Huffman Grace Brooke
Brooke Grove Foundation, Sandy Spring, Maryland 20860, USA.
Am Fam Physician. 2002 Feb 15;65(4):640-50.
Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. The leading causes of involuntary weight loss are depression (especially in residents of long-term care facilities), cancer (lung and gastrointestinal malignancies), cardiac disorders and benign gastrointestinal diseases. Medications that may cause nausea and vomiting, dysphagia, dysgeusia and anorexia have been implicated. Polypharmacy can cause unintended weight loss, as can psychotropic medication reduction (i.e., by unmasking problems such as anxiety). A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. A reasonable work-up includes tests dictated by the history and physical examination, a fecal occult blood test, a complete blood count, a chemistry panel, an ultrasensitive thyroid-stimulating hormone test and a urinalysis. Upper gastrointestinal studies have a reasonably high yield in selected patients. Management is directed at treating underlying causes and providing nutritional support. Consideration should be given to the patient's environment and interest in and ability to eat food, the amelioration of symptoms and the provision of adequate nutrition. The U.S. Food and Drug Administration has labeled no appetite stimulants for the treatment of weight loss in the elderly.
非故意体重减轻的老年患者感染、抑郁和死亡风险更高。非自愿体重减轻的主要原因是抑郁症（尤其是长期护理机构的居民）、癌症（肺癌和胃肠道恶性肿瘤）、心脏疾病和良性胃肠道疾病。可能导致恶心、呕吐、吞咽困难、味觉障碍和厌食的药物也与此有关。多种药物联用可能导致意外体重减轻，减少精神药物用量（即通过揭示焦虑等问题）也可能导致。在约四分之一非故意体重减轻的老年患者中未发现具体病因。合理的检查包括根据病史和体格检查进行的相关检查、粪便潜血试验、全血细胞计数、化学检查、超敏促甲状腺激素检测和尿液分析。上消化道检查在部分患者中的阳性率较高。治疗旨在治疗潜在病因并提供营养支持。应考虑患者的环境、对进食的兴趣和能力、症状改善情况以及提供充足营养。美国食品药品监督管理局未批准任何食欲刺激剂用于治疗老年人的体重减轻。
