Clinical Review

Investigation and management of unintentional weight loss in older adults

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1732 (Published 29 March 2011) Cite this as: BMJ 2011;342:d1732
  1. Jenna McMinn, foundation year 2, medicine1,
  2. Claire Steel, specialist trainee year 6 in medicine for the elderly2,
  3. Adam Bowman, consultant physician3
  1. 1Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow G51 4TF, UK
  2. 2Department of Medicine for the Elderly, Monklands Hospital, Airdrie, UK
  3. 3Department of Medicine for the Elderly, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to: J McMinn, Department of Medicine, Southern General Hospital jennamcminn{at}gmail.com
  • Accepted 7 March 2011

Summary points

  • Unintentional weight loss is common in elderly people and is associated with considerable morbidity and mortality

  • Weight loss is clinically relevant if more than 5% of body weight is lost over 6-12 months, although smaller losses may be important in frail elderly people

  • Causes can be classified as organic (malignant and non-malignant), psychological, social, or unknown

  • Drugs should be reviewed because side effects often contribute to weight loss

  • All patients should be assessed by a dietitian and screened for depression and cognitive impairment

  • If initial history, examination, and investigations are normal, three months of “watchful waiting” is preferable to further blind investigations

Unintentional weight loss occurs in 15-20% of older adults (those over 65) and is associated with increased morbidity and mortality.1 Clinical and epidemiological studies have reported even higher prevalence in certain populations, with as many as 27% of community dwelling elderly people and 50-60% of nursing home residents being affected.1 2 w1

Weight loss may be the presenting problem or an incidental finding during a consultation for other reasons. There are no published guidelines on how to investigate and manage patients with unintentional weight loss, and responses range from doing nothing (if it is viewed as a normal part of the ageing process) to extensive blind investigation because of the fear that it represents underlying cancer. Observational studies have shown that in as many as 25% of cases no identifiable cause is found, despite extensive investigation.3 4 It is not clear how far clinicians should go to investigate older patients with unintentional weight loss in the absence of an obvious medical cause.

We review the available evidence (mainly epidemiological and observational studies) and outline a structured approach to investigation and management of the older patient with unintentional weight loss.

Sources and selection criteria

We searched the literature for current …

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