From the Guidelines
When taking a history from a 75-year-old patient with 10 kg weight loss over 6 months, a comprehensive approach is crucial to identify the underlying cause, focusing on malnutrition and dehydration risk factors, as outlined in the ESPEN guideline on clinical nutrition and hydration in geriatrics 1.
Key Components of History Taking
To guide the physical examination and subsequent investigations, the following components should be included in the history:
- Appetite changes, dietary habits, and ability to eat
- Gastrointestinal symptoms such as nausea, vomiting, diarrhea, constipation, abdominal pain, and changes in bowel habits
- Dysphagia, early satiety, and changes in taste
- Systemic symptoms like fever, night sweats, fatigue, and pain
- Past medical history, particularly chronic conditions like diabetes, thyroid disorders, COPD, heart failure, and previous cancer diagnoses
- Detailed medication review, as some medications can cause weight loss
- Social history, including smoking, alcohol consumption, living conditions, and access to food
- Mental health assessment to identify depression, anxiety, or cognitive impairment that might affect eating
- Family history of cancer or other hereditary conditions
Importance of Recent Weight Loss
According to the ESPEN guideline, a striking unintended loss of body mass (>5% in six months or >10% beyond six months) should be regarded as a serious sign of malnutrition needing clarification of the underlying causes 1. The patient's 10 kg weight loss over 6 months exceeds this threshold, indicating a high risk of malnutrition.
Guiding Physical Examination and Investigations
The comprehensive history will guide the physical examination and subsequent investigations, which may include:
- Blood tests to assess nutritional status and rule out underlying conditions
- Imaging studies to investigate potential causes of weight loss
- Possibly endoscopic procedures to identify the cause of significant weight loss, which in this age group could indicate serious underlying pathology including malignancy By prioritizing a comprehensive history and physical examination, healthcare providers can identify the underlying cause of the patient's weight loss and develop an effective treatment plan to improve morbidity, mortality, and quality of life.
From the Research
History Taking Approach
When taking the history of a 75-year-old patient with a 10kg weight loss in 6 months, it is essential to consider the broad differential diagnosis of unintentional weight loss, as highlighted in the study by 2. This condition is associated with significant risks of morbidity and mortality.
Common Causes of Unintentional Weight Loss
The study by 2 notes that community-dwelling adults are often diagnosed with:
- Malignancy
- Nonmalignant gastrointestinal disorders
- Psychiatric disorders as the cause of unintentional weight loss In contrast, institutionalized older adults are most often diagnosed with psychiatric disorders.
Diagnostic Evaluation
The evaluation of unintentional weight loss may involve various tests, including:
- Complete blood count (CBC)
- Liver function tests (LFTs)
- Chest X-ray (CXR) However, the utility of these tests in detecting occult metastatic disease in asymptomatic patients with early-stage breast cancer is limited, as shown in the studies by 3 and 4.
Laboratory Tests
The study by 5 suggests that CBC components, such as white blood cell count, neutrophil-to-lymphocyte ratio, and red cell distribution width, can be useful markers to predict cardiovascular and metabolic diseases. However, the cost-effectiveness of routine laboratory tests, including CBC and LFTs, in the evaluation of early-stage breast cancer patients is questionable, as noted in the study by 4.
Key Considerations
When evaluating a 75-year-old patient with unintentional weight loss, it is crucial to: