Intervene to Counter Weight Loss in Elderly: Depression Is Usually the Biggest Culprit

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MIAMI -- Aggressive intervention to counter weight loss in the elderly can go a long way to improve quality of life and prevent morbidity and mortality, Dr. Jonathan T. Stewart said at a psychopharmacology update sponsored by the University of Miami.

"The first thing to do is notice the problem--that is the take-home message," Dr. Stewart said. "This is an area that doctors all ignore--and probably one of the long-range quality of life issues where we can make a difference."

Psychiatrists are well positioned to monitor elderly patients' weight and determine their ability to gain weight. Involuntary weight loss is a very strong predictor of 1-year mortality in the elderly, as well as a strong predictor of institutionalization, said Dr. Stewart, chief of the geropsychiatry section at Bay Pines Veterans Affairs Medical Center in St. Petersburg, Fla.

An estimated 10%-25% of the elderly are malnourished, but rates are considerably higher in medical settings. In one study, about 30% of geropsychiatry clinics, outpatients were malnourished, as were an estimated 30%-60% of older patients on medical-surgery wards. Dr. Stewart said.

Patients should be educated about the consequences of malnutrition; increased risk of infection, poor wound healing, loss of bone mineral density, increased risk of fractures and falls, and decreased functional capacity.

Begin by identifying potential psychiatric, medical, drug-related, and social causes. Treatment is mostly common sense. He suggested aggressive treatment of medical and or psychiatric causes, as well as removing any offending medications. Get rid of dietary restrictions when possible. "Explain why they really don't want to be drinking 1% milk," Dr. Stewart said. Encourage patients to maintain good dental hygiene and to exercise.

Maintaining weight is one of the biggest aspects of keeping an elderly patient well, Dr. Stewart said at the meeting, which was also sponsored by the Florida Psychiatric Society. "Keeping people from becoming frail is frequently an uphill battle in geriatric psychiatry."

Depression is the major culprit for weight loss in the elderly, Dr. Stewart said. "Depression is the biggie--the most important cause of involuntary weight loss in the elderly."

Control issues, such as a power struggle between patient and nurses in a nursing home, also should be considered. Alcoholism and drinking at the expense of eating are common. Another possible condition is "depletion," a state in which people do not eat right when they are near to death, explaining that the burden of living has become too great.

Delusions can play a role, although specific delusions about poisoning are rare, Dr. …