Life threatening age related weight loss in the elderly is a real concern. A reduction in food intake, and concomitant weight loss, is often linked to advancing age. Up to 20% of older adults experience this phenomenon. This may have serious consequences for the health and continued life-span of the older individual. Increased abstinence from eating may result in side-effects such as body mass reductions, lean muscle loss, increased confusion and dehydration, which may result in increased adversity with age.
A two-year study of nursing home residents indicated that losing 10% of bodyweight was associated with a significantly increased risk of mortality within 6 months of this event. Another study of 153 long-term care patients indicated that those who lost 5% of their weight over a month were 4.6 times more likely to die within a year. Another study included 53 women of an average age of 86 who lived in care but required minimal assistance. During 143 weeks of follow-up, 60% of these had experienced involuntary weight loss, which was associated with a significant increase in mortality or transfer to more assistive care. These women also experienced a significant decrease in physical function and walking ability. Their protein and energy intake was also significantly decreased.
Causes of Weight Loss in Seniors
Age-related decreases in bodyweight may be a result of a progressive loss of muscle tissue, not merely that of fat stores. This is known as sarcopenia, and is also associated with increased mortality in older people. If a senior loses a quantifiable proportion of bodyweight over a relatively short time, this is termed unintentional or involuntary weight loss, and may be associated with a range of factors. These include:
Drug use
Medication use is common among the elderly. Many medications may cause a reduction in appetite or other factors affecting food intake, such as nausea. Psychotropic drug discontinuation (sometimes necessary to diagnose underlying conditions such as anxiety) and withdrawal may also result in a loss of appetite or food intake.
Mood disorders
Conditions such as anxiety and depression are associated with advancing age. These may result in reduced appetite and anorexia.
Neurological disorders
These may affect the ability to eat or swallow normally. Age-related conditions such as these include Parkinson's disease or dementia. Dementias may also affect the maintenance of, or interest in, normal eating patterns, resulting in unintentional anorexia or dehydration.
Dental problems
Many older people may experience dental adversity or pain, which may affect the motivation to eat regularly or sufficiently. A study of over 1160 older people with tooth loss indicated that the risk of malnourishment was approximately 1.9 times higher for those without dentures in comparison to those with them.
Gastrointestinal/metabolic problems
Increasing age is associated with a range of conditions and disorders affecting the digestive system, liver or kidneys, which may reduce appetite or inhibit feeding. These include gastrointestinal cancers, liver disease, gallstones, kidney disease and renal failure.
Socioeconomic factors
The elderly are often susceptible to economic adversity or social problems. Reduced financial status affects not only the quantity and quality of food available, but the probability of obtaining medications or other forms of healthcare. These include dental care (such as well-fitting dentures), the availability of medical monitoring for possible symptoms of malnourishment, and nursing care or living assistance if required. In addition, increased isolation (a reality for many seniors) may also affect meal regularity and food intake, if the individual in question needs help in monitoring this.
Age
This is also an independent factor in the reduction of food intake. Increased age is associated with increased levels of molecules such as cholecystokinin, which is a hormone involved in the control of satiety ('fullness' after eating). Therefore, even healthy seniors may find they are inclined to eat less than normal over time.
Strategies to Increase Weight/Food Intake
Increased Monitoring of Food Intake
Reduced eating and/or appetite may be difficult to track or verify for seniors living either independently or in long-term care. For the latter, food intake management may be affected by a high turnover of staff (or overworking of existing staff members) resulting in some neglect of catering and/or ensuring meal attendance and food intake. This may also be affected by increased resistance to eating by certain patients (e.g. those on medications that suppress appetite or may result in nausea).
Some observations indicate that family members may have more success than caring professionals in encouraging an adequate intake. Establishing and maintaining records of caloric intake by concerned parties may contribute to weight maintenance for the senior(s) in question.
Physical Exercise
Increases in physical activity may improve food or caloric intake in older people. A clinical trial randomised 94 residential care patients to either resistance training, multinutrient supplementation, both or no intervention (i.e. placebo) for 10 weeks. Muscle strength and surface area increased significantly in those who exercised compared to those who did not, as did overall physical activity. Caloric intake increased significantly in the combination group only.
Meal Frequency Changes
Some seniors may feel overwhelmed by increased portion sizes at meals. In addition, some seniors may have been advised to enact dietary restrictions (or had these imposed upon them) such as reduced salt or cholesterol intake. In some cases, it may be acceptable to lift these and provide more appealing foods if the benefits of caloric intake outweigh other concerns. However, in cases of diabetes or insulin resistance, this option requires finer balance or is negated by the glycemic status of the patient. An alternative strategy is to offer smaller amounts of desirable foods at increased frequency throughout the day. This may better address problems of drug-induced appetite restriction, problems with swallowing or other issues. Liquid supplements can be given in addition to meals, and may optimise caloric intake.
Nutritional Supplementation
The study as above also concluded that those in the supplement only group did not experience a decrease in muscle weakness or physical function, indicating that adequate nutrition plays a protective role against these for older individuals. The role of nutritional supplementation in the prevention of sarcopenia has been demonstrated. Supplements in liquid form may also be more tolerable and desirable for seniors.
Medication
Many drugs repress appetite, however there are some which may promote it. Therefore, pharmacotherapy may help some older individuals to maintain food intake and a consistent bodyweight. Mirtazepine is an antidepressant that also stimulates appetite and weight gain, and may be of use in certain older people. Megestrol acetate is another drug that promotes weight gain, and may also have potential in geriatric care.
References
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- Murden RA, Ainslie NK. Recent weight loss is related to short-term mortality in nursing homes. J Gen Intern Med. 1994;9(11):648-650.
- Ryan C, Bryant E, Eleazer P, Rhodes A, Guest K. Unintentional weight loss in long-term care: predictor of mortality in the elderly. South Med J. 1995;88(7):721-724.
- Woods JL, Iuliano-Burns S, Walker KZ. Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality. Clin Interv Aging. 2011;6:311-317.
- Nishioka H. [Transdisciplinary Approach for Sarcopenia. Effect of nutritional support for the prevention of sarcopenia]. Clin Calcium. 2014;24(10):1527-1533.
- Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65(4):640-650.
- Han SY, Kim CS. Does denture-wearing status in edentulous South Korean elderly persons affect their nutritional intakes? Gerodontology. 2014.
- Smith GP, Gibbs J. The satiating effect of cholecystokinin. Curr Concepts Nutr. 1988;16:35-40.
- Fox CB, Treadway AK, Blaszczyk AT, Sleeper RB. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly. Pharmacotherapy. 2009;29(4):383-397.
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