From the Guidelines
The best diagnostic approach for an 83-year-old female with significant unintentional weight loss (60lb in 1 year) and fatigue should begin with a comprehensive history and physical examination, followed by targeted laboratory and imaging studies. Initially, basic laboratory tests should include a complete blood count, comprehensive metabolic panel, thyroid function tests, urinalysis, and inflammatory markers like ESR and CRP, as these can identify common causes such as anemia, infection, organ dysfunction, or thyroid disorders 1. Additional tests should include fecal occult blood testing, chest X-ray, and age-appropriate cancer screenings including mammography and colonoscopy if not recently performed. Given the severity of weight loss, CT scans of the chest, abdomen, and pelvis are warranted to evaluate for malignancy, as suggested by the significant weight loss which may indicate undernutrition or other serious conditions 1. Nutritional assessment including albumin, prealbumin, vitamin B12, folate, and vitamin D levels should be checked, and a medication review is essential as many medications can cause appetite suppression or taste changes 1. Depression screening is important as psychological factors can significantly impact appetite and weight. This approach is comprehensive because significant unintentional weight loss in elderly patients often indicates serious underlying pathology, with malignancy, gastrointestinal disorders, and depression being common culprits. The extensive weight loss (60lb) within a relatively short period (1 year) raises particular concern for malignancy or severe systemic disease requiring prompt and thorough evaluation. Key considerations include:
- Comprehensive history and physical examination
- Targeted laboratory tests (e.g., complete blood count, comprehensive metabolic panel)
- Imaging studies (e.g., CT scans of the chest, abdomen, and pelvis)
- Nutritional assessment
- Medication review
- Depression screening These steps are crucial in identifying the underlying cause of the patient's symptoms and guiding appropriate management to improve morbidity, mortality, and quality of life.
From the Research
Diagnostic Approach
The diagnostic approach for an 83-year-old female with significant unintentional weight loss (60lb in 1 year) and fatigue should include:
- Age-appropriate cancer screenings 2
- Complete blood count 2, 3
- Basic metabolic panel 2, 3
- Liver function tests 2
- Thyroid function tests 2, 3
- C-reactive protein level 2
- Erythrocyte sedimentation rate 2
- Lactate dehydrogenase measurement 2
- Ferritin 2
- Protein electrophoresis 2
- Urinalysis 2, 3
- Chest radiography 2
- Fecal occult blood testing 2, 3
Further Evaluation
Further imaging and invasive testing may be considered based on the initial evaluation 2. It is also important to consider social factors such as isolation and financial constraints that may contribute to unintentional weight loss 2. Additionally, medication use and polypharmacy should not be overlooked as causative factors 2, 4.
Potential Causes
Potential causes of unintentional weight loss in this population include:
- Malignancy 2, 3
- Nonmalignant diseases 2
- Depression 3, 5
- Cardiac disorders 3
- Benign gastrointestinal diseases 3
- Eating disorders 5
- Medication-induced nausea and vomiting, dysphagia, dysgeusia, and anorexia 2, 3, 4
Management
Management should focus on treating the underlying cause if known, and providing nutritional support 2, 3. Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered 2. Appetite stimulants and high-calorie supplements are not recommended 2, 3. Treatment should also focus on feeding assistance, addressing contributing medications, providing appealing foods, and social support 2.