Inadvertent weight loss

part (3)

Inadvertent weight loss usually develops within weeks or months TSH level study

As shown, the pathological results of these studies follow from additional analyzes. If all test results are within normal limits, and the clinical data are pathological free, then further comprehensive research (e.g. CT, MRI) is not recommended. Such testing is very ineffective and can be misleading and harmful, showing random, unrelated data. Such patients should be trained inadequate calorie intake and undergo follow-up examinations approximately once a month with body weight measurements. If patients continue to lose weight, you should re-read the entire history and results of the physical examination, because patients can share important, previously undisclosed information, and new, weak physical pathologies can be detected. If weight loss continues,

Inadvertent weight loss 

Inadvertent weight loss Treatment

Treatment of the underlying disease is necessary. If the underlying disease is associated with malnutrition and is difficult to treat, then the appointment of enhanced nutrition should be considered. Useful general behavioral measures include motivating patients to eat, helping them with nutrition, offering snacks between meals and at bedtime, providing their favorite foods or foods with a strong aroma and offering only small portions. If behavioral measures are ineffective and weight loss is extreme, enteral tube feeding may be prescribed if patients have a functioning gastrointestinal tract. Measures to maintain lean body mass are performed sequentially. To prolong life, appetite stimulants are not indicated.

Inadvertent weight loss Important points in geriatrics

Normal age-related changes that may contribute to weight loss include the following:

Decreased sensitivity to certain mediators-stimulants of appetite (e.g., orexins, ghrelin, neuropeptide Y) and increased sensitivity to certain inhibitory mediators (e.g., cholecystokinin, serotonin, corticotropin-releasing factor)

Reduced gastric emptying rate (prolonged satiety)

Decreased taste and olfactory sensitivity

Muscle loss (sarcopenia)

In the elderly, numerous chronic diseases often contribute to weight loss. Social exclusion tends to decrease food intake. In particular, in patients at nursing centers, depression is a common factor. It is difficult to 

distinguish the exact contribution of individual factors due to interactions between factors such as depression, loss of function, drug effects, dysphagia, dementia, and social isolation.

When evaluating elderly patients with weight loss, a checklist of potential factors contributing to the event, starting with the letter D, is useful:

Tooth positioning

Dementia

Depression

Diarrhea

Diseases (e.g. severe kidney, heart, or lung disease)

Medications

Dysfunction

Taste perversion

Dysphagia

Elderly patients who experience weight loss should be tested for vitamin D deficiency ( Vitamin D deficiency and dependence ) and B 12 ( Vitamin B 12 deficiency ) in the diet.

Enteral feeding is rarely useful for elderly patients, except for individual patients in whom this type of feeding is likely to be a short-term transition to normal nutrition.

Key points

In particular, multiple factors usually contribute to the weight loss of patients in nursing centers.

Inadvertent weight loss of more than 5% of body weight or 5 kg is grounds for examination.

The most highly effective aspects of the assessment are a thorough history and physical examination.

Modern imaging methods or other types of comprehensive examinations are usually not recommended unless this is due to clinical examinations.

Emphasize nutritional behavioral measures and try to avoid enteral nutrition, especially for older people.