Unintentional Weight Loss

#Unintentional Weight loss in a patient > 65
–Differential diagnosis: Malignancy, nonmalignant GI disease, psychiatric conditions, meds, social factors.
Top 3 most common malignancies: For males: Prostate, Lung, Colorectal. For females: Breast, Lung, Colorectal.
-Will order CBC, CMP (BMP, LFTs), TSH, ESR, CRP, Lactate dehydrogenase, UA, PSA, CXR, FOBT.
-Will have patient return to clinic in two weeks. At that time will evaluate for dementia. Will also consider CT chest + CT abd and pelvis both w/ and w/o contrast.
-Check Prealbumin / Albumin level.
-Refer to dietician / Nutrition (if it’s poor weight gain 2/2 to inadequate intake in an adult. Consider Ensure (if non-diabetic) or Glucerna (if diabetic).

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“Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality. The most common etiologies are malignancy, nonmalignant gastrointestinal disease, and psychiatric conditions. Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy. Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Social factors may contribute to unintentional weight loss. A readily identifiable cause is not found in 16% to 28% of cases. Recommended tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis. Chest radiography and fecal occult blood testing should be performed. Abdominal ultrasonography may also be considered. When baseline evaluation is unremarkable, a three- to six-month observation period is justified. Treatment focuses on the underlying cause. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. Appetite stimulants may increase weight but have serious adverse effects and no evidence of decreased mortality. ” AFP Journal