From the Guidelines
Unintentional weight loss in an elderly woman requires a comprehensive and multidisciplinary approach to management, prioritizing nutritional interventions as part of a team-based care plan to support adequate dietary intake, maintain or increase body weight, and improve functional and clinical outcomes. Begin with a comprehensive history and physical examination, focusing on appetite changes, difficulty eating, medication review, and screening for depression, cognitive impairment, and social factors like isolation or financial constraints. Initial workup should include complete blood count, comprehensive metabolic panel, thyroid function tests, urinalysis, inflammatory markers (ESR/CRP), and age-appropriate cancer screenings. Consider chest X-ray, abdominal imaging, and endoscopy if indicated by symptoms.
Key Considerations
- Treatment should address the underlying cause while implementing nutritional support, with a focus on calorie-dense foods and protein supplements, as recommended by the ESPEN guideline on clinical nutrition and hydration in geriatrics 1.
- Involve a dietitian for personalized nutritional planning, as individualized nutrition treatment plans have been shown to be effective in meeting energy requirements and preventing weight and fat loss in elderly patients 1.
- Consider social support interventions like meal delivery services, community dining programs, or caregiver assistance with meal preparation, as these can help address factors contributing to unintentional weight loss.
Nutrition Recommendations
- Offer high-protein foods (0.4 g/kg bw) at two or more meals every day to preserve muscle mass and prevent sarcopenia and frailty, as recommended by the nutrition policy for older adults living independently in Ireland 1.
- Encourage consumption of high-fibre, low-free sugar carbohydrate foods, healthier fats, and fortified foods to support overall nutritional status.
- Recommend a daily vitamin D supplement of 15 μg and adequate fluid intake (at least 1.6 l for women and 2 l for men) to support bone health and hydration.
Monitoring and Follow-up
- Monitor weight weekly and reassess nutritional status monthly to adjust the treatment plan as needed.
- Consider occupational therapy for eating assistance devices if needed, and involve a multidisciplinary team in the care plan to address the complex needs of the elderly patient.
From the Research
Causes of Unintentional Weight Loss
- Nonmalignant diseases are more common causes of unintentional weight loss in the elderly population than malignant causes, although malignancy accounts for up to one-third of cases 2, 3
- Medication use and polypharmacy can interfere with the sense of taste or induce nausea and should not be overlooked as causative factors 2, 3, 4
- Social factors such as isolation and financial constraints may contribute to unintentional weight loss 2, 3
- Psychiatric conditions, including depression, are also common causes of unintentional weight loss in the elderly population 3, 4, 5
Diagnostic Workup
- Recommended tests include age-appropriate cancer screenings, complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein level, erythrocyte sedimentation rate, lactate dehydrogenase measurement, ferritin, protein electrophoresis, and urinalysis 2, 3
- Chest radiography and fecal occult blood testing should be performed 2, 3, 4
- Abdominal ultrasonography may also be considered 3
- Upper gastrointestinal studies have a reasonably high yield in selected patients 4
Treatment
- Treatment should focus on the underlying cause if known 2, 3, 4, 5
- Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered 2, 3
- Nutritional supplements and flavor enhancers may be considered 3
- Appetite stimulants are not recommended due to serious adverse effects and lack of evidence of decreased mortality 2, 3, 4
- Treatment may also involve addressing contributing medications, providing appealing foods, and social support 2