Is weight loss in an elderly patient ever considered normal? What workup should be done for an elderly patient who has lost 10-20 pounds over the past year but has no obvious GI symptoms or signs other than decreased appetitie?
—Michael Van Grouw, PA-C, Newville, Pa.

Unintentional weight loss in the elderly can be difficult to evaluate, and the differential diagnosis is extensive. As people age, physiologic changes in appetite can occur, decline in taste buds can result in less interest in eating, and problems with teeth or dentures can limit food intake. The leading pathological causes of unintentional weight loss are depression, cancer (especially lung and GI malignancies), cardiac disorders, and nonmalignant GI diseases. Medications and polypharmacy are also associated with unintentional weight loss. Even after appropriate evaluation, a specific cause is not identified in 25% of elderly patients. The workup, which is dictated by the patient’s history (including nutritional assessment) and physical examination, usually includes a complete blood count, chemistry panel, thyroid-stimulating hormone, urinalysis, and fecal occult-blood testing. Any abnormalities on these initial tests direct further testing. GI endoscopy should also be considered.
—Jo Ann Deasy, PA-C, MPH (100-12)

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