An approach to the management of unintentional weight loss in elderly people

UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed.

[1]  C. Winograd,et al.  Geriatric Targeting Criteria as Predictors of Survival and Health Care Utilization , 1996, Journal of the American Geriatrics Society.

[2]  M. Binns,et al.  Meal delivery practices do not meet needs of Alzheimer patients with increased cognitive and behavioral difficulties in a long-term care facility. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[3]  J. Kayser-Jones,et al.  A Prospective Study of the Use of Liquid Oral Dietary Supplements in Nursing Homes1 , 1998, Journal of the American Geriatrics Society.

[4]  T. Harris,et al.  Insulin‐Like Growth Factor‐1 and Interleukin 6 Predict Sarcopenia in Very Old Community‐Living Men and Women: The Framingham Heart Study , 2003, Journal of the American Geriatrics Society.

[5]  G. G. Casasola,et al.  Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score. , 2002, European journal of internal medicine.

[6]  G. B. Huffman Evaluating and treating unintentional weight loss in the elderly. , 2002, American family physician.

[7]  L. Fried,et al.  Weight Change in Old Age and its Association with Mortality , 2001, Journal of the American Geriatrics Society.

[8]  G. Van den Berghe,et al.  Increased mortality associated with growth hormone treatment in critically ill adults. , 2000, The New England journal of medicine.

[9]  B. Ackerman,et al.  Disturbances of Taste and Smell Induced by Drugs , 1997, Pharmacotherapy.

[10]  R. Steele,et al.  Nutritional evaluation and supplementation of elderly subjects participating in a "meals on wheels" program. , 1985, JPEN. Journal of parenteral and enteral nutrition.

[11]  R. D'Agostino,et al.  Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. , 2003, The American journal of medicine.

[12]  M. Kergoat,et al.  Weight Change, Nutritional Risk and Its Determinants Among Cognitively Intact and Demented Elderly Canadians , 2001, Canadian journal of public health = Revue canadienne de sante publique.

[13]  H. W. Lin,et al.  Differences in diagnostic approach between family physicians and other specialists in patients with unintentional body weight loss. , 1999, Family practice.

[14]  J. Riancho,et al.  Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms. , 2003, The American journal of medicine.

[15]  H. Sox,et al.  Involuntary weight loss: diagnostic and prognostic significance. , 1981, Annals of internal medicine.

[16]  J. Feldman,et al.  An overview of body weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I--Epidemiologic Follow-up Study. , 1991, Journal of clinical epidemiology.

[17]  N. Cook,et al.  Does weight loss from middle age to old age explain the inverse weight mortality relation in old age? , 1995, American journal of epidemiology.

[18]  Suh‐Yuh Wu,et al.  Improvement in Quality‐of‐Life Measures and Stimulation of Weight Gain After Treatment with Megestrol Acetate Oral Suspension in Geriatric Cachexia: Results of a Double‐Blind, Placebo‐Controlled Study , 2000, Journal of the American Geriatrics Society.

[19]  D. Deeg,et al.  Weight change, survival time and cause of death in Dutch elderly. , 1990, Archives of gerontology and geriatrics.

[20]  S. Schiffman Taste and smell in disease (first of two parts). , 1983, The New England journal of medicine.

[21]  J. Morley Orexigenic and anabolic agents. , 2002, Clinics in geriatric medicine.

[22]  H. Payette,et al.  Meals-on-wheels improves energy and nutrient intake in a frail free-living elderly population. , 2006, The journal of nutrition, health & aging.

[23]  J. Manson,et al.  A prospective study of weight change and health-related quality of life in women. , 1999, JAMA.

[24]  H. Payette,et al.  Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. , 2000, Journal of clinical epidemiology.

[25]  D. Snowdon,et al.  Weight Change and Physical Function in Older Women: Findings from the Nun Study , 1995, Journal of the American Geriatrics Society.

[26]  D. Schaid,et al.  A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia , 1990, Cancer.

[27]  Increasing oral intake in dementia patients by altering food texture , 1995 .

[28]  D. Walsh,et al.  Pharmacologic management of anorexia/cachexia. , 1998, Seminars in oncology.

[29]  H. Keller,et al.  Construct validation and test-retest reliability of the seniors in the community: risk evaluation for eating and nutrition questionnaire. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  S. Kritchevsky,et al.  Body mass index, weight change, and death in older adults: the systolic hypertension in the elderly program. , 2002, American journal of epidemiology.

[31]  Leif Bjermer,et al.  Airway hyperresponsiveness to methacholine, adenosine 5-monophosphate, mannitol, eucapnic voluntary hyperpnoea and field exercise challenge in elite cross-country skiers , 2010, British Journal of Sports Medicine.

[32]  C. Graaf,et al.  Effect of dietary supplements and physical exercise on sensory perception, appetite, dietary intake and body weight in frail elderly subjects. , 2000, The British journal of nutrition.

[33]  P. Lankisch,et al.  Unintentional weight loss: diagnosis and prognosis. The first prospective follow‐up study from a secondary referral centre , 2001, Journal of internal medicine.

[34]  N. Ryan,et al.  Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being. , 1999, Journal of the American Dietetic Association.

[35]  K. Soltesz,et al.  The effects of menu modification to increase dietary intake and maintain the weight of Alzheimer residents , 1995 .

[36]  S. Langmore,et al.  Geriatric Oral Health and Its Impact on Eating , 1996, Journal of the American Geriatrics Society.

[37]  S. Castle,et al.  MEGESTROL ACETATE SUSPENSION THERAPY IN THE TREATMENT OF GERIATRIC ANOREXIA/CACHEXIA IN NURSING HOME PATIENTS , 1995, Journal of the American Geriatrics Society.

[38]  E. Yearick,et al.  The effects of improved oral hygiene on taste perception and nutrition of the elderly. , 1976, Journal of gerontology.

[39]  W. Dowling,et al.  Metabolic changes induced in elderly patients with an anabolic steroid (oxandrolone). , 1967, Journal of gerontology.

[40]  C. P. de Groot,et al.  Longitudinal changes in anthropometric characteristics of elderly Europeans. , 1996 .

[41]  W. O'Fallon,et al.  Epidemiology of Sarcopenia , 2000, Journal of the American Geriatrics Society.

[42]  O. Ljungqvist,et al.  Energy-enriched hospital food to improve energy intake in elderly patients. , 1996, JPEN. Journal of parenteral and enteral nutrition.

[43]  J. Scolapio,et al.  Rational approach to patients with unintentional weight loss. , 2001, Mayo Clinic proceedings.

[44]  S. M. Massompoor Unintentional Weight Loss , 2004 .

[45]  C. Fileti,et al.  Instant nutritional assessment: absolute weight loss and surgical mortality. , 1982, JPEN. Journal of parenteral and enteral nutrition.

[46]  H. Payette,et al.  Weight loss and mortality among free-living frail elders: a prospective study. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[47]  J. Thigpen,et al.  Nutrition, Cancer, and Aging: An Annotated Review , 1986, Journal of the American Geriatrics Society.

[48]  J. Riancho,et al.  Involuntary weight loss without specific symptoms: a clinical prediction score for malignant neoplasm. , 2003, QJM : monthly journal of the Association of Physicians.

[49]  V. Leirer,et al.  Development and validation of a geriatric depression screening scale: a preliminary report. , 1982, Journal of psychiatric research.

[50]  S. Heymsfield,et al.  Standardization of nomenclature of body composition in weight loss. , 1997, The American journal of clinical nutrition.

[51]  A. LaCroix,et al.  Involuntary Weight Loss in Older Outpatients: Incidence and Clinical Significance , 1995, Journal of the American Geriatrics Society.

[52]  S. Pitlik,et al.  Unintentional Weight Loss: A Retrospective Analysis of 154 Cases , 1986 .

[53]  P. J. Bowman,et al.  Intentional and Unintentional Weight Loss Increase Bone Loss and Hip Fracture Risk in Older Women , 2003, Journal of the American Geriatrics Society.

[54]  R. Seeley,et al.  Neuroendocrine Responses to Starvation and Weight Loss , 1997 .

[55]  L. Volicer,et al.  Effects of Dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease , 1997, International journal of geriatric psychiatry.

[56]  S B Roberts,et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. , 1994, The New England journal of medicine.

[57]  B. Vellas,et al.  Study Design for Nutritional Assessments in the Elderly , 1998 .

[58]  J. Morley,et al.  Effect of liquid dietary supplements on energy intake in the elderly. , 2002, The American journal of clinical nutrition.

[59]  H. Keller,et al.  Predictors of dietary intake in Ontario seniors. , 1997, Canadian journal of public health = Revue canadienne de sante publique.

[60]  H. Payette,et al.  Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. , 1995, The Journal of nutrition.

[61]  C. Winograd,et al.  Aggressive oral refeeding in hospitalized patients. , 1990, The American journal of clinical nutrition.

[62]  J. Goodwin,et al.  The Use of Dietary Restrictions in Malnourished Nursing Home Patients , 1994, Journal of the American Geriatrics Society.

[63]  G. Huerta,et al.  [Involuntary weight loss as a clinical problem]. , 1989, Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion.

[64]  C. Greenwood,et al.  Malnutrition in Institutionalized Seniors: The Iatrogenic Component , 2003, Journal of the American Geriatrics Society.

[65]  C. de Graaf,et al.  Flavor enhancement of food improves dietary intake and nutritional status of elderly nursing home residents. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[67]  L. Chu,et al.  A randomized controlled trial of low-dose recombinant human growth hormone in the treatment of malnourished elderly medical patients. , 2001, The Journal of clinical endocrinology and metabolism.

[68]  L. Morris,et al.  Unexplained Weight Loss in the Ambulatory Elderly , 1991, Journal of the American Geriatrics Society.

[69]  N. Wellman,et al.  Position of the American Dietetic Association: nutrition, aging, and the continuum of care. , 1996, Journal of the American Dietetic Association.

[70]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[71]  J. Everhart,et al.  Unintentional weight loss in the United States. , 1995, American Journal of Epidemiology.

[72]  C. M. Reife Involuntary weight loss. , 1995, The Medical clinics of North America.

[73]  J. Morley,et al.  Treating malnutrition with megestrol acetate: literature review and review of our experience. , 2002, The journal of nutrition, health & aging.

[74]  J. Morley,et al.  Nutritional Issues in Nursing Home Care , 1995, Annals of Internal Medicine.

[75]  J. Ship,et al.  The Importance of Oral Health in the Older Patient , 1995, Journal of the American Geriatrics Society.

[76]  C. Greenwood,et al.  Shift in diurnal feeding patterns in nursing home residents with Alzheimer's disease. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[77]  S. Borst Interventions for sarcopenia and muscle weakness in older people. , 2004, Age and ageing.

[78]  D. Hamerman Molecular-based therapeutic approaches in treatment of anorexia of aging and cancer cachexia. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[79]  J. Thigpen,et al.  Nutrition, Cancer, and Aging: An Annotated Review , 1986, Journal of the American Geriatrics Society.

[80]  M. Horowitz,et al.  Evidence for the anorexia of aging: gastrointestinal transit and hunger in healthy elderly vs. young adults. , 1997, The American journal of physiology.

[81]  Byung Pal Yu,et al.  Methods in Aging Research , 1998 .

[82]  S. Heymsfield,et al.  Epidemiology of sarcopenia among the elderly in New Mexico. , 1998, American journal of epidemiology.

[83]  D. Volkert,et al.  Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up , 1996, Aging.

[84]  R. Weindruch,et al.  Seminars in medicine of the Beth Israel Deaconess Medical Center. Caloric intake and aging. , 1997, The New England journal of medicine.

[85]  H. Payette,et al.  Predictors of dietary intake in a functionally dependent elderly population in the community. , 1995, American journal of public health.

[86]  A. Fletcher,et al.  Micronutrient supplementation in later life: limited evidence for benefit. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[87]  H. Payette,et al.  Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation. , 1994, Journal of the American College of Nutrition.

[88]  S. Schiffman,et al.  Effect of flavor enhancement of foods for the elderly on nutritional status: Food intake, biochemical indices, and anthropometric measures , 1993, Physiology & Behavior.

[89]  W. Frontera,et al.  Body Composition in Elderly Men: Effect of Dietary Modification during Strength Training , 1992, Journal of the American Geriatrics Society.

[90]  H. Keller,et al.  The Development of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN). , 2000, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[91]  L. Launer,et al.  Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I. , 1994, JAMA.

[92]  Hélène Payette,et al.  Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. , 2002, Journal of the American Dietetic Association.

[93]  E. Barrett-Connor,et al.  Weight Loss Precedes Dementia in Community‐Dwelling Older Adults , 1996, The journal of nutrition, health & aging.

[94]  J. Morley Decreased food intake with aging. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[95]  R. Walls,et al.  Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. , 1990, The American journal of clinical nutrition.

[96]  H. Rasmussen,et al.  Control of food intake in older men. , 1994, JAMA.

[97]  B. Vellas,et al.  A two-centre, randomized, double-blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. , 1994, Age and ageing.

[98]  S. L. Phillips,et al.  The Role of Medications in Geriatric Failure to Thrive , 1996, Drugs & aging.