Weight loss in the elderly can seem inevitable at times and the cause unknown.
Let me dispel the mystery of unexplained weight loss in the elderly. Weight loss may be inevitable in the case of diseases, but the cause can be determined.
Here’s the top 4 common causes of weight loss in the elderly.
Are There Categories of Weight Loss in the Elderly?
Yes, not all weight loss is considered the same in the elderly population.
As a healthcare professional there are two categories of weight change in older adults:
Significant and Non-Significant.
5% weight gain or loss in 30 days
7.5% weight gain or loss in 90 days
10% weight gain or loss in 180 days
Non-significant weight loss is still important to monitor. Someone can have slow, progressive weight loss month after month. But their weight loss may not fall into the significant category.
This is still important because someone can have progressive weight loss month after month. One year later their weight loss is very concerning.
No matter how much weight an older person is losing, if they are consistently losing weight over time, they need to be assessed by a Registered Dietitian.
Why is Weight Loss a Risk?
Weight loss is a risk because it can be the result of an unknown underlying medical condition.
Monitoring weights monthly in the elderly is a great tool to know if something is going on with their overall health.
I always recommend that as long as an individual agrees to be weighed, their weights should be tracked. A requirement in long term care homes currently.
If someone doesn’t want to be weighed on a scale, there are other ways to know if they are losing weight.
This can include if their clothes aren’t fitting like they used to, their underwear is needing to be replaced because it’s too big, or a nutrition focused physical exam (NFPE).
The NFPE is to be used by a Registered Dietitian trained on using the tool. It monitors for muscle and fat loss, and is a great way to determine a shrinking body.
Weight loss is a complex issue because it impacts muscle strength, mortality risk, and if serious enough can be a major contributing factors to early cause mortality.
Top 4 Causes of Weight Loss in the Elderly
There are 4 areas as to why elderly patients may be losing weight. Here are the four areas that may help you discover the underlying cause of weight loss.
By treating the underlying cause you may be help to restore the individual to a healthy weight.
Physiological Causes
Physiological means a physical body reason why unintended weight loss may be occurring.
The reasons may be a diagnosis or underlying condition. It may cause sudden weight loss, as some medical conditions will change at different paces.
In the early stages of many health conditions we don’t observe weight loss, but as it progresses, we may see weight dropping more rapidly.
Here are a few physiological conditions that may cause involuntary weight loss in the elderly:
Crohn’s Disease
Heart Disease
Cardiovascular Disease
Congestive Heart Failure
Celiac Disease
Chronic Obstructive Pulmonary Disease (COPD)
Parkinson’s Disease
Alzheimer’s Disease
Infections
Recent Surgery
Dysphagia
For some on the list, the weight loss will be indirectly caused by the condition above.
Take for example Dysphagia, it does not necessarily cause weight loss. But if Dysphagia is not properly managed, a person will have difficulty swallowing, may reduce their food intake, and lose weight.
Infections can be a temporary serious health condition, but in a short time they can have a serious impact on weight.
When the body is healing from an infection it is requiring increased calories and protein to provide the infected area to heal.
It is very important for family members and health care professionals to closely monitor for any signs or symptoms of infections.
A great example that I have observed in my clinical experience has been a patient with Type 2 Diabetes, that seemingly is following a strict Diabetic diet.
For unexplained reasons, staff have referred to me as the Clinical Dietitian, for elevated blood sugars. Their A1C going from 7.0% (normal range) to 11.1%.
Any experienced health care professional would recognize that this is an unlikely realistic change in a short period of time.
Upon further investigation, the patient turned out to have an infection in their mouth. Infections can give falsely high A1C levels. The infection in their mouth was of course causing them pain, leading to decreased food intake and weight loss.
It’s important that if you notice an older person with weight loss, you really do your investigating.
Psychological Causes
This category I always feel is vastly underrated in the affect it has on elderly people.
Examples of psychological causes include:
Depression
Dementia
Alzheimer’s Disease (both psychological and physiological)
Parkinson’s Disease
Anxiety Disorders
One research study found that depression was a primary reason for weight loss in the elderly.
Today however many medical professionals recognize depression in the early stages, this helps with an early diagnosis and treatment.
Escitalopram is a frequently used medication in the long term care setting to treat late-life depression, and many see positive results.
While Doctor’s treat the depression, Dietitian’s can deal with the results of the depression.
Some results we see are unintentional weight loss, malnutrition, loss of appetite, and inadequate food and fluid intake.
All symptoms that Dietitian’s can treat with a food first approach and oral nutritional supplements.
Medication Causes
Medication side effects play a role in weight loss in the elderly as they can alter:
Taste Perception
Dry Mouth
Dysphagia
Anorexia
Altered Bowel Habits
Though medications are beneficial for patient’s to treat certain conditions, they can impact nutrition in a dramatic way as well.
The best way to handle a situation where a medication is have a negative effect on a patient’s nutrition, is to speak with the Doctor about alternatives.
Alternatives to certain prescription medication can be explored to reduce their impact.
Social Causes
Social isolation is most frequently observed in patient’s in a long term care setting.
If a person is newly admitted to long term care, they may have been suffering from financial constraints, social isolation, and loneliness in the community.
It’s important to provide someone with the social supports that they feel comfortable with to reduce the social isolation preventing them from eating.
This might mean having them sit with one person at meals to get them comfortable with the idea of social dining experiences.
Social dining experiences have been shown to increase food and fluid intake in the elderly.
A shift to long term care or away from a single living life to a different environment can take time for elderly persons to get used to.
Provide them the support and time to adjust to a new setting.
If an individual has been in a long term care home for awhile and shows social isolation, I highly recommend talking with family members and the team to combat this.
Though some individuals will want to eat alone, I discourage eating in their rooms. This is for both their safety and food and fluid intake.
We can’t always ‘cure’ the social factors impacting someone, but we can try our best to minimize their impact.
Treatment for Unexplained Weight Loss
The treatment for unintentional weight loss in the elderly will vary depending on what they cause of the weight loss is.
Some general principles for preventing further weight loss in the elderly are:
Try a food first approach
Fortify foods with high calorie and protein additions
Prioritizing nutritious foods
Add oral nutritional supplement drinks between meals
Provide frequent snacks throughout the day
Provide their preferred/favourite foods to their routines
Encourage social interactions during meals
Reduce distractions during meals (No tv, only play soft music)
Ensure the meal is visually appealing
For more tips and tricks to prevent weight loss, check out this article!
By treating the causes of weight loss in the elderly we can try our best to increase their quality of life as they age.
Have you heard that the Long Term Care RD launched a podcast?
To find our channel on Apple Podcasts – Simply Click the Picture Below!
