Email: enquiry@medicyatra.com            Definition of Weight loss in the elderly• Objectives:      1. Describe the signif...
Email: enquiry@medicyatra.com           Definition of Weight loss in the elderly• No uniformly accepted definition of weig...
Email: enquiry@medicyatra.com       Epidemiology of Unintentional weight loss :•   Prevalence:     13% to 27% in frail old...
Email: enquiry@medicyatra.com             Pathophysiology of weight loss• Decreased caloric intake• Altered gastrointestin...
Email: enquiry@medicyatra.com     Etiology of weight loss in the elderly• The nine D of weight loss in the older patients:...
Email: enquiry@medicyatra.com   Common Causes of unintentional weight loss:Malignant disease :         (16%-36%)Psychiatry...
Email: enquiry@medicyatra.com                   Evaluation: History• : Are there Side effects due to medication           ...
Email: enquiry@medicyatra.com         Evaluation: Physician Exam• Use information from H&P       1.Comprehensive: Emphasiz...
Email: enquiry@medicyatra.com                        Evaluation• Assessment Tools:  1. DETERMINE checklist:   Use to Ident...
Email: enquiry@medicyatra.com                            Lab tests:• Test should be based on clues from history physical  ...
Email: enquiry@medicyatra.com               Other diagnostic studies:•   Other diagnostic test based on History and physic...
Email: enquiry@medicyatra.com          Management of weight loss:• Identify and treat the under-lying cause.• Addressed im...
Email: enquiry@medicyatra.com                   Management:• Non pharmacological :     1. less restricted diet: diabetics,...
Email: enquiry@medicyatra.com                               Interventions:•   Pharmacologic management:         Evidence f...
Email: enquiry@medicyatra.com                                Summary:• Unintentional weight loss in the elderly is increas...
Email: enquiry@medicyatra.com                     Future research:• Future: Cytokines such as interleukins, interferon, TN...
Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd
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Definition of Weight loss in the elderly

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MedicYatra provides the safe & best Weight loss treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

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Definition of Weight loss in the elderly

  1. 1. Email: enquiry@medicyatra.com Definition of Weight loss in the elderly• Objectives: 1. Describe the significance of unintentional weight loss in the older patient. 2. Identify the factors and conditions associated with weight loss in the elderly. 3. Develop an appropriate approach to investigate and manage7. weight loss in the older patient. 4. Describe the components of inter-disciplinary approach in the management of unintentional weight loss in the older patient. Copyright @ Forever Medic Online Pvt. Ltd
  2. 2. Email: enquiry@medicyatra.com Definition of Weight loss in the elderly• No uniformly accepted definition of weight loss in the older patientDefinition varies with patient population setting . These include: 1. Community dwellers 2. Hospitalized patients 3. Nursing home residents• The Minimal data set : use for nursing home patients, defines weight loss at 5 % or more in 1month or 10% or more in past 6 months. Copyright @ Forever Medic Online Pvt. Ltd
  3. 3. Email: enquiry@medicyatra.com Epidemiology of Unintentional weight loss :• Prevalence: 13% to 27% in frail older community patients 50% to 65% of nursing home residents Copyright @ Forever Medic Online Pvt. Ltd
  4. 4. Email: enquiry@medicyatra.com Pathophysiology of weight loss• Decreased caloric intake• Altered gastrointestinal absorption• Impaired utilization Copyright @ Forever Medic Online Pvt. Ltd
  5. 5. Email: enquiry@medicyatra.com Etiology of weight loss in the elderly• The nine D of weight loss in the older patients: 1. Dentition 6. Depression 2. Dysgeusia 7. Dementia 3. Dysphagia 8. Dysfunction 4. Diarrhea 9. Drugs 5. Disease(chronic) 10. “Dollars”(econonic factors) Copyright @ Forever Medic Online Pvt. Ltd
  6. 6. Email: enquiry@medicyatra.com Common Causes of unintentional weight loss:Malignant disease : (16%-36%)Psychiatry disorder : (9% 24%)Gastrointestinal disease : (6-19%)Endocrine disorder: : (4%-11%)Cardiovascular disease: (2%-9%)Nutritional disorders: (4%-8%)Respiratory disease: (6%)Neurological disease: (2%-7%)Chronic infection: (2%-5%)Renal Disease (5%)Connective tissue disease (2%-4%)Drug-induced (2 %)Unknown (10%-36%) Copyright @ Forever Medic Online Pvt. Ltd
  7. 7. Email: enquiry@medicyatra.com Evaluation: History• : Are there Side effects due to medication Food preference: Food access and ability to secure food 3. Weight loss with normal intake: Red Flag for Physiologic cause• Take a good History : 1. Document weight loss; up to 50% of wt loss is undocumented 2. Detailed medical, psychosocial and dietary history: ie. Dental: Inability to chew or swallow Functional: Is is due to Dementia or depression Medication Copyright @ Forever Medic Online Pvt. Ltd
  8. 8. Email: enquiry@medicyatra.com Evaluation: Physician Exam• Use information from H&P 1.Comprehensive: Emphasize on oral cavity , respiratory an GI exam 2.Calculate: Body mass index(BMI) = wt(kg)/ht(m2):. . 3. Cognition: mood and affect. Copyright @ Forever Medic Online Pvt. Ltd
  9. 9. Email: enquiry@medicyatra.com Evaluation• Assessment Tools: 1. DETERMINE checklist: Use to Identify patients at risk and raise awareness. 2. The Short form Mini-nutritional Assessment): (MNA-SF) use as the first step for nutritional screening 3. SNAQ (Simplified nutritional Appetite questionnaire) training tool can predict weight loss in the older patients. Copyright @ Forever Medic Online Pvt. Ltd
  10. 10. Email: enquiry@medicyatra.com Lab tests:• Test should be based on clues from history physical exam• In general, Initial test are: 1. Complete blood count 2. Electrolytes, BUN/Cr , albumin 3. TSH 4. Urinalysis 5. Stool guiac Copyright @ Forever Medic Online Pvt. Ltd
  11. 11. Email: enquiry@medicyatra.com Other diagnostic studies:• Other diagnostic test based on History and physical:• Chest X-ray: Smokers• Skeletal X-ray: Focal bone pain• Renal USN/Cysto: Hematuria• Endo/Colonoscopy: Heme+, Reflux symptoms, dysphagia• CT/MRI: To further asses exam findings if other evaluations are negative. Copyright @ Forever Medic Online Pvt. Ltd
  12. 12. Email: enquiry@medicyatra.com Management of weight loss:• Identify and treat the under-lying cause.• Addressed important associated factors• Involve a dietician and social worker early• Nonpharmacologic and pharmacologic approach to treatment Copyright @ Forever Medic Online Pvt. Ltd
  13. 13. Email: enquiry@medicyatra.com Management:• Non pharmacological : 1. less restricted diet: diabetics, CHF, hypercholesterol 2. Oral nutritional supplements 3. Enhance protein and energy intake: between meals 4. Optimized diet texture in consult with speech therapy 5. Encourage oral intake: greater than 75% of meal 6. Use flavor enhancers: patients with hyposmia 7. Exercise: To stimulate appetite. Copyright @ Forever Medic Online Pvt. Ltd
  14. 14. Email: enquiry@medicyatra.com Interventions:• Pharmacologic management: Evidence for use in geriatric weight loss is limited• Appetite stimulant: Mirtazapine: doses: 3.75-45mg; increase appetite and promote while treating depression. Cyproheptadine: 2-4mg with meals (CNS); no weight data. Megestrol: 400-800mg orally has been use to treat cachexia in AIDS and cancer patients. Shows some weight gain in LTC pts. Dronabinol: 2.5mg in older patients; side effects includes confusion, dizziness and somnolence. Benefit from antimemetic and analgesic effect. Copyright @ Forever Medic Online Pvt. Ltd
  15. 15. Email: enquiry@medicyatra.com Summary:• Unintentional weight loss in the elderly is increasing unrecognized.• It is important to do nutritional screen periodically.• Identify patients at risk and intervene early• Treat underlying cause• No identifiable cause of weight loss may be found in some patients. Keep close follow-up. Copyright @ Forever Medic Online Pvt. Ltd
  16. 16. Email: enquiry@medicyatra.com Future research:• Future: Cytokines such as interleukins, interferon, TNF alpha, hypothalamic monoaminergic neurotransmission play roles in cachexia.• Interference with these factors may be effective therapeutic strategy in patients with anorexia along with CCK antagonist.• There is Research on Feeding associated gene products which will enhance understanding of the mechanisms of anorexia. Copyright @ Forever Medic Online Pvt. Ltd
  17. 17. Email: enquiry@medicyatra.comCopyright @ Forever Medic Online Pvt. Ltd

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