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Dealing With Unintentional Weight Loss in the Elderly

Unintentional weight loss is defined as an involuntary decline in body mass, usually occurring over a relatively short period of time. The condition is quite common among elderly adults, particularly those over 70 years of age. Seniors who experience this form of weight loss lose some of their ability to function independently, see a reduction in quality of life and have an increased risk of mortality. Unintentional weight loss can result from a variety of conditions, with physical, mental, emotional and social factors playing potential roles. Up to 25 percent of cases among the elderly have no identifiable cause.

Sudden or rapid weight loss is considered to be a significant risk factor for seniors. It can be a sign of a serious health condition, and is invariably associated with a decline in overall health and an increase in mortality (9% to 38% within two years). Frail seniors more than 20 percent below their ideal body weight are more susceptible to a wide range of health problems, injuries and complications. They experience a marked decline in the ability to perform activities of daily living, and must often be relocated to care facilities as a result.

In elderly patients who suffer from serious health disease conditions such as cancer or heart disease, the amount of weight loss experienced. Unintentional weight loss may also point to an as of yet undiagnosed condition. Seniors who lose more than 4 percent of their body weight in a year or 10 percent over five years should seek medical attention to address the issue, as this degree of weight loss increases morbidity and mortality.

Causes

Causes of unintentional weight loss among seniors fall under the following classifications:

  • Organic causes. These include physiological changes caused by neoplastic and non-neoplastic diseases
  • Psychological causes. Clinical depression, anxiety disorders, dementia and other mental illnesses can result in weight loss.
  • Nonmedical causes. Nonmedical causes of unintentional weight loss include socio-economic and social conditions.
  • Idiopathic causes. These are cases with no identifiable cause, and the weight loss is often more reversible for these seniors.

    In many cases of elderly weight loss, a combination of factors is to blame. Many of these factors can be considered secondary to existing medical conditions. For example, some seniors who suffer from mental illnesses such as psychotic disorders or Alzheimer’s disease experience paranoia and suspicion which prevent them from eating the food they are served. This is actually quite common in long term and psychiatric care facilities. Elderly people with these disorders also expend extra energy pacing and performing other habitual movements.

    Physical illnesses may also have secondary characteristics that lead to weight loss. For example, gall stones often result in decreased appetite and nausea, which causes them to avoid high-energy foods.
    There are also some age related physiological changes that are not associated with a specific disease process, but may result in unintentional weight loss. These include:

  • A decline in chemosensory function (reduced ability to smell and taste)
  • Reduced ability to chew
  • Reduced rate of gastric emptying and concurrent neuroendocrine changes. This includes waning levels of peptides and hormones such as cholecystokinin, leptin, neuropeptide Y and others.

    These changes often result in appetite reduction, increased satiety and a decline in the natural appreciation of food. Collectively, these conditions contribute to a condition referred to as the “anorexia of aging.” To further exacerbate the problem, older adults show a reduced ability to adapt to periods of under- or overeating. They gain or lose weight quickly, and do not easily return to their original weight following such periods. This makes the elderly population much more susceptible to unintended (and lasting) changes in weight.

    Another significant factor contributing to weight changes in seniors is medication. A large percentage of seniors take multiple daily medications, many of which cause weight related side effects.

    Signs & Symptoms

    The most obvious symptom of this condition is, of course, sudden or gradual weight loss. Unfortunately, the latter can be difficult to identify, especially when the weight loss occurs over several months. There are other symptoms to be aware of that may contribute to or correlate with unintentional weight loss. These include:

  • Clinical or situational depression: Depression may reduce appetite and/or the enjoyment of food. Neglect of self-care is also associated with several forms of depression and mental illness.
  • Impaired sense of taste and smell: Diminished senses are considered to be a normal among adults of advanced age, and can be exacerbated by illness or medications. This often results in anorexia.
  • Chronic constipation: Many older adults suffer from chronic constipation, which may result from inadequate nutrition. Caregivers should ensure that the seniors in their care are eating properly and addressing any issues with regularity of bowel movements.
  • Loss of appetite: Reduced appetite can result from dental issues, medical conditions, medication and several other causes. Disinterest in food, for any reason, is a cause for concern.
    Family members and caregivers should keep an eye out for any of these symptoms, even if noticeable weight loss has not yet occurred. If caught early, many of the primary causes of unintentional weight loss can be remedied.

    Treatment & Prevention

    The first step in addressing unintentional weight loss in seniors is to identify the underlying cause and provide appropriate treatment. If malnutrition is to blame, providing reliable access to good nutrition is crucial. In many cases, the underlying cause cannot be corrected, so treatment is limited to nutritional intervention.

    There are instances when the factors contributing to malnutrition can be addressed directly. These include:

  • Poverty
  • Limited access to nutritious food
  • Dental issues or oral pain
  • Problems with chewing or swallowing
  • Impaired hearing or vision
  • Arthritis
  • Emotional distress (loss of a loved one)
  • Sedentary lifestyle

    It may be beneficial to involve a social worker and/or a dietitian depending on the specific circumstances. This is particularly true if no identifiable health conditions are contributing to malnutrition or if the senior is living in poverty. Sedentary seniors should be encouraged to become more active, as exercise is a powerful appetite stimulant.

    Oral nutritional supplements can be quite beneficial in preventing or reversing weight loss among elderly adults. Beverages such as Ensure are high in calories and nutrients, and are very convenient for seniors who have a limited ability to prepare nutritious meals. Seniors may need assistance from caregivers or family members to consistently supplement their nutrition so as to achieve maximum benefit.

    Psychological conditions that contribute to weight loss must be addressed promptly, as they can result in rapid loss of body mass if left untreated. Counselling, therapy and perhaps medication may be required to mitigate the effects of the mental condition.

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