Weight loss in older adults can be intentional or unintentional. The patient or relative should provide an estimate of the weight loss. To diagnose cachexia syndrome, three of the following characteristics must be present: fatigue, anorexia, low fat-free mass index amount of muscle mass to height , decreased muscle strength, and abnormal laboratory testing such as low serum albumin levels, anemia, or elevated inflammatory markers.
The pathophysiology of unintentional weight loss is not well understood. Multiple studies have looked at inflammatory cytokines such as tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, and gut hormones such as cholecystokinin, glucagon-like peptide, and ghrelin.
Body composition and lean body mass decrease with age. Lean body mass can decrease up to 0. Fat mass continues to increase until 65 to 70 years of age. Therefore, total body weight usually peaks at 60 years of age with only small decreases after that.
The normal reduction in appetite and food intake that occurs with aging should not lead to weight changes substantial enough to be confused with unintentional weight loss. Unintentional weight loss in older adults is a diagnostic challenge. There are no validated clinical guidelines, and the differential diagnosis is broad. Patients 18 years and older presenting with weight loss are up to For people older than 60 years, more than one in 10 presenting with weight loss will be diagnosed with cancer.
In community-dwelling older adults, unintentional weight loss causes are most often classified as organic or psychosocial.
