An Approach to the Nonpharmacologic and Pharmacologic Management of Unintentional Weight Loss Among Older Adults

Karen L. Smith, MSc; Carol Greenwood, PhD; Helene Payette, PhD; Shabbir M.H. Alibhai, MD, MSc


Geriatrics and Aging. 2007;10(2):91-98. 

In This Article

Abstract and Introduction

Unintentional weight loss is common among older adults and is associated with significant adverse health outcomes, increased mortality, and progressive disability. The diagnosis is often associated with an underlying illness; however, in as many as one in four older adults with unintentional weight loss, no obvious medical cause can be identified. A variety of nonpharmacologic interventions may improve energy intake and lead to weight gain. The most common approach to the treatment of weight loss among older adults is consumption of high-energy/protein oral supplements between meals as a means of increasing daily energy intake. Involving other health professionals, including a dietitian, may be helpful in the assessment and management plan. In addition, a number of pharmacologic treatments have been investigated, but the potential benefit of these treatments remains unclear.

Unintentional weight loss among older adults is a problem commonly encountered in clinical practice. As discussed in the first part of this article,[1] clinically significant weight loss is typically defined as a decrease of >5% of usual body weight over six to twelve months[2] and has been associated with a decline in functional status, quality of life, and with increased morbidity and mortality. After the age of 70, some weight loss may be attributed to the aging process itself. Studies of healthy older adults report that weight loss of approximately 0.1-0.2 kg per year due to aging alone is considered normal.[3] The decline in body weight experienced with age, therefore, is quite small, and clinicians should be careful not to dismiss weight loss as natural without carefully ruling out other medical and social causes.

The causes of weight loss among older adults frequently depend on the presence of underlying health problems and/or poor nutritional status. Although up to one in four patients present with no identifiable cause, weight loss is often a symptom of one or more diagnosed or undiagnosed illnesses (the most common being depression and gastrointestinal illnesses, e.g., peptic ulcer disease or motility disorders, and cancer).[4] Medication side effects such as anorexia, dry mouth, dysgeusia, dysphagia, and nausea can also contribute significantly to weight loss among older adults, as can social problems such as poverty and isolation.

Once weight loss has been established, older individuals should undergo a complete physical examination, screening lab tests, and evaluation, using common assessment tools for prevalent disorders such as dementia and depression. When no evidence of an organic disorder is present, weight loss due to primary malnutrition (i.e., resulting from inadequate food intake) must be considered as a contributor. The routine use of nutritional screening tools, especially those that are solely questionnaire-based and can be completed by the patient or primary caregiver, provides an effective way to identify those at the greatest nutritional risk and may aid in timely treatment (discussed in part one of this series).

This article is the second installment of a two-part clinical review of unintentional weight loss among older adults. Portions of this article are reviewed in greater detail elsewhere.[4]


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