General
When talking about unintentional weight loss, what % of weight loss do we need for diagnosis?
5% or greater
True or false:
The pathophysiology of unintentional weight loss can explained to increased activity of TNF-alpha.
False. The Pathophysiology is not well understood. Evidence supports that inflammation and inflammatory mediators play a role in weight regulation, exact mechanism is not well understood. (TNF-alpha, IL-1 beta, IL-6 and gut hormones were studied and are likely contributing).
What is the most important part of evaluating unintentional weight loss?
Complete history and physical exam
There are four amendments to the Constitution about who can vote. Describe one of them.
▪ Citizens eighteen (18) and older (can vote).
▪ You don’t have to pay (a poll tax) to vote.
▪ Any citizen can vote. (Women and men can vote.)
▪ A male citizen of any race (can vote)
What are some ways to address unintentional weight loss in elder adults?
dietary changes, environmental modifications, nutritional supplements, flavor enhancers, appetite stimulants
- fewer teeth --> lower weight
Finish this sentence:
Unintentional weight loss of >5% within 6-12months is associated with ___________________ and should prompt evaluation.
Unintentional weight loss of >5% within 6-12months is associated with increased mortality and morbidity and should prompt evaluation.
At what age does total body weight peak?
60
- lean body mass can decrease up to 0.7 lb per year between 20-30 years of age
- fat mass increases until 65-70 (peaks at 60 with only small decreases after that)
- normal reduction in appetite and food intake that occurs with aging should not cause significant changes that can be confused for unintentional weight loss
What should you consider when weighing a patient?
Have them take of their shoes
Why did the colonists fight the British?
because of high taxes (taxation without representation)
because the British army stayed in their houses (boarding, quartering)
because they didn’t have self-government
What things that are important but we might not think about?
Decreased saliva production
Ill-fitting dentures
Periodontal disease
Weakened mastication muscles
--> can lead to impaired chewing and poor dentition
What does this sign mean? " > "
greater than
Who is more likely to have cancer as an underlying cause?
- 65 year old with unintentional weight loss
- 25 year old with unintentional weight loss
25 year old
- younger individuals are 12.5 more times likely to have cancer as etiology vs people older than 60 more than 1 in 10 will be diagnosed with cancer
You decide to work up your patient, what IMAGING will you order?
consider abdominal US
more are patient dependent
Under our Constitution, some powers belong to the federal government. What is one power of the federal government?
to print money
to declare war
to create an army
to make treaties
What do we do all the time but should be avoided per Choosing Wiley campaign by American Geriatrics Society?
- High calorie supplements
- Appetite stimulation
= there is lack of evidence on long term survival and QoL
if given, should not replace meal. Has shown small but consistent weight gain but no change in mortality (unless you only look at undernourished patients)
Definition of cachexia syndrome
Weight loss (greater than 5%) within 12 months attributed to a known chronic illness
What are causes of unintentional weight loss in older adults? (Name as many as you can)
Nonmalignant GI disease 9 - 45%
Psychosocial disorders 9 - 24%
Unknown 6 - 28%
Infectious disease 4 -12%
Endocrine 4 - 11%
Cardiopulmonary 2 - 10%
Systemic autoimmune disorders 4 - 9%
Neurologic 7 -8 %
Alcohol-related diseases 8%
Renal disorders 4%
You decide to work up your patient, what LABS will you order?
CBC
BMP
LFTs
TFTs
CRP
ESR
Glucose measurement
LDH
Protein electrophoresis
Ferritin
UA
FOBT
When was the Constitution written?
▪ 1787
Side effects of Megestrol (Megace)
GI upset, insomnia, impotence, hypertension, thromboembolic events and adrenal insufficiency
Diagnostic criteria for cachexia syndrome
We need three out of the following
- Fatigue
- Anorexia
- Low fat-free mass index (amount of muscle mass to height)
- decreased muscle strength
- abnormal lab values (low albumin or elevated inflammatory markers)
Can you name some medications that might leave to weight loss and why? (Exclude weight loss meds including diabetic meds)
- Altered taste or smell: allopurinol, ACE, antibiotics, anticholinergics, antihistamines, CCB, levodopa, propanolol, spironolactone, selegiline
- Anorexia: amantadine, antibiotics, anticonvulsants, antipsychotics, benzos, digoxin, levodopa, metformin, neuroleptics, opiates, SSRI, theophylline
- Dry mouth: anticholinergics, antihistamines, clonidine, loop diuretics
- Dysphagia: Biphosphonates, doxy, gold, iron, NSAIDs, potassium
- Nausea/Vomiting: amantadine, abx, bisphosphonates, digoxin, dopamine agonist, metformin, SSRI, statin, TCA
low albumin
elevated WBC
elevated platelets
elevated calcium
elevated inflammatory markers
- BUT normal labs do not exclude malignancy
Patient is a 73year old male who you found to have lost 8% of his weight since your last appointment 6 months ago. Your initial workup is negative and screening tests are negative. What is your next step?
Wait 3-6 months is warranted.
Side effects of Mirtazapine (Remereon)
dizziness, fatigue, nausea and somnolence (fall risk)