Weight loss may be intentional or appropriate to bring the body back to a safer, more desirable weight. Weight loss may also be unintentional as a result of a serious illness, a decline in memory or a behavioral problem.

Unplanned weight loss is defined as an unintended decrease from a person's usual weight. Significant weight loss is defined as a decrease of five percent or more of a person's usually weight in one month or a ten percent or greater decrease in body weight in six months.

We must keep in mind that not all weight loss is bad or abnormal. Weight loss is also an anticipated part of the dying process in individuals with end-stage problems, such as dementia, chronic obstructive pulmonary disease (lung disease) or a failure to thrive.

Risk Factors

Many elderly patients – because of serious medical problems, decreased appetite and decreased mobility – are at risk for unplanned weight loss. Significant weight loss can lead to malnutrition, which if not corrected may lead to death. Unfortunately, in cases such as end-stage diseases like dementia, the body gives up and even if food is given, the body may not be able to “process it” correctly. The best way to care for a person at risk for weight loss is to offer them nutritious food that they enjoy eating.

Some risk factors for weight loss include:

• History of weight loss
• Depression, feeling of abandonment, dementia or other emotional problems
• Increased food requirements due to illness, fever, or pressure ulcers
• Indigestion
• Poorly fitting dentures
• Person “gives up” and refuses to eat
• Infections
• Dehydration

Effects of Aging

Age related reasons leading to weight loss include:

• Decreased overall body weight (mass)
• Decreased sense of taste and smell, which makes food less appetizing
• Inability of absorb nutrients
• Loss of the learned ability to eat

Acute or chronic illnesses such as stroke, Alzheimer's, or Parkinson's diseases, which may result in:

• Chewing and swallowing problems
• Decreased ability to feed oneself
• Decreased appetite

Prevention of Weight Loss

Sometimes weight loss may be prevented by:

• Early identification of risk
• Assessing the person for early signs of weight loss and malnutrition
• Assessing the need for devices to assist in eating
• Maintaining nutrition
• Treating underlying medical problems
• Treating depression
• Checking for thyroid disease
• Serving foods the person enjoys

If your loved one suffers a significant weight loss, our staff will:

• Seek out the underlying illness and problems
• Treat pain or stomach problems
• Treat depression
• Treat dry mouth or denture problems
• Remove medications that decrease appetite, when possible
• Provide small, more frequent meals where indicated
• Position your loved one properly during meals
• Provide assistance and supportive equipment
• Provide supplements or artificial nutrition and hydration consistent with your loved one's expressed preferences and physician's orders.

What Can You Do To Help

• Tell the nursing staff your loved one's food preferences and eating routine
• Bring in favorite foods from home (after talking to the dietary department)
• Encourage your loved one to eat and drink
• Join your loved one during mealtime when possible
• Assist your loved one in dining if he or she eats better for you
• Discuss the issue of artificial nutrition or hydration with your family member before the question arises. Provide us with accurate telephone numbers for family members or responsible parties.

Treatment Options

Artificial nutrition and hydration involves placing a tube in the patient's nose, stomach or into the veins (intravenous).

The best method for residents who require long-term nutritional support is the G-tube (gastric tube), which is placed through the skin of the belly into the stomach by a doctor. This procedure is usually performed at the hospital and normally does not require an overnight stay. In a study of terminally ill persons, few experienced hunger or thirst, and there was no evidence suggesting that tube feeding increased the comfort of persons with dementia.

For residents who are able to eat, it is best to utilize the most liberal diet medically advisable. The American Dietetic Association state that the quality of life and nutritional status of residents in long-term care facilities may be improved on a regular diet rather than a therapeutic diet. Therapeutic diets, such as diabetic, low salt, and low cholesterol diets, are often unpalatable and have been shown to be associated with weight loss and other problems in nursing home settings.