the right senior care for their loved ones. Some causes of unintentional weight loss include: Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Under normal circumstances, dumping syndrome is not dangerous or life-threatening. Is depression a factor in rheumatoid arthritis? Causes Diagnosis Treatment Cardiac cachexia is a condition that can happen to people who have heart failure. These include the mnemonic Meals on Wheels (medication effects; emotional problems, especially depression; anorexia nervosa; alcoholism; late-life paranoia; swallowing disorders; oral factors, such as poorly fitting dentures and caries; no money; wandering and other dementia-related behaviors; hyperthyroidism, hypothyroidism, hyperparathyroidism, and hypoadrenalism; enteric problems; eating problems, such as inability to feed oneself; low-salt and low-cholesterol diet; stones; social problems, such as isolation and inability to obtain preferred foods).20 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, dysphagia).21. Mayo Clinic does not endorse companies or products. Your ability to absorb nutrients from the food you eat also affects your weight. You may opt-out of email communications at any time by clicking on What is ulcerative colitis? Most communities, especially nursing homes, measure weight and vitals regularly. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information. If other health problems are suspected to contribute to weight loss, they need to be identified and treated. Staff at assisted living communities tend to develop close relationships with residents, so it is unlikely for drastic changes in weight or eating habits to go unnoticed. Organic disease was identified in 57 patients, and 16 patients had a psychiatric diagnosis. 1) You have a gut disease. Also searched were Essential Evidence Plus, the Agency for Healthcare Research and Quality evidence reports, Clinical Evidence, Google Scholar, and the Cochrane database. Gaddey HL, et al. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. References from those sources were also searched. Unintentional weight loss in older adults., British Medical Journal. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, 6 tips to manage rheumatoid arthritis symptoms. information is beneficial, we may combine your email and website usage information with What causes unexplained weight loss? This loss is offset by gains in fat mass that continue until 65 to 70 years of age. Glycemic index: A helpful tool for diabetes? 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://academic.oup.com/ajcn/article/71/2/637S/4729339). Dental problems or tooth pain. the unsubscribe link in the e-mail. How much weight loss is considered dangerous? Learn more about the causes of sudden weight loss in seniors and the steps you can take to keep your family member healthy. The point at which unexplained weight loss becomes a medical concern is not exact. Review/update the Another study7 found a 13.1 percent annual incidence of involuntary weight loss in outpatient male veterans older than 64 years of age. information submitted for this request. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Second, older adults often have chronic conditions such as arthritis, Parkinson's disease or diabetes that can . The physical examination of an elderly patient with unintentional weight loss is directed by the information gathered during the history-taking process. Diabetic neuropathy and dietary supplements. The risk of mortality was significantly higher in the men who lost weight than in those whose weight did not decrease. A thorough review of medications may reveal that the patient is suffering from polypharmacy, which is known to interfere with taste and cause anorexia.18,22 Many individual medications have been associated with unintentional weight loss.13 These include some selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac).23 Other SSRIs may have a lesser anorectic effect, but patients taking those drugs should still be followed closely. High-dose vitamin C: Can it kill cancer cells? Skip to content Care at Mayo Clinic Care at Mayo Clinic About Mayo Clinic Request Appointment Find a Doctor Clinical Trials 2009; Apr 15;(2):CD007209. The physical examination can aid in evaluating concerns prompted by history findings. The history should also identify prescription and over-the-counter medications and herbal supplements that may be affecting appetite or contributing to weight loss. Helicobacter pylori (H. pylori) infection. Abnormal weight loss. The weight loss occurs without any attempt to lose weight, such as cutting the calories you eat or starting to . 2021; doi:10.1016/j.mcna.2020.08.019. Mayo Clinic; 2021. How do I reduce fatigue from rheumatoid arthritis? Consistent findings from two prospective trials. Multiple studies, prospective and retrospective and in inpatient and outpatient settings, have demonstrated that the most common etiologies are malignancy (19% to 36%), nonmalignant gastrointestinal disease (9% to 19%), and psychiatric conditions such as depression and dementia (9% to 24%). Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone. https://www.uptodate.com/contents/search. Is depression a factor in rheumatoid arthritis? Approach to patients with unintended weight loss. Definition By Mayo Clinic Staff Unexplained weight loss, or losing weight without trying particularly if it's significant or ongoing may be a sign of a medical disorder. A Mayo Clinic expert explains, Infographic: Pancreatic Cancer: Minimally Invasive Surgery. Baseline investigations include laboratory studies and imaging. 02 What is sudden weight loss for seniors? Rapid, unintended weight loss in an elderly loved one could be a sign of a serious health problem. This is especially true of the patient with dementia. Liquid oral supplements allow for rapid gastric emptying and can be given two hours before a meal.29 Flavor enhancers such as ham, natural bacon, and roast beef flavors sprinkled on cooked food or added during food preparation may improve food consumption and weight gain, but study results have been mixed.3234, Several medications to stimulate appetite are available, but none have been shown to reduce mortality in older patients with unintentional weight loss.17,27 Megestrol (Megace), the most commonly studied medication, has been shown to improve appetite and increase weight gain in patients with cancer and AIDS cachexia35; however, studies in older patients are limited, and there are insufficient data to define an optimal dose.27,35 Adverse effects of megestrol include gastrointestinal upset, insomnia, impotence, hypertension, thromboembolic events, and adrenal insufficiency. Rheumatoid arthritis: Can it affect the eyes? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. How to tell if a loved one is abusing opioids, Infographic: Innovative Rectal Cancer Treatments. See permissionsforcopyrightquestions and/or permission requests. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. A Mayo Clinic expert explains, No appetite? I'm not always physically able to shop, cook, or feed myself. Dr. Fabius recommends his patients weigh themselves twice weekly, with assistance from caregivers or family members if necessary. Diabetes foods: Can I substitute honey for sugar? Approach to patients with unintended weight loss. The findings of the history and physical examination guide the initial diagnostic assessment. Lack of appetite, nausea. Salt craving: A symptom of Addison's disease? I have tooth or mouth problems that make it hard for me to eat. Epub 2014 Jul 17. If weight loss is a concern when the resident moves in,staff will likelycheck their weight weekly or more. Often, clues to the etiology of unintentional weight loss can be obtained by watching a patient eat part of a meal. Polypharmacy can cause unintended weight loss, as can psychotropic medication reduction (i.e., by unmasking problems such as anxiety). Does stress make rheumatoid arthritis worse? Lean body mass begins to decrease up to 0.7 lb (0.3 kg) per year in the third decade. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. information highlighted below and resubmit the form. I have an illness or condition that made me change the kind or amount of food I eat. Amyloidosis. All current prescription and over-the-counter medications and supplements should be reviewed. When cancer returns: How to cope with cancer recurrence, Fecal transplant treatment of C. difficile at Mayo Clinic, Mayo Clinic study reporting increased incidence of C. difficile infection. In: Ferri's Clinical Advisor 2022. Doctors often call. Anabolic steroids and agents with anabolic properties (e.g., oxandrolone [Oxandrin] and ornithine) have been used with some success to treat wasting syndrome in patients with AIDS and cachexia in patients with cancer.39,40 However, these agents have not been tested in the elderly. This content does not have an Arabic version. Vegetarian diet: Can it help me control my diabetes? About 15% to 20% of seniors experience sudden weight loss, according to theCanadian Medical Association Journal. Less common conditions that may include weight loss as one of the symptoms are: Causes shown here are commonly associated with this symptom. The treatment of unintentional weight loss is directed at the underlying causes. American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. A thorough evaluation should still be performed. 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. A baseline evaluation for unexplained, unintentional weight loss in older adults includes history, physical examination, laboratory tests, chest radiography, fecal occult blood testing, and possibly abdominal ultrasonography. This content does not have an English version. health information, we will treat all of that information as protected health Diabetic neuropathy and dietary supplements. Artificial sweeteners: Any effect on blood sugar? Natural remedies for depression: Are they effective? Diabetes diet: Should I avoid sweet fruits? Individuals with Alzheimer's disease may lose weight because they may burn more calories than elderly people without the disease. There is a problem with Treatment focuses on the underlying cause. Physical causes of a loss of appetite. Accessed May 25, 2022. Senior care facilities often keep track of factors contributing to your loved ones sudden weight loss as part of their regular services. Cochrane Database Syst Rev. It might be caused by a stressful event like a divorce, losing a job, or the death of a loved one. How to tell if a loved one is abusing opioids, Infographic: Innovative Rectal Cancer Treatments. Confusion, impaired thinking. 2021;104:34. If baseline test results are negative, close observation for three to six months is justified. Medications are often reviewed as the first step in determining the cause of weight loss. Nutritional supplements should provide extra calories but not replace scheduled meals. "Diseases of the bowel will generally include some sort of additional symptoms, like decreased appetite,. Merck Manual Professional Version. Patients may benefit simply from being offered frequent small servings of foods that they like. Causes of Weight Loss in the Elderly Loss of Appetite + Lower Intake Poorly Managed Illness Undiagnosed Illness Mobility Changes + Weakness Mental Changes Conclusion Sources Causes of Weight Loss in the Elderly The causes of weight loss in the elderly are varied, and it's important to be aware of them. See permissionsforcopyrightquestions and/or permission requests. The patient with neuromuscular or other functional limitations may be unable to move adequately to feed himself or herself. Antidepressants and weight gain: What causes it? In the long-term care facility, the food service manager and care-givers can often offer individualized suggestions for facilitating food intake. Weight loss is frequently seen in individuals with Alzheimers disease. Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Coronary artery spasm: Cause for concern? Gupta R, et al. Our free tool provides options, advice, and next steps based on your unique situation. I have three or more drinks of beer, liquor, or wine almost every day. Weight loss is just one possible indicator. Weight loss in older adults is considered a problem when theres a loss of 5% body weight in one month or 10% over a six-month period. Author disclosure: No relevant financial affiliations. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. Mirtazapine (Remeron) has been shown to increase appetite and promote weight gain while also treating the underlying depression.33. Hodgkin's vs. non-Hodgkin's lymphoma: What's the difference? Possible causes of early satiety include gastroesophageal reflux disease, commonly known as GERD, and peptic ulcers. A Mayo Clinic expert explains, Thalidomide: Research advances in cancer and other conditions. Depression in women: Understanding the gender gap, Depression: Provide support, encouragement, Depression: Supporting a family member or friend, Diabetes and depression: Coping with the two conditions, Diabetes and exercise: When to monitor your blood sugar, What is type 1 diabetes? Tricyclic antidepressants and tetracyclic antidepressants, Ulcerative colitis flare-ups: 5 tips to manage them. A nutritional assessment should be performed. 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. Sudden senior weight loss is quick, unintentional, and unexplained weight loss in older adults. An exam can help you discover and rule out potential causes. Find out when losing weight without trying calls for a medical evaluation. Most often, medical disorders that cause weight loss include other symptoms. Large portions may be overwhelming and may actually discourage intake. Colon cancer screening: At what age can you stop? This degree of weight loss should not be considered a normal part of the aging process. The Mini Nutritional Assessment, a tool that has been validated in the elderly for measuring nutritional risk, can be used to collect some of this information (Figure 1).21 Once the shorter form of this instrument has been validated in the elderly, it may be a more practical tool for the family physician. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Similarly, prealbumin and transferrin levels may reflect nutritional status, but they can also be abnormal in elderly patients with chronic illnesses.29. An algorithm for the management of unintentional weight loss in the elderly patient is provided in Figure 2. A Mayo Clinic expert explains, No appetite? include protected health information. MAOIs and diet: Is it necessary to restrict tyramine? Gaddey HL, et al. Social factors may contribute to unintentional weight loss. 2021; doi:10.1016/j.mcna.2020.08.019. Yes. Ferri FF. Total body weight usually peaks at 60 years of age with small decreases of 0.2 to 0.4 lb (0.1 to 0.2 kg) per year after 70 years of age. Although unexplained weight loss in the elderly can have myriad causes, an undirected (shotgun) approach to laboratory tests and other diagnostic studies is rarely fruitful. Unexplained weight loss. To provide you with the most relevant and helpful information, and understand which Children who have unintentional weight loss may . Fatigue. Ferri FF. So be sure to pay attention if your cat suddenly stops eating. In another study,6 institutionalized elderly patients who lost 5 percent of their body weight in one month were found to be four times more likely to die within one year. Prostate and breast cancers are also prevalent in the elderly, and symptoms related to those malignancies should also be sought. The mnemonic Meals on Wheels is useful for remembering these etiologies (Table 2).1,20 Another approach is to distinguish among four basic causes of weight loss: anorexia, dysphagia, socioeconomic factors and weight loss despite normal intake.18 Often, these causes are interrelated. Dronabinol has been associated with significant adverse effects, particularly central nervous system toxicity. A caregiver or relative may notice this first. Unintentional weight loss in the elderly patient can be difficult to evaluate. Assisted living communitiesoffer different services depending on each residents needs. The causes can be physical or psychological, and include: An overactive or underactive thyroid gland. This article focuses on the evaluation, diagnosis, and potential treatments of unintentional weight loss in patients older than 65 years. Few randomized controlled trials have been conducted, Nonmalignant gastrointestinal disease (9% to 19%), Allopurinol, angiotensin-converting enzyme inhibitors, antibiotics, anticholinergics, antihistamines, calcium channel blockers, levodopa, propranolol, selegiline (Eldypryl), spironolactone (Aldactone), Amantadine, antibiotics, anticonvulsants, antipsychotics, benzodiazepines, digoxin, levodopa, metformin (Glucophage), neuroleptics, opiates, SSRIs, theophylline, Anticholinergics, antihistamines, clonidine (Catapres), loop diuretics, Bisphosphonates, doxycycline, gold, iron, nonsteroidal anti-inflammatory drugs, potassium, Amantadine, antibiotics, bisphosphonates, digoxin, dopamine agonists, metformin, SSRIs, statins, tricyclic antidepressants, Infection, autoimmune disorders, malignancy, diabetes mellitus, thyroid disease, Compete blood count, erythrocyte sedimentation rate, C-reactive protein level, serum glucose level, thyroid-stimulating hormone level, urinalysis, age-appropriate cancer screening, chest radiography, abdominal ultrasonography, Poorly fitting dentures, dental caries or abscess, periodontal disease, esophageal stricture or webs, Congestive heart failure, pulmonary infection, worsening emphysema and chronic obstructive lung disease, Complete blood count, chest radiography, electrocardiography, basic metabolic panel, Indigestion, abdominal pain, change in stool pattern, early satiety, Gastrointestinal malignancies, peptic ulcer disease, dyspepsia, gastroesophageal reflux, cholecystitis, Complete blood count, erythrocyte sedimentation rate, C-reactive protein level, fecal occult blood test, liver function panel, abdominal ultrasonography, endoscopy, colonoscopy. https://www.merckmanuals.com/professional/special-subjects/nonspecific-symptoms/involuntary-weight-loss. 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. In addition to performing a physical examination of the patient, doctors may ask the caregiver for a detailed history of the patients eating habits and weight. Antidepressants: Which cause the fewest sexual side effects? To provide you with the most relevant and helpful information, and understand which Involuntary weight loss can lead to muscle wasting, decreased immunocompetence, depression and an increased rate of disease complications.3 Various studies have demonstrated a strong correlation between weight loss and morbidity and mortality.4. Recovering from surgery. Diabetes diet: Should I avoid sweet fruits? Total caloric intake does not improve with this method of administration.31,32 Liquid supplements are preferable to solids.32 With liquids, gastric emptying time is quicker, and total caloric intake is more likely to be maximized. One recent analysis showed that tube feeding in elderly patients with dementia does not promote weight gain (or prevent aspiration or lengthen life), even when adequate calories are provided.42. Medical Clinics of North America. It is unclear whether this relationship is a direct cause or a marker for an underlying condition.9, Body composition changes with age. Depression in women: Understanding the gender gap, Depression: Provide support, encouragement, Depression: Supporting a family member or friend, Diabetes and depression: Coping with the two conditions, Diabetes and exercise: When to monitor your blood sugar, What is type 1 diabetes? Gupta R, et al. Diabetes treatment: Can cinnamon lower blood sugar? Elsevier; 2022. https://www.clinicalkey.com. 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.) Diabetes management: How lifestyle, daily routine affect blood sugar, Diabetes prevention: 5 tips for taking control. What are opioids and why are they dangerous? Medical Clinics of North America. Prolonged dehydration can cause: 7. Accessed May 25, 2022. Click here for an email preview. June 9, 2022. 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. Salt craving: A symptom of Addison's disease? Although medications may help promote appetite and weight gain in an elderly patient with unintentional weight loss, drugs should not be considered first-line treatment. Late-night eating: OK if you have diabetes? Rheumatoid arthritis: Can it affect the lungs? Why does cancer sometimes cause weight loss? Glycemic index: A helpful tool for diabetes? At the first sign of unhealthy weight loss, get them to see a physician as soon as possible, Dr. Fabius says. Unintentional weight loss in older adults. Mouth sores caused by cancer treatment: How to cope. Unintentional weight loss, according to the NHS, can be attributed to a number of causes other than cancer including: stress from an event such as a divorce, a job change, or a death of a. The goals of long-term tube feeding (usually through a PEG tube [percutaneous endoscopic gastrostomy]) are to improve malnutrition, prevent aspiration (food, drink, secretions, stomach content that enter the airways [lungs] instead of the digestive tract), and extend life. Ann Long Term Care 2009;17(5):32-39. unintentional weight loss in older adults, http://www.mna-elderly.com/mna_forms.html, https://www.aafp.org/afp/2008/0715/p244.html, https://www.aafp.org/afp/2011/1115/p1149.html, https://www.aafp.org/afp/2009/0315/p497.html. These are addressed in the Q & A below. privacy practices. Abdominal ultrasonography may be considered.1, A prospective study evaluated 101 patients (inpatient and outpatient) with an average age of 64 years and unintentional weight loss of at least 5% within six to 12 months.12 Baseline evaluation included a comprehensive history and physical examination, the laboratory studies mentioned in the previous paragraph except for fecal occult blood testing, and abdominal ultrasonography and ferritin measurement. Megestrol (Megace) has been used successfully to treat cachexia in patients with AIDS or cancer.35 When given in a dosage of at least 320 mg per day, megestrol has produced weight gain, but side effects of edema, constipation and delirium may limit its usefulness. Heart, lung, gastrointestinal, and neurologic examinations evaluate for illnesses contributing to or causing weight loss. Investigation and management of unintentional weight loss in older adults., Canadian Medical Association Journal.Unintentional weight loss in older adults.. An appetite stimulant, such as megestrol acetate (Megace), dronabinol (Marinol), mirtazapine (Remeron), or growth hormone secretagogues may be prescribed. When cancer returns: How to cope with cancer recurrence, Fecal transplant treatment of C. difficile at Mayo Clinic, Mayo Clinic study reporting increased incidence of C. difficile infection, Previous stroke or neurological disorders. Recombinant human growth hormone (somatotropin [Serostim]) can increase lean body mass. I take three or more different prescription or over-the-counter drugs per day. 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. If the patient also has cognitive impairment, the evaluation is further complicated. One study30 found that caloric intake was greater in patients who received both nutritional supplements and exercise than in patients who received only supplements. Unexplained weight loss has many causes, medical and nonmedical. Chemotherapy side effects: A cause of heart disease? What is kidney cancer? Many communities will also work with residents and their families to developspecial diet plansto help the seniors manage their weight and improve their overall well-being. As mentioned previously, formal assessment of mood may be necessary,25 particularly if the initial screen for depression is positive. Often, a combination of things results in a general decline in your health and a related weight loss. If we combine this information with your protected The history should focus on the amount of weight lost and the time frame in which the weight loss occurred. 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. If no baseline weight is available, evidence of change in clothing size, confirmation of weight loss by a relative or friend, and a numerical estimate of weight loss can be used.1116 Assessing appetite determines if the weight loss is related to poor food intake. 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. From there, you can find a solution to the problem. If your family member is experiencing rapid weight loss, dont ignore it. A Mayo Clinic expert explains. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. Coronary artery spasm: Cause for concern? Unintentional weight loss has many different causes. Finding out the cause of your elderly loved one's weight loss can help you to know what is going on. This content is owned by the AAFP. This content does not have an English version. Because dizziness and orthostatic hypotension are possible adverse effects of mirtazapine, caution is warranted in patients at risk of falls.36,37, Although cyproheptadine has been studied in patients with cancer and cachexia,38 routine use in older adults with unintentional weight loss has not been studied. Unexplained weight loss is defined as the unintentional loss of at least 5% of body weight over a period of six to 12 months. Treatment should be focused on the identified causes of weight loss. Chemotherapy side effects: A cause of heart disease? It is particularly important to evaluate the oral cavity and the respiratory and gastrointestinal systems. Ease rheumatoid arthritis pain when grocery shopping, Eating during cancer treatment: Tips to make food tastier, GLP-1 agonists: Diabetes drugs and weight loss. Antidepressants and alcohol: What's the concern? the unsubscribe link in the e-mail. The Mini Nutritional Assessment is a validated tool to help measure nutritional risk.22 The tool, which is available at http://www.mna-elderly.com/mna_forms.html, involves anthropometric measurements and general, dietary, and subjective assessments. Accessed May 25, 2022. Unintentional weight loss in older adults. Approach to the patient with unintentional weight loss. Since 2010, his editing work has spanned several industries, including education, technology, and financial services. The physician needs to understand the patient's wishes about prolonging life and maximizing function and comfort. This often involves a multidisciplinary team, including dentists; dietitians; speech, occupational, or physical therapists; and social service workers. Although albumin and cholesterol levels, as well as lymphocyte counts, may help to establish a diagnosis of malnutrition, these determinations do not contribute to finding the etiology of unintended weight loss.2 Open wounds, nephrotic syndrome, infections and other conditions can also cause low serum albumin levels. Copyright 2014 by the American Academy of Family Physicians. In one series,14 CT scanning provided no new information beyond confirming one cancer that was already suspected. 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. The causes of weight loss in elderly are many and may include natural, psychological, or non-medical. The point at which unexplained weight loss becomes a medical concern is not exact. Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality. The thyroid gland helps regulate your body temperature and control your heart rate and metabolism (the process that turns the food you eat into energy). Diabetes foods: Can I substitute honey for sugar? 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. It means you lose a serious amount of body fat, muscle, and bone. When baseline evaluation is unremarkable, a three- to six-month observation period is justified. Policy. Some of the conditions commonly associated with sudden weight loss in the elderly include: Many behavioral and social factors may also affect an older persons eating habits and nutrition level: When it comes to weight loss in the elderly, watch for a few key warning signs: Early detection and action are key to improving your loved ones health. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Illness. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. There are many causes of weight loss in the elderly and in persons with Alzheimers disease. Most assisted living communities offer meal plans and special dining options, medication management, health monitoring, and social opportunities to help keep senior residents active and safe. In this Article 01 Do you lose weight when you get older? Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. What Is a Healthy BMI for Seniors Ages 65+? Danny Szlauderbach is a managing editor at A Place for Mom, where he's written or reviewed more than 250 articles covering a wide range of senior care topics, from veterans benefits and home health services to innovations in memory care. Severe nutritional problems are often found in residents of assisted-living facilities or nursing homes and may, in fact, be the reason for long-term care placement. Unintentional weight loss in adults older than 65 years is generally defined as a 5% or greater loss of body weight in a six- to 12-month period and is associated with increased morbidity. Loss of appetite is one of the key clues that something is wrong. ), Emotional problems, especially depression, Oral factors (e.g., poorly fitting dentures, caries), Wandering and other dementia-related behaviors, Hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoadrenalism, Eating problems (e.g., inability to feed self), Stones, social problems (e.g., isolation, inability to obtain preferred foods). What is depression? A number of different conditions may be responsible,. HEIDI L. GADDEY, MD, AND KATHRYN HOLDER, MD. Artificial sweeteners: Any effect on blood sugar? The types of medications include: Other reasons for weight loss in persons with Alzheimers disease include: Other events in the lives of the elderly, such as grief and mourning the loss of a spouse or life-long friends as well as social isolation, can also lead to weight loss. Although, if you are overweight or obese, you are advised to lose weight for optimal health. Many doctors review a patients medications as the first step since they are often the cause of loss of appetite and weight. Diabetes treatment: Can cinnamon lower blood sugar? Common causes of unintentional weight loss in seniors, Why its important to track weight loss in elderly loved ones, How senior living communities help manage unintentional weight loss in elderly, Worsening of cognitive and mood disorders, Adverse effects oftaking multiple medications, VA Aid and Attendance Benefits for Senior Living, Alzheimers disease or other types of dementia, Unintentional weight loss in older adults., Best Meals and Dining in Senior Living Awards. To successfully address this problem, the family physician needs to understand the normal physiologic changes in body composition that occur with aging, as well as the consequences of weight loss in the elderly patient. Work with your doctor or other health care professional for an accurate diagnosis. 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. This drug has also been studied, with some promising results, in patients with Alzheimer's disease.34 Because of side effects of dizziness, confusion and somnolence, dronabinol should not be used in patients whose cognitive deficits are not well defined. You might have this feeling, known as early satiety, along with nausea, vomiting, bloating or weight loss. 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. What is Crohn's disease? information is beneficial, we may combine your email and website usage information with Perera LAM, et al. In patients with Alzheimer's disease, weight loss correlates with disease progression, and a weight loss of at least 5 percent is a significant predictor of death.8, Regulation of food intake changes with increasing age, leading to what has been called a physiologic anorexia of aging. The amount of circulating cholecystokinin, a satiating hormone, increases in the circulation.9 Other substances are also thought to cause satiety.10,11 A role for cytokines, including cachectin (or tumor necrosis factor), interleukin-1 and interleukin-6, has also been postulated.1 Physiologic changes in food intake regulation occur even in the presence of the increased body fat and increased rates of obesity that occur with age, some of which can be explained by altered patterns of physical activity.12, Loss of lean body mass is common with increased age.2 Advancing age is also associated with a decrease in the basal metabolic rate, as well as changes in the senses of taste and smell.13 By the age of 65 years, approximately 50 percent of Americans have lost teeth, and resultant chewing problems can affect food intake.4, Lower socioeconomic status and functional disabilities can also contribute to involuntary weight loss in older patients.4 Elderly patients with dementing illnesses who are dependent on others for daily care are more likely to suffer unintended weight loss than are those who are demented but less dependent or those who are not demented.2. A Mayo Clinic expert explains. The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. 03 Common causes of unintentional weight loss in seniors 04 Warning signs of failing senior health Medical Clinics of North America. However, rapid and sudden weight loss in seniors is not normal; when an older adult loses five percent of their weight in one month or ten percent over six months, this is cause for concern. Accessed May 25, 2022. What are opioids and why are they dangerous? The most commonly identified causes are depression, cancer and gastrointestinal disorders1 (Table 1).1418 Pulmonary disease, cardiac disorders (e.g., congestive heart failure), dementia, alcoholism and prescription medications have also been implicated in the problem.3 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.4,19 No cause is found in about one quarter of patients.4,14, Causes of weight loss in residents of long-term care facilities may differ from those in ambulatory patients. Mayo Clinic does not endorse companies or products. Patients with diabetes mellitus may also be given a less restrictive diet. Continued weight loss necessitates a discussion with the patient or family members about whether long-term tube feeding is desired. The pathophysiology of unintentional weight loss is poorly understood. Involuntary weight loss. As you age it brings weight loss consisting of both fat mass and fat-free mass losses. .a feeling of being full or sick to your stomach. Common strategies to address unintentional weight loss in older adults are dietary changes, environmental modifications, nutritional supplements, flavor enhancers, and appetite stimulants.27, Diet modification incorporating patient preferences, softer food consistency to accommodate for chewing or swallowing disabilities, and assisted feeding may lead to weight gain and improved laboratory parameters; however, study results of this approach are mixed.2830 Creating a more leisurely eating environment simulating an in-home dining experience may improve nutrition in nursing home residents.31, Nutritional supplements are predominantly available in liquid form, but also come in puddings, bars, and soups. Accessed May 25, 2022. The staff may feel pressure from regulatory agencies to feed residents within a certain amount of time. .memory loss and feelings of disorientation. Strategies for Improving Care for Patients with Advanced Dementia and Eating Problems. Sedatives and narcotic analgesics may interfere with cognition and the ability to eat.21 A reduction in the dosage of psychotropic medications may also cause weight loss, possibly by unmasking an underlying disorder such as anxiety or depression.15 The effects of selected medications associated with unintentional weight loss are listed in Table 3.18,22,24. 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. Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy. Data Sources: A PubMed search was completed in Clinical Queries. Amyloidosis. Blood sugar levels can fluctuate for many reasons, Bone and joint problems associated with diabetes, Dr. Mark Truty (surgery, MN) better outcomes with chemo, Infographic: Cancer Clinical Trials Offer Many Benefits, Cancer survivors: Care for your body after treatment, Cancer survivors: Late effects of cancer treatment, Cancer survivors: Managing your emotions after cancer treatment, Cancer treatment decisions: 5 steps to help you decide. In one study, depression was present in 36 percent of nursing home residents with unintentional weight loss.12 Overall, psychiatric disorders, including depression, account for 58 percent of the cases of involuntary weight loss in nursing home patients.15, Common treatable causes of weight loss in elderly patients should be sought. Metoclopramide is also associated with a number of drug interactions. In someone who is 200 pounds (90 kilograms), it's 10 pounds (4.5 kilograms). American Geriatrics Society feeding tubes in advanced dementia position statement. Initial targeted studies can determine the cause in many patients.1,17. Clinical depression: What does that mean? Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. Review/update the Unintentional weight loss in older adults. High-dose vitamin C: Can it kill cancer cells? Colon cancer screening: At what age can you stop? The first step in the history is to obtain information about the weight loss itself. 13 Causes of Unexplained Weight Loss Muscle loss Hyperthyroidism Rheumatoid arthritis Diabetes Depression IBD COPD Endocarditis Tuberculosis Cancer Addison's disease Heart failure Differences. Weight loss may occur throughout the course of Alzheimers disease, but becomes more common as the disease progresses. Sometimes a specific cause isn't found. Antidepressants: Selecting one that's right for you. Health Concerns About Weight Loss How to Maintain a Healthy Weight as You Age Getting Help for Weight Loss Weight loss is something many. Other reasons for weight loss in persons with Alzheimer's disease include: More calories being burned. . Perera LAM, et al. Metoclopramide (Reglan), a prokinetic agent, may relieve nausea-induced anorexia.38 However, this drug can cause serious dystonia and precipitate parkinsonian symptoms in elderly patients. Tests with the highest yield (i.e., typically abnormal in the setting of organic disease) were C-reactive protein, hemoglobin, lactate dehydrogenase, and albumin measurements. Physical Causes Heart disease, gastrointestinal disorders, and cancer are leading causes of weight loss in the elderly. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Many facilities have high rates of staff turnover or inconsistent staffing levels, and mealtimes may be affected. Upper gastrointestinal studies have a reasonably high yield in selected patients. Dehydration. Because the brain regulates so many of the bodys functions including hunger and satiety scientists say it makes sense that the effects of Alzheimers disease in the brain would affect many different aspects of bodily function including weight. Elsevier; 2022. https://www.clinicalkey.com. The evaluation of unexplained weight loss in the elderly sometimes yields no cause other than unexplained. If a physical cause for the weight loss exists, it usually becomes evident within six months.1,43 Consequently, continued weight loss should be monitored, even when the initial evaluation does not supply a diagnosis. This condition also is called overactive thyroid. Poor circulation causes a decrease in body mass because of the heart's inability to effectively pump and deliver nutrients to the various parts of the body. Overall, nonmalignant diseases are more common than malignancy.1,1116 Etiologies are further delineated in Table 1.1116, Medication adverse effects (Table 21,17,18 ) are common but often overlooked causative factors.17 Polypharmacy has been shown to interfere with taste and can cause anorexia.19 In addition, a variety of social factors are associated with unintentional weight loss and include poverty, alcoholism, isolation, financial constraints, and other barriers to obtaining food (e.g., impairment in activities of daily living, lack of assistance in grocery shopping or preparing meals).1 In 16% to 28% of patients, no readily identifiable cause for unintentional weight loss is determined.1116, Several tools have been developed to aid physicians in remembering the multiple etiologies of unintentional weight loss.

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