Unintentional weight loss differential diagnosis
, by unmasking problems such as anxiety). e. Furthermore, the underlying psychological or behavioral issues that can precipitate and fuel geriatric anorexia can infiltrate the lives of the susceptible elderly and progress undetected by these patients, their families, and their caregivers, a camouflaged and potentially lethal invader if not recognized and treated judiciously. Unintentional weight loss in the elderly patient can be difficult to evaluate. 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. Unfortunately, eating disorders in the institutionalized elderly frequently are overlooked or missed by health care professionals, with potentially grave consequences. Evaluating and Treating Unintentional Weight Loss in the Elderly. GRACE BROOKE HUFFMAN, M. 1, 2 When a patient has multiple medical problems and is taking several medications, the differential diagnosis of unintentional weight loss can be extensive. Additionally, saliva production usually decreases in the elderly, causing dry mouth, thick secretions, and poor oral and dental hygiene, leading to diminished food intake. Accurate evaluation is essential, however, because this problem is associated with increased morbidity and mortality. These include affective illnesses, paranoid psychosis, obsessive-compulsive disorders, and dementia, among others. Eating disorders such as anorexia nervosa and bulimia can occur insidiously and surreptitiously in the elderly, often because of the multiple other causes of unintentional weight loss that commonly accompany the aging process. , Brooke Grove Foundation, Sandy Spring, Maryland Am Fam Physician.
Polypharmacy can cause unintended weight loss, as can psychotropic medication reduction (i. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. Learn about the issues underlying the growing prevalence of eating disorders in the elderly, the contributing factors to weight loss, strategies for managing the disease, and the part dietitians play in caring for this vulnerable population. Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. 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. D. The primary factor underlying anorexia in younger individuals is the distress caused by a distorted self-perception of body image, which is of less importance in the elderly. Indeed, eating and anxiety disorders have increased to the point that the majority of deaths currently secondary to anorexia nervosa in this country occur in people aged 65 and older. Consequences of Weight Loss Pathophysiology Differential Diagnosis Evaluation Evaluation in the Long-Term Care Facility Treatment Final Comment References Article Sections. 1. Management is directed at treating underlying causes and providing nutritional support. 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. Upper gastrointestinal studies have a reasonably high yield in selected patients. Moreover, voluntary or involuntary weight loss in the elderly is well known to predispose them to muscle wasting, frailty, diminished immunocompetence, depression, and increased susceptibility to diseases and disorders, and strongly correlates with consequent morbidity and mortality.
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