special subjects
Involuntary Weight Loss
Geriatrics Essentials: Involuntary Weight Loss
Normal age-related changes that can contribute to weight loss include the following: Decreased sensitivity to certain appetite-stimulating mediators (eg, orexins, ghrelin, neuropeptide Y) and increased sensitivity to certain inhibitory mediators (eg, cholecystokinin, serotonin,corticotropin-releasing factor) A decreased rate of gastric-emptying (prolonging satiety) Decreased sensitivities of taste and smell Loss of muscle mass (sarcopenia) In older people, multiple chronic disorders often contribute to weight loss. Dental problems (eg, periodontitis) become more common with aging and can compromise nutrient intake and digestion. Social isolation tends to decrease food intake. Particularly in nursing home patients, depression is a very common contributing factor. It is difficult to sort out the exact contribution of specific factors because of the interactions between factors such as depression, loss of function, drugs, dysphagia, dementia, and social isolation. When evaluating older patients with weight loss, a useful checklist is of potential contributing factors beginning with the letter D: Dentition Dementia Depression Diarrhea Disorders (eg, severe renal, cardiac, or pulmonary disorders) Drugs Dysfunction Dysgeusia Dysphagia Older patients who have lost weight should be evaluated for Vitamin D Deficiency and Dependency and Enteral (tube) feeding is rarely beneficial in older patients, except for specific patients in whom such feeding may possibly be a short-term bridge to eating normally. 