Involuntary Weight Loss in the Elderly
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CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Valid August 1 - October 31, 2005. Estimated time: 1 hour
Educational Objectives
1. To recognize the importance of involuntary weight loss in the elderly
2. To understand the factors associated with unintentional weight loss in the elderly
3. To be able to investigate and manage weight loss in the elderly in a logical way, avoiding unnecessary investigations
4. To understand the importance of psychosocial factors and a multidisciplinary approach in the management of unintentional weight loss in the elderly
Involuntary weight loss is a common complaint in the elderly. Prevalence estimates of weight loss among older persons vary tremendously and are as high as 27% in high-risk populations, such as free-living frail elderly receiving community services.1 Increasing age, disability, coexisting medical illnesses, previous admission to the hospital, low education level, presence of cognitive impairment, smoking, loss of a spouse, and low baseline body weight have all been associated with a higher likelihood of weight loss.2 Although there is no clear consensus, the most well-accepted definition of clinically important weight loss is 5% over a period of 6-12 months. This is based on the finding that weight loss of 4-5% over a 1-year period identified subjects whose weight loss was associated with increased mortality.3 A 4% weight loss at 1 year had a sensitivity of 75% and specificity of 61% for predicting subsequent 2-year mortality. In this study, the annual incidence of 4% weight loss was 13% with a relative risk of 2-year mortality at 2.43 (95% confidence interval [CI], 1.23-4.41). These findings have been confirmed in other studies.4 The relationship of weight and subsequent mortality was examined in the Framingham Heart Study.
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