Unintentional Weight Loss Causes

Aka: Unintentional Weight Loss Causes, Meals on Wheels Mnemonic, Unintentional Weight Loss Causes in Older Adults, Unintentional Weight Loss Causes in the Elderly

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II. Causes: "Meals on Wheels" Mnemonic

  1. Medication Effects
  2. Emotional Problems (Major Depression)
  3. Anorexia Nervosa or Alcoholism
  4. Late-life paranoia
  5. Swallowing Disorders (See Dysphagia)
  6. Oral factors (e.g. Poorly fitting dentures)
  7. No Money
  8. Wandering (Dementia related behavior)
  9. Hyperthyroidism, Hyperparaythyroidism, Hypoadrenalism
  10. Enteric problems (e.g. Malabsorption)
  11. Eating problems (e.g. difficult self-feeding)
  12. Low salt diet or low Cholesterol diet
  13. Stones (Cholecystitis) or social problems (isolation)
  14. References
    1. Morley (1995) Ann Intern Med 123:850-9 [PubMed]

III. Causes: 9Ds of Weight Loss Mnemonic

  1. Dementia
  2. Dentition
  3. Depression
  4. Diarrhea
  5. Disease
  6. Drugs
  7. Dysfunction (e.g. ADL)
  8. Dysgeusia
  9. Dysphagia
  10. Robbins (1989) Geriatrics 44(4): 31-7 [PubMed]

IV. Causes: Based on Timing

  1. Acute
    1. Infection (e.g. Pneumonia, UTI, Cellulitis)
    2. CHF exacerbation
    3. COPD exacerbation
    4. Diabetes Mellitus
    5. Elecrolyte disrders
    6. Acute gastrointestinal bleeeing
    7. See Medications above
  2. Subacute
    1. Anemia
    2. Cirrhosis
    3. Chronic Kidney Disease
    4. Infection
    5. Diabetes Mellitus
    6. See Medications above
  3. Chronic
    1. Cancer
    2. Dementia
    3. Endocrine conditions (Thyroid, Parathyroid disease)
    4. Tuberculosis
    5. HIV Infection
    6. Chronic Obstructive Pulmonary Disease
    7. Cardiomyopathy
    8. Valvular heart disease
    9. Chronic Kidney Disease
    10. Chronic Liver Disease
    11. Polymyalgia Rheumatica

V. Causes: Common

  1. Idiopathic in one quarter of cases
  2. Malignancy (19 to 36%)
    1. See Cachexia in Cancer
    2. Stomach Cancer
    3. Pancreatic Cancer
    4. Colon Cancer
    5. Other cancers (e.g. Breast Cancer)
  3. Non-malignant Gastrointestinal Causes (9 to 19%)
    1. Cholecystitis
    2. Peptic Ulcer Disease
    3. Gastroesophageal Reflux Disease and other Esophageal disorders (e.g. Esophageal Dysmotility)
    4. Colitis
    5. Mesenteric Ischemia
    6. Celiac Sprue and other malabsorption
  4. Cardiopulmonary Disorders
    1. Congestive Heart Failure (5-10%)
    2. Chronic Obstructive Pulmonary Disease (5-10%)
  5. Social Factors
    1. Alcoholism or other Drug Abuse (5-10%)
    2. Major Depression and other mental illness (9 to 24%)
    3. Social isolation and loneliness
    4. Financial contraints
    5. Impaired Activities of Daily Living
  6. Medications
    1. See Medications to Avoid in Older Adults
    2. See Polypharmacy
    3. See Medications Associated with Unintentional Weight Loss
    4. Most common medication culprits
      1. Psychotropic medications
      2. Anticholinergic Medications
      3. Recently added medications
    5. Consider non-prescription drug use, Herbals
    6. Missed dose and non-compliance
    7. Medication Overdosage (or with Renal Insufficiency)

VI. Causes: Other Causes

  1. Endocrine Conditions
    1. Diabetes Mellitus
    2. Hyperthyroidism
    3. Hypothyroidism
  2. Connective Tissue Disease
    1. Sarcoidosis
    2. Rheumatoid Arthritis
  3. Neurologic Diseases
    1. Muscular Dystrophy
    2. Bulbar Palsy
    3. Cerebrovascular Accident
    4. Myasthenia Gravis
    5. Parkinson's Disease
    6. Dementia
    7. Delirium
  4. Anorexia Nervosa
  5. Acute Infection
    1. Fever (See also Fever of Unknown Origin)
      1. Basal metabolic rate increases 7% per degree F
    2. See Infections in Older Adults
    3. See Infection in the Nursing Home Resident
    4. See Pneumonia in the Nursing Home
    5. See UTI in Older Adults
    6. See Intra-Abdominal Infection in Older Patients
  6. Chronic Infection
    1. HIV Infection
    2. Tuberculosis
  7. Malabsorption
    1. Pancreatic Insufficiency
    2. Celiac Sprue

VII. References

  1. Heizer in Dornbrand (1992) Ambulatory Care, p. 15-18
  2. Karsh in Friedman (1991) Medical Diagnosis, p. 13-16
  3. Gaddey (2014) Am Fam Physician 89(9):718-22 [PubMed]
  4. Grazewood (1998) J Fam Pract 47(1): 19-25 [PubMed]
  5. Huffman (2002) Am Fam Physician 65(4):640-50 [PubMed]
  6. Morley (1995) Ann Intern Med 123:850-9 [PubMed]
  7. White (1991) Am Fam Physician 44(6): 2087-97 [PubMed]
  8. Zawada (1996) Postgrad Med 100(1):207-25 [PubMed]

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