Physiological Causes of Weight Loss in the Elderly

The regulation of food intake changes with age and involve mechanisms that are complex and multifactorial, making the treatment of weight loss more challenging. Weight loss and poor food intake in the elderly may be due to the following [10,11] (Tables 1,2):

1. Changes associated with normal aging (reduced basal hunger, decreased gastric emptying time, failure to adjust food intake after periods of overfeeding or underfeeding)

2. Endocrine disturbances (hyperthyroidism, hyperparathyroidism, hypoadrenalism)

3. Medications (theophylline, lithium, digoxin, chemotherapy agents for cancer treatment, antibiotics, and many other medications that distort normal smell and taste perception)

4. Dementia and related behavioural disturbances

5. Psychiatric problems (depression, anorexia nervosa, alcoholism, late-life paranoia)

6. Gastric, intestinal, and related problems (swallowing disorders, missing dentures, pain, malabsorption, diarrhoea, constipation)

7. Systemic-disease-related dysphagia (strokes, Parkinson's disease, achalasia, scleroderma)

8. Dysgeusia (age-related decline in taste and smell)

9. Chronic diseases (chronic obstructive pulmonary disease, congestive heart failure, rheumatoid arthritis, HIV, cancers)

10. Dysfunction (inability to feed oneself, limited income, poor eyesight, poor diet)

11. Infections (acute and chronic diseases, HIV, gastritis, cholecystitis).

The Council for Nutritional Strategies in Long-Term Care has developed an algorithm for the assessment of undernutrition in long-term care settings. This algorithm was published in a supplement to the Annals of Long-Term Care, 2004, and addresses the diagnosis of weight loss. The first step in the management of weight loss in the elderly is to attempt to identify and treat any specific underlying treatable or contributing conditions (e.g. endocrine diseases, medication, polypharma-

Table 1. Causes of involuntary weight loss in the elderly; the 9 'D's'. (Adapted from [11])

Dysgeusia

Dentition

Dysphagia

Depression

Drugs

Dementia

Diseases

Diarrhoea (malabsorption) Dysfunction

Table 2. Treatable causes of malnutrition ('meals on wheels'). (Adapted from [10])

M Medication effect E Emotional problems (depression) A Anorexia tardive (nervosa, alcoholism) L Late-life paranoia S Swallowing disorders

O Oral factors (e.g., poorly fitting dentures, caries) N No money

W Wandering and other dementia related behaviours

H Hyperthyroidism, hypothyroidism, hyperparathy-roidism, hypoadrenalism

E Enteric problems (malabsorption)

E Eating problems (inability to feed oneself)

L Low-salt, low-cholesterol diets

S Stones, social problems (e.g., isolation, inability to obtain preferred foods)

cy, depression, dentition, constipation, dehydration diarrhoea, systemic diseases, infections, and social support for providing food and feeding). However, Kayser-Jones et al. found that a lack of attention to individual food preferences, inadequate staffing, and a lack of feeding assistance were major factors accounting for weight loss in the elderly [12].

These are some of the important issues that need to be addressed first.

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