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

Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Ont.
Canadian Medical Association Journal (Impact Factor: 5.96). 04/2005; 172(6):773-80. DOI: 10.1503/cmaj.1031527
Source: PubMed


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.

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Article: An approach to the management of unintentional weight loss in elderly people. CMAJ

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    • "The maximum BMI criterion was applied so that results would be relevant to the overweight/obese population. The age limit serves to avoid implications due to unintentional weight losses over the age of 65 years [25]. Current pregnancy is an exclusion criterion. "

    Mediterranean Journal of Nutrition and Metabolism 01/2014; 7:201-10. DOI:10.3233/MNM-140022
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    • "Dietary monotony, common in these cases, associated with low consumption of fresh meats, fruits and vegetables can lead to nutritional deficiencies in older people, such as protein, fibre, vitamins A, B 12 and C, folic acid and mineral deficiencies, especially iron, zinc and calcium (Frank & Soares, 2004; Mü ller & Nitschke, 2005; Soini et al., 2006; Unfer et al., 2006). As dementia advances, behavioural disorders such as food aversions, forgetfulness, impaired appetite and satiety control , agitation and depression can lead to weight loss (Moriguti et al., 2001; Alibhai et al., 2005; Suominen et al., 2005). Weight loss increases as senile dementia progresses and becomes more severe and is a predictor of mortality in these cases (Gorzoni & Pires, 2008).The relationship between malnutrition and cognitive function is complex, and malnutrition is likely a cause and consequence of dementia (Sampson, 2009). "
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    ABSTRACT: Background and aims. Dementia weakens older people and can lead to malnutrition; therefore, the objective of this study was to assess the association between indicators of dementia and biochemical indicators, anthropometric indicators and food intake in institutionalised older people. Methods. A total of 150 older people of both genders participated in this study. Nutritional status was determined by body mass index and other anthropometric variables, and biochemical indicators were used to analyse the differences between individuals with and without dementia. Energy and nutrient intakes were determined by food records, and dementia was investigated with the Mini-Mental State Examination. The data were analysed by the chi-square test, Student’s t-test and Mann–Whitney tests. Results. Of the 150 individuals studied, 48% were men with a mean age of 73 ± 10 years and 52% were women with a mean age of 80 ± 9 years. Thirty-six per cent had some degree of malnutrition and 48% presented dementia, which was more prevalent in women (59%). The nutritional status of men and women individuals with and without dementia differed significantly (P < 0.001 for men and women). The only variables that presented a significant difference between individuals with and without dementia were those associated with muscle mass in men. There were no differences in energy and nutrient intakes between individuals with and without dementia except for vitamin C intake, which differed among women (P = 0.032). Conclusion. In the conditions of the present study, dementia was associated with nutritional status, but not with energy and nutrient intakes, suggesting that older people with dementia may have higher nutritional requirements. Implications for practice. Investigation of dementia may contribute to the nutritional status assessment of older people and energy expenditure and immobility should be investigated for a more complete assessment.
    International Journal of Older People Nursing 03/2012; 8(3). DOI:10.1111/j.1748-3743.2012.00321.x
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    • "Unintentional weight loss can result from reduced nutrient intake, improper nutrient utilisation and activation of biochemical processes which induce catabolism (Carey 2000; Evans 2008). Factors which may reduce nutrient intake include: physical discomfort from uncontrolled pain, bloating, reflux or nausea; poor appetite or early satiety due to delayed gastric emptying, slowed gastrointestinal transit or ascites; oral problems including a sore or dry mouth, taste changes, infection, poor dentition or ill fitting dentures; side effects from prescribed or over the counter medications; adherence to a therapeutic or altered consistency diet or suffering from food aversions which limit food choice; reliance on others to buy or prepare food or to assist with feeding; depression or anxiety caused by loss of hope, spiritual distress or loss of social status and social contact; breathlessness and fatigue; influences of culture, family and other belief systems (Alibhai 2005; Aston 2006; Richardson 2004). "
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    ABSTRACT: Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness and can be of great concern to those affected and of even greater concern to formal and informal caregivers. No robust information currently exists on optimal interventions to manage fatigue and/or weight loss in any advanced progressive illness. This overview presents what we know from research held within Cochrane systematic reviews on treatments to manage these symptoms in non curative illnesses such as advanced cancer, heart failure, lung failure, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia and acquired immune deficiency syndrome (AIDS). The treatment approaches for managing fatigue were pharmacological treatments including eicosapentaenoic acid (EPA), amantadine, carnitine and non pharmacological interventions including exercise and physical training, medically assisted hydration, psychosocial interventions including self management education programmes, occupational therapy and professional support services and dietary interventions including nutritional support. The treatment approaches for managing weight loss were pharmacological treatments including eicosapentaenoic acid (EPA), megestrol acetate and anabolic steroids and non pharmacological interventions including nutritional support, progressive resistive exercise and aerobic exercise. More research is required to determine which interventions help to manage these symptoms for those who are living with advanced illness. Researchers need to consider how they can reduce the variability of study design and outcome measurements to allow for meaningful comparisons across future studies.
    Cochrane database of systematic reviews (Online) 01/2012; 1(1):CD008427. DOI:10.1002/14651858.CD008427.pub2 · 6.03 Impact Factor
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