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Introduction

Age-related physiological changes cause alterations in body weight and composition as one ages.1 These changes may include unintentional weight loss, also known as the “anorexia of aging.” With increasing age, decrease in appetite leads to older adults eating much less.2 Average daily energy expenditure also decreases, leading to loss of body weight.4 Older adults who present with weight loss are likely to have a decrease in lean body mass, bone mass, and basal metabolic rate, a decrease in taste and smell, and altered gastric signals that lead to early satiation.2 Observational studies of healthy older adults report normal weight loss due to age-related changes to be about 0.1-0.2 kg a year. Older adults also tend to maintain their weight over a period of 5-10 years. For all adults, substantial weight loss should warrant further investigation by nurses and health care providers and should not be dismissed as a normal consequence of aging.3

Interprofessional Assessment and Collaborative Interventions

Unintentional weight loss, defined as 5% decrease in one’s body weight within a time frame of 6 to 12 months, occurs in 15 to 20% of older adults.4 Major adverse effects associated with unintentional weight loss include a decline in ability to perform activities of daily living, increase in morbidity occur in in hospitals, increase in the number of hip fractures, and increase in mortality.4 Substantial weight loss has also been associated with higher risk of in-hospital and disease-related complications, greater disability and dependency, increased rates of admission to residential home or nursing home, and overall poor quality of life.3 The most common causes of unintentional weight loss are psychiatric conditions, malignancy, and nonmalignant gastrointestinal disease.4 Other causes of unintentional weight loss include alcohol-related, infectious, neurologic, rheumatic, renal, cardiopulmonary, and endocrine diseases. Additionally, use of multiple medications, or polypharmacy, can contribute to unintentional weight loss due to various side effects of medications such as changes in taste, anorexia, dry mouth, dysphagia, nausea, and vomiting. These side effects may lead to decreased appetite in older adults and subsequent weight loss. Common medications that exacerbate weight loss include angiotensin-converting enzyme (ACE) inhibitors, antibiotics, anticholinergics, benzodiazepines, digoxin, selective serotonin reuptake inhibitors (SSRIs), metformin, bisphosphonates, statins, and many others.4

Health care professionals should thoroughly evaluate patients presenting with unintentional weight loss, including review of 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.4 If no potential cause has been identified, primary care providers may choose to observe patients over a three- to six-month period to determine the underlying cause of weight loss. Registered dietitians and speech-language pathologists will also assess the patient for nutritional deficiencies and dysphagia. It is likely that patients with unintentional weight loss will be given nutritional supplements and flavor enhancers to enhance the client’s diet. 4 Pharmacists may be able to prescribe medication regimens to help increase appetite, including use of steroids such as Megestrol acetate (Megace).5 Patients will be educated on the need for dietary modifications to increase caloric intake while taking patient preferences into account and addressing chewing or swallowing issues.4 If patients are having difficulty with grocery shopping and meal preparation due to functional impairment in activities of daily living (ADLs) and instrumental activities of daily living (iADLs), referral to a social worker will be beneficial to arrange for additional help in the home and possible intervention by a physical or occupational therapist. Family members and caregivers are also key players in identifying nutritional issues in older adults with cognitive impairment. In addition to facilitating communication of patient’s medical history and medications with provider, caregivers are instrumental in ensuring patient’s adherence to nutritional interventions in the community.3

Interprofessional contacts for this topic:

Primary care providers

Acute care providers

Registered nurses

Pharmacists

Registered dietitians

Speech-language pathologists

Social workers

Physical therapists

Occupational therapists

Home health aides

Link to the following evidence-based protocols:

Age-related changes

Family caregiving

Function

Mealtime difficulties

Medication

Nutrition in the elderly

References

1Chapman, I.M. (2011). Weight loss in older persons. Medical Clinics of North America, 95, 579-593.

2Chapman, I.M. (2006). Nutritional disorders in the elderly. Medical Clinics of North America, 90 (5), 887- 907.

3McMinn, J. & Bowman, A. (2011).  Investigation and management of unintentional weight loss in older adults. BMJ, 342, 1-9.

4Gaddey, H.L., & Holder, K. (2014). Unintentional weight loss in older adults. American Family Physician, 89(9), 718-722.

5Morley, J. E. (2001). Anorexia, sarcopenia, and aging. Nutrition, 17(7), 660-663.