Unintentional Weight Loss in Older Adults

 

Am Fam Physician. 2021 Jul ;104(1):34-40.

  Patient information: A handout on this topic is available at https://familydoctor.org/preventing-malnutrition-in-older-adults and https://www.aafp.org/afp/2014/0501/p718-s1.html.

Author disclosure: No relevant financial affiliations.

Unintentional weight loss in people older than 65 years is associated with increased morbidity and mortality. Nonmalignant diseases are more common causes of unintentional weight loss in this population than malignant causes. However, malignancy accounts for up to one-third of cases of unintentional weight loss. Medication use and polypharmacy can interfere with the sense of taste or induce nausea and should not be overlooked as causative factors. Social factors such as isolation and financial constraints may contribute to unintentional weight loss. A readily identifiable cause is not found for 6% to 28% of cases. Recommended tests include age-appropriate cancer screenings, complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein level, erythrocyte sedimentation rate, lactate dehydrogenase measurement, ferritin, protein electrophoresis, and urinalysis. Chest radiography and fecal occult blood testing should be performed. Further imaging and invasive testing may be considered based on initial evaluation. When the initial evaluation is unremarkable, a three- to six-month observation period is recommended with follow-up based on clinician and patient preferences. Treatment should focus on the underlying cause if known. Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered. Appetite stimulants and high-calorie supplements are not recommended. Treatment should focus on feeding assistance, addressing contributing medications, providing appealing foods, and social support.

Weight loss in older adults can be intentional or unintentional. 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 and mortality.13 Weight loss can be assessed by numerical documentation or, if no baseline weight is available, corroboration with a change in clothing size or from a relative may be used. The patient or relative should provide an estimate of the weight loss.2,3 Unintentional weight loss in older adults can be classified as unexplained, unintentional weight loss when no definable cause is found or as unintentional weight loss with a known origin.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Unintentional weight loss of 5% or greater within six to 12 months is associated with increased morbidity and mortality in older adults and should prompt evaluation.2,3,8,13,15

B

Consistent findings from multiple prospective cohort studies with good follow-up

The initial evaluation for unexplained, unintentional weight loss in older adults should include history, physical examination, laboratory tests, chest radiography, fecal occult blood testing, and possibly abdominal ultrasonography.8,1116

C

Findings from three retrospective and four prospective studies

If initial test results are negative, close observation for three to six months is justified. Annual follow-up should be considered after the observation period.2,8,12

C

Consistent findings from three prospective trials


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Unintentional weight loss of 5% or greater within six to 12 months is associated with increased morbidity and mortality in older adults and should prompt evaluation.2,3,8,13,15

B

Consistent findings from multiple prospective cohort studies with good follow-up

The initial evaluation for unexplained, unintentional weight loss in older adults should include history, physical examination, laboratory tests, chest radiography, fecal occult blood testing, and possibly abdominal ultrasonography.8,1116

C

Findings from three retrospective and four prospective studies

If initial test results are negative, close observation for three to six months is justified. Annual follow-up should be considered after the observation period.2,8,12

C

Consistent findings from three prospective trials


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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BEST PRACTICES IN GERIATRIC MEDICINE

Recommendations from the Choosing Wisely Campaign

RecommendationSponsoring organization

Avoid using prescription appetite

The Authors

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HEIDI L. GADDEY, MD, is the director of medical education and the designated institutional official at David Grant Medical Center, Travis Air Force Base, Calif., and an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md....

KATHRYN K. HOLDER, MD, is the director of graduate medical education and a faculty member at the Kaiser Permanente Napa Solano Family Medicine Residency Program, Vallejo, Calif.

Address correspondence to Heidi L. Gaddey, MD, David Grant Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94535 (email: heidigaddey@yahoo.com). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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