Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force Base, NE, USA.
David Grant Medical Center, Travis Air Force Base, CA, USA.
Am Fam Physician. 2014 May 1;89(9):718-22.
Unintentional weight loss in persons older than 65 years is associated with increased morbidity and mortality. The most common etiologies are malignancy, nonmalignant gastrointestinal disease, and psychiatric conditions. Overall, nonmalignant diseases are more common causes of unintentional weight loss in this population than malignancy. Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked. Social factors may contribute to unintentional weight loss. A readily identifiable cause is not found in 16% to 28% of cases. Recommended tests include a complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein levels, erythrocyte sedimentation rate, glucose measurement, lactate dehydrogenase measurement, and urinalysis. Chest radiography and fecal occult blood testing should be performed. Abdominal ultrasonography may also be considered. When baseline evaluation is unremarkable, a three- to six-month observation period is justified. Treatment focuses on the underlying cause. Nutritional supplements and flavor enhancers, and dietary modification that takes into account patient preferences and chewing or swallowing disabilities may be considered. Appetite stimulants may increase weight but have serious adverse effects and no evidence of decreased mortality.
65 岁以上人群的非故意体重减轻与发病率和死亡率增加有关。最常见的病因是恶性肿瘤、非恶性胃肠道疾病和精神疾病。总的来说，与恶性肿瘤相比，非恶性疾病是该人群非故意体重减轻的更常见原因。药物使用和多种药物治疗会干扰味觉或引起恶心，不应忽视。社会因素也可能导致非故意体重减轻。在 16%至 28%的病例中，无法找到明确的病因。建议的检查包括全血细胞计数、基本代谢小组检查、肝功能检查、甲状腺功能检查、C 反应蛋白水平、红细胞沉降率、血糖测量、乳酸脱氢酶测量和尿液分析。应进行胸部 X 光检查和粪便潜血检查。腹部超声检查也可以考虑。当基线评估无异常时， justifies 有理由进行三到六个月的观察期。治疗重点是潜在的病因。营养补充剂和风味增强剂，以及考虑到患者偏好、咀嚼或吞咽障碍的饮食调整，可以考虑。食欲刺激剂可能会增加体重，但会产生严重的不良反应，并且没有证据表明死亡率降低。
