What You Should Know About Weight Loss in the Elderly
Older adults need weighed often to make sure they are not losing weight. Whether they live
independently or in an assisted living or skilled living facility, it is necessary to address and
monitor weight loss.
Doctors and dietitians who work with older adults know that watching for weight loss in older
adults is important. With aging, changes occur in their habits, body, and behaviors that put them
at risk for weight loss. For many older adults or frail elderly persons, weight loss is the first clue
that other medical, physical, or cognitive changes are taking place that require action.
What are some of the causes of weight loss in the elderly?
Many older adults eat less food than they did when they were younger. This is not usually a
cause of unexpected weight loss, because we require less food as we age.
However, consistently poor intake at meals and snacks will likely result in unexpected weight
loss and may relate to the following factors:
 Cognitive changes that affect the ability to eat or their interest in food
 Physical changes that affect the ability to feed themself
 Medications that affect the appetite or cause a metallic taste in the mouth
 Underlying medical conditions that cause the body to use food more quickly for energy
What are the warning signs that a person is susceptible to weight loss?
Individuals who live with or help care for older adults, especially the frail elderly, should look
for the following risk factors:
 Needs help eating and drinking
 Eats less than half of meals or snacks served
 Has mouth pain, poorly fitting dentures, or no teeth or dentures
 Has a hard time chewing or swallowing
 Coughs or chokes while eating
 Has crying spells, withdrawal from others, or other signs of depression
 Is confused, wanders, or paces
 Has diabetes, chronic obstructive pulmonary disease (COPD), cancer, human
immunodeficiency virus (HIV), or other chronic diseases
How is weight loss in the elderly treated?
Treatment usually is individualized, depending on the cause of the weight loss. A frail elderly
person may need feeding assistance or a texture-modified diet to help with swallowing problems.
A change in dining environment sometimes is enough to increase appetite in older adults. While
some people eat better in a quiet environment with no distractions, others prefer the group
environment where they can converse with others.
Sometimes medications are changed to treat depression or increase appetite. At times
supplemental nutrition, such as fortified foods, high-nutrition puddings, or Ensure®) is suggested.
When individuals refuse food or clamp their mouth shut, caregivers should never force them to
eat. For some people, refusing food and liquid is a natural part of the end-of-life process, which
caregivers must respect and accept.
Patients with normal intake also may suffer weight loss, perhaps because of an underlying
medical condition that is not yet diagnosed. Providing more food may help with this problem.
What about someone who is overweight? Is weight loss OK for that person?
For individuals who have remained overweight all of their life, sudden or unexpected weight loss
may signal another health problem. While planned weight loss that is desired may improve a
person’s health, unexpected weight loss, even when it may benefit the individual, sometimes is
cause for concern.
What is an appetite stimulant?
Some older adults take an appetite stimulant, which is a medicine that will make them eat more.
Periactin® and Megace® are the appetite stimulants often ordered to help with weight loss. Some
patients with depression take Remeron®, which can stimulate the appetite and treat underlying
depression at the same time. Appetite stimulant medications will not improve the appetite unless
they are taken according to the prescription.
What happens if a person keeps losing weight and nothing helps?
Older adults who are unable to maintain their weight after attempts to stop weight loss may need
to consider a tube feeding. This is a very personal decision that the patient, family, and medical
team must make together in order to meet the needs of the patient in the best way possible.
References and recommended readings
American Medical Directors Association. Altered Nutrition Status in the Long-Term Care Setting
Clinical Practice Guideline. Columbia, MD: American Medical Directors Association; 2010.
Bales CW, Ritchie CS. Redefining nutritional frailty: interventions for weight loss due to
undernutrition. In: Handbook of Clinical Nutrition and Aging. 2nd ed. New York, NY: Human
Press; 2009.
Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Phys.
2002;65:640-650.
Review Date 4/11
G-1576