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The case
A 73-year-old woman presents to your clinic complaining of unintentional weight loss. She reports having lost 15 lbs (6.8 kg) over the past year. Previously, her weight was 135 lbs (61.3 kg) and now it is 120 lbs (54.5 kg). She reports that she is eating three meals per day as usual.
The patient’s past medical history is notable for osteoporosis, a left hip fracture three years ago, osteoarthritis, hypothyroidism and hyper-cholesterolemia. She is taking levothyroxine, a statin and a bisphosphonate plus vitamin D and calcium. She recently started taking nonsteroidal anti-inflammatory medications (NSAIDs) as needed for knee pain. She is an ex-smoker and does not drink alcohol. On examination, her weight was 121 lbs (55 kg), with a body mass index (BMI) of 22. She also had osteoarthritic changes in the knees. Results of investigations, including radiograph of the chest, complete blood count, electrolytes, creatinine, thyroid stimulating hormone and albumin are within normal limits.
Unintentional or involuntary weight loss is a common phenomenon among older adults, with an annual incidence of approximately 13%.1 Problematic weight loss in the older adult is defined by the United States Omnibus Budget Reconciliation Act of 1987 (Title IV: subtitle C: Nursing Home Reform) as a loss of 5% of body weight in one month or 10% over a period of six months or longer.2,3 In this review, we focus on unintentional weight loss for which no organic cause can be found, although frequently, the loss of weight may be associated with chronic conditions.3 Older patients who involuntarily lose substantial amounts of weight without an obvious cause can pose difficult diagnostic and management dilemmas for physicians.
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