Changes to metabolic demands can be caused by illness, surgery and organ dysfunction. Cancer, a very common and sometimes fatal cause of unexplained ( idiopathic ) weight loss. Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. Lack of food can result from: poverty, difficulty in shopping or cooking, and poor quality meals. Evaluating and Treating Unintentional Weight Loss in the Elderly. Patients who have uremia often have poor or absent appetite, vomiting and nausea. Consequences of Weight Loss Pathophysiology Differential Diagnosis Evaluation Evaluation in the Long-Term Care Facility Treatment Final Comment References Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. A reasonable work-up includes tests dictated by the history and physical examination, a fecal occult blood test, a complete blood count, a chemistry panel, an ultrasensitive thyroid-stimulating hormone test and a urinalysis. Weight loss issues related to specific diseases include. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. Intentional weight loss is commonly referred to as slimming. , by unmasking problems such as anxiety). GRACE BROOKE HUFFMAN, M. Eating restrictions may also be imposed as part of treatment or investigations. Consequences of Weight Loss Pathophysiology Differential Diagnosis Evaluation Evaluation in the Long-Term Care Facility Treatment Final Comment References Article Sections. The leading causes of involuntary weight loss are depression (especially in residents of long-term care facilities), cancer (lung and gastrointestinal malignancies), cardiac disorders and benign gastrointestinal diseases. Weight loss occurs when the body is expending more energy in work and metabolism than it is absorbing from food or other nutrients. Upper gastrointestinal studies have a reasonably high yield in selected patients.
This can result from conditions that affect the digestive system. 1, 2 When a patient has multiple medical problems and is taking several medications, the differential diagnosis of unintentional weight loss can be extensive. Poor appetite can be a direct symptom of an illness, or an illness could make eating painful or induce nausea. Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. There can also be losses from drains, including nasogastric tubes. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, and some other subacute or occult infections may cause weight loss. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Management is directed at treating underlying causes and providing nutritional support. Accurate evaluation is essential, however, because this problem is associated with increased morbidity and mortality. Inability to eat can result from: diminished consciousness or confusion, or physical problems affecting the arm or hands, swallowing or chewing. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobilary ( hepatocellular carcinoma, pancreatic cancer ), ovarian, hematologic or lung malignancies. Other losses: Conditions such as burns can be associated with losses such as skin exudates. Unintentional weight loss in the elderly patient can be difficult to evaluate. , Brooke Grove Foundation, Sandy Spring, Maryland Am Fam Physician. D. e. Losses from the gastrointestinal can occur because of symptoms such as vomiting or diarrhea, as well as fistulae and stomas. Polypharmacy can cause unintended weight loss, as can psychotropic medication reduction (i.
