From the Guidelines
Weight loss in the very old becomes concerning when it exceeds 5% of body weight over 6-12 months, or 10% over a longer period, as stated in the most recent guideline by ESPEN 1. This threshold is lower than for younger adults because elderly individuals have less physiological reserve and are more vulnerable to the negative effects of weight loss. Unintentional weight loss in this population should always prompt medical evaluation, even if it seems minor. Common causes include medication side effects, dental problems, difficulty swallowing, depression, dementia, cancer, and chronic diseases. For the very old, even small weight losses can lead to significant functional decline, increased fall risk, immune system impairment, and higher mortality rates. Regular weight monitoring is essential, ideally monthly. Interventions should focus on identifying and addressing underlying causes, ensuring adequate caloric intake (often 25-30 calories per kg of body weight daily), providing nutrient-dense foods, and considering nutritional supplements when necessary. Social factors like isolation and inability to shop or prepare meals should also be addressed as part of a comprehensive approach to preventing further weight loss, as supported by the ESPEN guideline on clinical nutrition and hydration in geriatrics 1. Key points to consider in the management of weight loss in the very old include:
- Identifying and addressing underlying causes of weight loss
- Ensuring adequate caloric intake and providing nutrient-dense foods
- Considering nutritional supplements when necessary
- Addressing social factors that may contribute to weight loss, such as isolation and inability to shop or prepare meals
- Regular weight monitoring, ideally monthly, to promptly identify and address any significant weight loss.
From the Research
Concerning Weight Loss in the Very Old
- Unintentional weight loss in older adults can lead to numerous adverse health outcomes, including decreased daily activities, loss of functional status, and increased mortality 2.
- Approximately 15% to 20% of older adults experience unintentional weight loss and require intervention to maintain quality of life 2.
- There is no specific percentage of weight loss that is considered concerning in the very old, but any unintentional weight loss should be evaluated and addressed by a healthcare professional.
Factors to Consider
- Changes in body weight can affect the overall health of an older patient and should not be considered a normal part of the aging process 2.
- Malnutrition, inflammation, and poor quality of life are prevalent among elderly patients, particularly those on haemodialysis 3.
- Megestrol acetate and mirtazapine are two pharmacotherapeutic options that have been used to stimulate appetite and promote weight gain in older adults, but their effectiveness and safety vary depending on the individual and the specific clinical setting 4, 2, 5, 3.
Treatment and Intervention
- Treatment of unintentional weight loss in older adults should involve a comprehensive assessment of the underlying causes and addressing any underlying medical conditions 4.
- Pharmacotherapy, such as megestrol acetate or mirtazapine, may be considered in some cases, but should be used with caution and under close monitoring due to potential side effects and interactions 4, 2, 5, 3.
- Non-pharmacological interventions, such as dietary changes and nutritional support, may also be effective in promoting weight gain and improving overall health outcomes in older adults.