Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Unintentional Weight Loss in the Elderly (Part 2)
Michael Morcos, Clinical Pharmacist, Ward MM
While malnutrition in older people is common, it is frequently overlooked and can result in many negative outcomes. Management should be /directed at identifying and treating underlying causes, and providing nutritional support. Consideration should be given to the patient’s environment, interest in food and ability to eat, as well as potential contributory factors such as poor oral health, difficulty in swallowing or chewing, bereavement and unhappiness.
- Allied health professionals have an important role to play. A dietitian, speech pathologist and social worker are very helpful to assist with assessment and management, particularly in cases where an obvious organic cause has not been identified. Also, a physiotherapist may encourage patients to increase their amount of exercise, to thereby stimulate appetite and increase energy intake and retain muscle mass.
- A trained clinical pharmacist from WARD MM can perform a medication review – medications that are not clearly required and that may be contributing to the weight loss can be discontinued or appropriate alternatives considered.
- The role for specific nutritional interventions targeted at increasing caloric intake and improvement weight in unclear. The use of an oral nutritional supplements, such as high energy drinks, as a means of arresting weight loss and increasing food intake may sometimes, but not always, reverse weight loss. Counselling patients to consume their usual food intake rather than as a replacement of that intake is essential.
- Various drugs, including appetite stimulants and antidepressants (e.g. cyproheptadine, mirtazapine) have been used to improve appetite or promote weight gain in elderly individuals, but the evidence base is weak, with very few randomised trials. Any pharmacological intervention should be aiming at resolving or improving the underlying illness or cause.
- Within aged care facilities, changes such as providing favourite foods, increasing food flavours, providing companionship at mealtimes, and increasing staffing levels and organising staff to produce higher quality feeding assistance can be extremely beneficial.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.