Unexplained weight loss is a common problem posing diagnostic and management dilemmas in the geriatric population. Without accurate data on outcomes of ambulatory geriatric patients with significant weight loss, physicians may have difficulty in appropriately selecting diagnostic evaluations. Also, families of these patients often fear that these patients may have a hidden malignancy. Thompson and Morris performed a case series review study to identify the most common clinical outcomes of unexplained weight loss in the elderly.

Forty-five elderly ambulatory patients with significant unexplained weight loss were identified by computer search of the billing diagnoses of seven family practice centers and entered into the study. Significant weight loss was defined as a loss of at least 7.5 percent of baseline body weight over a six-month period. The average age of the patients was 71.9 years. The medical records were reviewed at study entry, three months, six months, nine months and finally at 24 months or until a definitive cause of the weight loss was determined.

The cause of weight loss remained unknown in 24 percent of patients, even after at least two years of investigation. A specific cause of the weight loss was eventually determined in 76 percent of the cases. Depression was the most common identificable cause (18 percent), followed by cancer (16 percent) and gastrointestinal problems other than cancer (11 percent).

The study findings indicate that, in many instances, a careful physical examination and history can reveal a cause of significant weight loss in elderly ambulatory patients. In addition, information on social, psychologic and physical factors may prove vital to the diagnosis. Tests with a high diagnostic yield in this study were stool hemoccult, barium enema, sigmoidoscopy, upper gastrointestinal series, endoscopy, and thyroid function studies. Computed tomography was not a useful screening procedure. Counseling on selecting and preparing nutritious foods and assistance in feeding are effective in reversing nutritional deficiencies. (Journal of the American Geriatrics Society, May 1991, vol. 39, p. 497.)

COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group