Unexplained Weight Loss in Older People

Introduction

Aging is a physiological process that causes many changes in the body. People experience poor eyesight, hearing loss, decreased sensitivity, fragile skin, etc. when they approach old age. Many older people also face unexplained or unintentional significant weight loss which occurs over six to twelve months. In some cases, unexplained weight loss is associated with any diseases while in other cases it is difficult to find the real cause. Sudden weight loss may interfere with a person's daily activities, appetite, and mood and it is caused by increased excretion of calories, decreased food intake, and high metabolism which occurs due to an underlying condition. People with sudden unexplained weight loss may experience cognitive dysfunction, mood disorders, malnutrition, etc.

What Causes Unexplained Weight Loss in Older People?

Unexplained weight loss occurs in association with many conditions which are broadly classified into;

1. Physiologic Factors: Many age-related conditions, medications, and other problems can predispose significant weight loss in older adults.

• Diseases: Sudden weight loss is common in the following diseases.

1. Alzheimer’s disease.

2. Parkinson’s disease.

3. Hyperthyroidism.

4. Cancer.

5. Gastrointestinal issues.

6. Oral diseases.

7. Pressure ulcers.

8. Diabetes.

9. COPD.

• Medication Side Effects: Several medications taken for various disease conditions can cause many side effects leading to sudden weight loss.

1. Anorexia or Eating Disorder: Antibiotics, antipsychotics, benzodiazepines, Metformin, Digoxin, Levodopa, etc.

2. Xerostomia or Dry mouth: Antihistamines, anticholinergics, loop diuretics, etc.

3. Altered Taste or Smell: Allopurinol, angiotensin-converting enzyme inhibitors (ACE inhibitors), antibiotics, etc.

4. Dysphagia or Difficulty in Swallowing: Non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, Doxycycline, gold, iron, etc.

5. Nausea or Vomiting: Bisphosphonates, Digoxin, dopamine agonists, Metformin, etc.

• Lifestyle Factors: Following lifestyle factors can affect the weight of an individual adversely;

1. Excessive consumption of alcohol.

2. Smoking or tobacco use.

3. Poor nutrition.

4. Substance abuse.

2. Psychological Factors: Various psychological issues like depression, anxiety, memory loss, etc. can alter eating habits leading to insufficient intake of food. People with depression often experience psychomotor agitation and restlessness causing calorie burn. In addition, they may also have decreased appetite which causes severe weight loss. Psychological and psychiatric diseases are considered one of the main reasons for unintentional weight loss.

In anxiety, there will be decreased appetite and increased stress causing weight loss. In contrast, some cases of depression and anxiety can also cause unintentional weight gain.

3. Social Factors: Social isolation can lead to depression which causes unexplained weight loss. Financial issues are another social factor that causes severe weight loss. A study found that unexplained weight loss was more prevalent among low-income groups.

How Is Unexplained Weight Loss Diagnosed?

The unexplained or unintentional weight loss is assessed based on detailed history provided by the patient or caretaker. The amount of weight loss in a period will be noted. If that record is not available the significant weight loss is evaluated based on the change in cloth size or confirmation by a relative or caretaker. Any type of medication whether prescribed or over-the-counter taken by the person will be asked by physicians. Any past or present history of tobacco use, excessive alcoholism, substance use, etc. would be inquired. The physician will check for associated symptoms such as fever, dysphagia or difficulty in swallowing, dyspnea or difficulty in breathing, oral diseases, indigestion, abdominal pain, etc. In addition, blood tests and imaging tests will be advised to determine the underlying cause. The cognitive functions like motor and memory are also checked to look for diseases like Alzheimer’s or Parkinson’s.

What Is the Treatment Plan For Unexplained Weight Loss?

The treatment varies among individuals and relies on the underlying cause and encompasses a multidisciplinary team of specialist doctors, dieticians, dentists, psychologists, occupational therapists, and speech therapists. The treatment plan can be broadly classified into non-pharmacological and pharmacological interventions.

1. Non-pharmacological intervention includes providing nutritional supplements and diet modification with exercise.

• Diet Modification: Individuals are advised to take softer food which is easier to chew and swallow. Flavor enhancers can be added to the diet for patients with altered smell or taste sensations. Fruits, vegetables, grains, and other raw foods which improve digestion can be preferred over non-vegetarian diets. They are also advised to have sufficient water intake to prevent dehydration.

• Nutritional Supplements: High-calorie and high-protein diets are recommended by dieticians. However, these nutritional supplements are available in liquid form, bars, snacks, etc. Proteins are available in powder forms such as whey, soy, hemp, etc. Nutritional supplement drinks are easy to consume and are highly effective in healthy weight gain for the elderly.

• Exercise: Exercises that emphasize muscle strength, resistance, and balance training are found to be effective in increasing muscle mass and overall strength. Aerobic exercise, yoga, pilates, brisk walking, hiking, jogging, etc. can improve health in older adults.

2. Pharmacological intervention includes medications to stimulate appetite in older adults with low appetite.

• Megestrol Acetate (Megace): It is commonly used in treating anorexia, cachexia or wasting syndrome, and unexplained weight loss. It is a man-made version of progesterone and is also used in treating breast cancer and endometrial cancer. The appetite will be stimulated in three weeks. The side effects of megestrol are dry skin, blurred vision, abdominal pain, etc.

• Mirtazapine: It is an antidepressant medication used to treat anxiety, depression, and obsessive-compulsive disorder (OCD). Weight gain is considered a side-effect of Mirtazapine. However, when used in older adults with depression and significant weight loss, Mirtazapine was found to be effective.

How to Maintain a Healthy Weight for Older Adults?

Individuals during old age experience a decrease in muscles and fats due to several factors. Adopting a good lifestyle with healthy eating habits can prevent excess weight loss or weight gain in older people.

1. Consume fruits, vegetables, and high-protein foods.

2. Drink sufficient amounts of water.

3. Exercising regularly can improve muscle mass.

4. Practicing yoga, Tai chi, breathing exercises, etc. can improve cognitive functions and hence reduce the risk of memory loss and other cognitive dysfunctions which affect eating habits.

5. Staying more active can boost appetite.

6. Improve sleeping patterns and try to get at least seven hours of sleep.

Conclusion

As age advances many people suffer from problems like poor eyesight, hearing problems, speech problems, severe weight loss, etc. Unexplained weight loss is a major concern as it could be a sign of any conditions. Various psychological, physiological, and social factors contribute to severe weight loss in a short period. However, many treatment methodologies have been developed to treat underlying conditions as well as to improve weight in these individuals. Also, following a healthy lifestyle and avoiding certain factors can prevent severe weight loss.