Causes of elderly weight loss can be a struggle to find. Elderly patients have multiple comorbidities, medications, diagnoses, cognitive issues, and more. It takes a Dietitian with excellent investigative skills to find the root cause. This article will give you cues on what to look at.
Elderly Weight Loss Causes
Investigating the causes of weight loss in elderly requires looking in depth at the factors that affect their nutrition care plan. Before I delve into the steps to find the root cause, here are some ideas for what to look at:
An elderly patient is ever changing. Check over their list of diagnoses, they may have one or a combination of some that are progressively getting worse. Perhaps they have a cancer diagnosis, maybe it was stable for a time but is now progressing.
A patient may also have developed an infection (look at WBC lab levels). Infections may cause a temporary drop in appetite and overall condition. This can result in elderly weight loss. Typically when the infection clears up, the patient stabilises back to themselves.
Similar to infections, if a patient has a surgery, a hip fracture repair for example. Once they recover, their intake stabilises. Recovering from a surgery requires increased protein and calories to aid in repair.
Don’t forget to increase calories and protein post surgery. This can help prevent weight loss before it starts.
Social And Family Issues
This is discussed further down in the article, but discussing elderly weight loss with loved ones can help! Maybe they have just informed the patient that their sibling died. Or maybe they have received other difficult news.
Their food and fluid intake may be negatively impacted by social and family issues going on. It’s important to take these into account when we’re looking at why a patient may be losing weight.
They feel social impacts just like the rest of us. So ensure you touch base with loved ones to see if something happened.
Dementia is a progressive disease that will continue to get worse over time. The negative impact it has on nutrition is felt all throughout the diagnosis.
As Dementia progresses, food and fluid intake can decrease, and weight loss can progress. The typical timeline of Dementia is 7 years. Dementia sometimes can be diagnosed 3 years into when it actually started. There is much we don’t know about it.
What we do know though is that we need to adapt a nutrition care plan to manage the symptoms associated with Dementia.
Mouth issues can include a variety of things to investigate such as:
- Dentures not being put in
- Dentures not fitting properly anymore
- Mouth sores from ill fitting dentures
- Mouth sores from medications/treatments
- Dry mouth from medications
All of these avenues need to be investigated. You can work with the Doctor and Nurses to get them to check if there are mouth issues with a patient. These will all contribute to weight loss in elderly patients.
A variety of medications can impact the nutrition status of an elderly person. If you want a free list of common medications used in the elderly and a free resource on Food and Medication Interactions, click here.
Unexplained Elderly Appetite Loss
At times we don’t know exactly why elderly appetite loss occurs. Unexpected elderly appetite loss happens frequently, we may not know the etiology but we can manage the symptoms. If you want to know some ways that we can stimulate appetite in elderly, we have an article!.
Click here to read an article about 5 tricks to stimulating appetite in elderly!
Unexpected elderly appetite loss can also be related to end of life. I cover this further down the article. But we do have an eBook explaining End of Life Nutrition, you can see it here!
Uncovering the Root Causes of Elderly Weight Loss
It all starts with your initial nutrition assessment. These are the steps that you need to take to uncover the root cause of elderly weight loss!
Initial Nutrition Assessment
Your initial nutrition assessment will help you build your initial nutrition care plan. Your patient will change with time, but having an initial nutrition assessment can help you have a baseline.
A baseline nutrition care plan helps to have something to compare to as their status changes. I recommend having a good nutrition assessment form that includes information such as:
- Social information: Family involved, religious affiliations, beliefs surrounding food, social history.
- Medical history: Relevant nutrition medical history and current diagnoses, surgeries, etc.
- Cognitive status: This can be an MMSE score, it can be your subjective assessment (patient upon interview does not give appropriate verbal responses), medical diagnoses of cognitive status, etc. This can give an insight into your assessment details.
- Weight status and weight history: I wouldn’t go much beyond 1-2 years weight history, anything beyond that isn’t terribly relevant to their current status. Work off of a usual body weight that is relatively current. Also find out the reason (if any) that weight status has changed over the year.
- Anthropometrics: This will include both height (if available – if not, have an estimate done), as well as the weight history above.
- Food Intake (Current and Historical): Record the percentage of meals that they typically eat (Again, only look over the past number of months that a weight change has happened).
- Symptoms Affecting Intake: Nausea, vomiting, diarrhoea, pain, dental issues, physical issues, etc. These should only be if they are affecting their intake. For example, someone can have physical issues (fractures), but if it’s not affecting their intake, it shouldn’t necessarily go in this section.
- Subjective Global Assessment (SGA): Every nutrition assessment should have an SGA built into it. The SGA allows you to diagnose Malnutrition! If you don’t have a good long term care nutrition assessment form, check this one out.
- Nutrition Focused Physical Exam: This will help determine weight loss and areas affected. There’s a great guide out there to help with an NFPE, click here to see one.
- Relevant Biochemical, Medication and Lab Data.
- Nutrition Requirements.
- Nutrition Care Process Steps.
All of the information in your initial nutrition assessment will give you an insight into the whole picture of your patient. If you have a good initial nutrition assessment, it will help to narrow down what could be contributing to weight loss in the elderly.
But let’s look further at what could be contributing to your patient’s weight loss.
Health Care Team Consultation
Your health care team can help give you insight into why an elderly person is losing weight. A care aide for example assists a patient every single day through every need they have.
They will know that patient better than anyone else. By consulting with the health care team you can find out information that you may not have gathered on your own.
Before I perform a meal observation I like to gather information from the health care team that can contribute to my nutrition assessment. They can give you cues about things such as:
- Preferences not being accommodated
- Increasing fatigue
- Change in their cognition
- Behaviours at meals
- Increasing pacing during the day (increasing nutrition needs), decreasing physical activity, etc.
- Taste changes
With some cases of Dementia, a patient may pace up and down the hallway consistently. This can result in weight loss if their needs aren’t being met. If you weren’t around the patient all the time, you may not know something like this.
Collaborating with your healthcare team can really benefit your patient! Always ask questions and find out what they think might be contributing to weight loss.
Building positive relationships with your team can also help them feel comfortable bringing things to you. Over the years I have had team members let me know something about a patient’s intake that I never would have known on my own.
If you want to know how to create positive work relationships, check out this article here.
Meal Time Observation
A meal time observation will give you so many pieces to the puzzle that is your patient. I wrote an article about how to perform a meal time observation, what to look for, and have a FREE meal time observation audit that you can use!
Click here to read the article.
Click here to download the free Meal Time Observation audit.
Observing a patient at a meal time can help you observe if they have any of the following:
- Difficulty with chewing and swallowing.
- Pocketing food.
- Drooling can indicate swallowing difficulty.
- Difficulty eating independently. Not every patient will want assistance at meals or ask for help if they need it. Sometimes they just won’t eat.
- Check for sensory aids (Do they need their glasses, hearing aids, etc).
- Currently have cueing at meals but may require increased assistance now.
- Aren’t getting along with their table mates resulting in unpleasant meal times.
- Don’t enjoy the location of their seat.
- Dining room environment needs improvement overall (Lighting inadequate, music too loud, television on, staff talking loudly to each other, staff not talking to the patients, etc).
- Patient needs adaptive utensils, cups, plates, etc.
If you have an elderly patient losing weight you will want to make sure that you do a meal observation. It’s so important because watching a patient eat can really help you see what’s going wrong.
I recommend you perform a meal observation at least annually or when there is a status change with the patient. It is one thing to get a report from the team about what’s going on, it’s another to see it with your eyes.
A Dietitian will notice things about a patient eating that others won’t. We are the experts in nutrition and it’s important to do the observation for yourself.
You should always get input as to the causes of elderly weight loss from the patient. A patient may voice some concerns to you that are easy fixes to prevent further weight loss.
This is a great time to catch up with your patient and find out if there is anything they want to tell you about their nutrition needs. Your conversation can start similar to:
“Hi Mrs Smith I was wondering if I could speak with you for a few minutes. I’m the Dietitian and I’d like to speak with you about some weight loss that I’ve noticed. Are you open to talking about this?…”
Some questions that you may want to ask include:
“Have you noticed that you’ve lost weight in X amount of months?”
“Have you found that your appetite is decreasing?”
“Do you like your meals lately?”
“Is there any food or drinks that you would like for me to get for you?”
“What are some of your favourite meals?”
“We love to provide snacks, is there anything that I can make sure you get?”
“What time do you like to eat your meals?”
“Do you think someone helping you at meals would be beneficial?”
You want to ask open-ended questions and allow them to inform you of what they want. Try to record preferences, maybe they have new ones that you aren’t aware of.
The patient is entitled to know about their weight status. Weight is a medical marker and they have the right to have input on their care. Always try to incorporate them in conversations, especially when you need to implement a new care plan.
Connecting with Family Members
If a patient is unable to have a meeting, not cognitively intact enough to grasp the issue, reach out to family members. You need to ensure that you connect with the Alternate Decision Maker (ADM) or the Power of Attorney (POA).
You are only allowed to discuss the medical status of your patient with someone who is designated as the contact person. You can find this in their chart, or ask a Nurse who connects with them. Don’t make the mistake and think you can discuss this with just any family member that comes in!
If you have an elderly patient losing weight consistently, you should connect with the family. It is best to keep them in the loop because the last thing you want is them to be surprised with a significant weight loss.
To start, you can either meet with them when they’re visiting, or you can make a phone call. I don’t think that talking about weight loss is inappropriate for a phone call. It’s an easy way to connect and get their input.
Here’s some conversation starters to discuss elderly weight loss:
“Hi Mrs Smith, this is Michelle the Dietitian from your mom’s home. I was wondering if you had a few minutes to discuss your mom’s weight?”
If the answer is yes, awesome! Make sure that you have your data in hand to talk to her. Things you want to have on hand is:
- Weight history.
- Intake history.
- Healthy weight range.
- Meal observation findings.
- Discussion points you had with their loved one (if possible).
- Their current nutrition care plan with the interventions you’ve tried.
You don’t need to be too dramatic on the phone call, as you don’t want them to worry. But you do want to be honest and open about the current situation.
Here’s some talking points:
“Have you noticed that your mom has lost weight in the last 3 months?”
“From my records, I’ve noticed that your mom has lost X pounds in 3 months. It isn’t classified as significant yet, but my concern is that it’s moving in that direction.”
“Are there any food or drinks that your mom really enjoyed previously that I can try to put on her menu?”
“I’d like to try some new nutrition interventions to prevent further weight loss in your mom, (give the proposal), what do you think of these?”
Try to get their input on why she thinks weight loss has occurred. A loved one may be able to cue you into things, just like team members, that you may not know about.
Keep loved ones in the loop as much as you can. The worst thing is them being surprised by a decline in their loved ones’ condition and they weren’t aware.
You can also try to get them involved. If they have a favourite cookie recipe that the patient loved, maybe they can try to bring them in and staff give them.
Once you have an idea about the root cause of your elderly patient’s weight loss, you can work on developing a new nutrition care plan.
Think about the following:
- How can I adapt my patients nutrition care plan to manage the root cause of the weight loss?
- How can I work with the team to manage the root cause?
- What new nutrition interventions can I implement to prevent further weight loss?
- What are my nutrition goals for my patient based on their current status?
- What will be my monitoring and evaluation plan based on my nutrition care plan?
What if the Elderly Weight Loss Doesn’t Stop?
Sometimes you cannot prevent elderly weight loss. There is only so much that is within the control of a Dietitian. If it is Dementia for example, and it has progressed to such a level that end of life has been declared, you change to the nutrition care plan to comfort care.
There are also conditions such as Chronic Kidney Disease, Cancer, COPD, etc, to consider. There will come a time when nothing the Dietitian does will prevent further deterioration.
You will need to develop a nutrition care plan that is comfort care and end of life nutrition care.
If you want to know more about managing end of life nutrition care as a Dietitian, click here to read this article.
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