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

Disclosures

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

In This Article

Strategies for Managing Unintentional Weight Loss

The first priority in managing weight loss is to systematically identify and treat the underlying causes (Figure 1). However, as stated above, up to one in four older adults experiencing weight loss have no discernable medical cause. For these individuals in particular, as well as for all older individuals with weight loss, treatment often requires access to good nutrition. Table 1 lists several important nonpharmacologic strategies that can be implemented to prevent or treat malnutrition and enhance food intake. Factors associated with poor diet such as poverty, poor dental health, difficulty chewing or swallowing, vision or hearing loss, arthritis, stress (e.g., illness or death of a loved one), and unhappiness should be targeted.[5,6] It is prudent to involve a dietitian and a social worker to assist with assessment and management, particularly in cases where no obvious pathologic cause has been identified. In addition, a physiotherapist may help older adults increase their physical activity levels as a means of stimulating appetite and increasing energy intake and muscle mass.[7,8,9,10]

The use of oral nutritional supplements, such as high-energy and high-protein drinks, is a common strategy for reversing weight loss and increasing food intake. Studies have shown that short-term supplementation has resulted in improvements in body weight status and other nutritional parameters; however, long-term supplementation data are somewhat limited.[11,12,13,14] Counselling and encouraging patients to consume supplements in addition to their usual food intake rather than as a replacement of that intake is essential, since weight gain is confined to those who actually increase their energy intake.[12,14] Advising patients to consume supplements between meals, rather than with the meal, may help minimize appetite suppression and facilitate increased overall intake.[15] Although supplement use has been associated with short-term weight gain and improvements in biochemical, anthropometric, and quality of life parameters in a number of trials, the long-term beneficial effects on health, ability to function, and survival in undernourished older adults are yet to be consistently demonstrated.[11,16] A systematic review of 49 randomized and quasi-randomized trials showed a mean percentage weight gain of 2.3% (95% confidence interval [CI] 1.9-2.7) with protein-energy supplementation. In addition, the review found a reduction in mortality (Relative Risk 0.74, CI 0.59-0.92) among older adults who received protein-energy supplements, irrespective of whether they had weight loss.[17]

The question of whether a multiple vitamin/mineral supplement should be recommended needs to be addressed. Indeed, many older adults, both institutionalized and community-dwelling, consume too little food to meet their vitamin and mineral needs[18] and, therefore, improving food intake should be the first line of defense against vitamin and mineral deficiency. Older adults who consume oral supplements rich in micronutrients as a regular part of their diet are less likely to require additional vitamin/mineral supplements. Due to the high nutrient density of oral supplements, improvements in vitamin and mineral intakes are measurable in patients consuming these products, even in those who do not show increases in energy intake.[12,14] Vitamin and mineral supplements should be considered for those individuals among whom improvements in food intake are not observed, emphasizing products with a broad spectrum of vitamins and minerals rather than a limited composition, since low food intake generally leads to multiple nutrient deficiencies.

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