Aging

Unintended Weight Loss in Older Adults

Many of us understand the anguish of watching an older loved one struggle to achieve adequate nutrition during their golden years. Normal age-related changes, including decreased appetite and reduction in lean body mass, can make it challenging for older adults to consume enough food to maintain their usual body weight. This may leave health care providers, including RDs, wondering what can be done to prevent unintended weight loss among the aging adult population.

What Is Unintended Weight Loss?
Unintended weight loss can be defined as any unplanned or undesired weight loss from the usual body weight range over time. This weight loss can occur quickly or may happen gradually over a longer period. Unintended weight loss puts older adults’ health at significant risk and has been associated with increased risk of morbidity and mortality among this population.

Causes
A variety of physical, psychological, social, and economic factors can cause unintended weight loss in older adults, along with normal, age-related changes that may impact an individual’s body weight.

Age-related changes can include decreased appetite, changes in taste, chewing and swallowing difficulties, and reduction in ability to perform activities of daily living. Diseases such as depression, cancer, CVD, dementia, and gastrointestinal disorders can contribute to unintended weight loss in this population. Therapeutic diets and food insecurity among seniors also can result in the reduction of food intake.

Nutrition Interventions and Strategies for Prevention
The following are strategies RDs can employ to prevent and/or minimize unintended weight loss among older patients:

• Obtain an individual’s food preferences. Work with individuals or families to ensure that favorite foods are incorporated into meals and snacks.
• Observe at mealtime. Several factors may be impacting an individual’s ability to consume enough calories for weight maintenance. These may include eating too slowly, forgetfulness or confusion at mealtime, difficulty chewing or swallowing, physical limitations, social isolation, and access to food. By observing an individual during meals, RDs can identify and address underlying factors contributing to unintentional weight loss.
• Provide nutrient- and energy-dense foods routinely as part of meals and snacks.
• Increase between-meal snacking. It may be appropriate to encourage frequent, small meals with snacks throughout the day for individuals experiencing anorexia or diminished appetite.
• Liberalize the diet when possible. Therapeutic diet orders that limit dietary components such as sodium, calories, sugar, or fat may lead to unintentional reduction in food intake.
• Assess for polypharmacy and medication side effects. Investigate medications and supplements that may be impacting appetite and weight and discuss with the individual’s physician as appropriate.
• Offer oral nutrition supplements in addition to meals and snacks. When using an oral nutrition supplement to prevent or minimize weight loss, dietitians should counsel patients to consume these supplements in addition to meals and snacks rather than as a meal replacement. Consider providing the supplement after meals or between meals to help minimize appetite suppression from the supplement.
• Carefully consider use of a pharmacologic agent. Several medications have been identified as appetite stimulants; however, studies exploring their efficacy in preventing unintended weight loss in older adults are limited and pharmacologic agents may have side effects that could limit their overall usefulness for improving appetite. Weighing the pros and cons of an appetite stimulant is a discussion RDs can have with the patient’s physician once other nutrition interventions have been exhausted.

Unintended weight loss drastically can reduce seniors’ quality of life and can be a challenging obstacle to overcome. As dietitians, there are multiple nutrition interventions we can use to help prevent or minimize weight loss among our patients. A good first step may be to identify the underlying factors impacting a patient’s weight and then tailor an individualized approach to combat unintended weight loss. Keep in mind that the goal may not be to simply prevent unintended weight loss but ultimately to improve quality of life for older adults during their golden years.

— Allison Herries, MS, RDN, CDN, is a clinical dietitian and freelance nutrition writer with more than five years of experience in the nutrition and dietetics field. Her specialties include diet and aging, nutrition for older adults, intuitive eating, nondiet approaches to health, nutrition research, and evidence-based nutrition and health writing. She’s also the founder of Bite Out of Life Nutrition at www.biteoutoflifenutrition.com.

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