Information
- Unintentional weight loss may affect 15 – 20% of adults over 65.
- Unintentional weight loss of more than 5% body weight over the preceding 6 months may indicate serious underlying pathology. Causes include medical and psychiatric illnesses and social factors. Weight loss is common in some conditions such as COPD and late stage dementia. These conditions may occur in isolation or in combination.
- Rates in care home residents may be as high as 60%.
- Diagnosis can be challenging, and no identifiable cause is found in up to 25% of patients despite investigation.(1)
Who to refer:
Frail older people with clinically significant weight loss (weight loss of > 5% of body weight over 6 months) in whom no clear specific cause is identified after investigations detailed in Primary Care Assessment and Management section.
Who not to refer:
Single organ pathology should be referred to the appropriate specialty.
How to refer:
Patients should be referred via SCI Gateway to their local geriatric medicine service;
- North East Edinburgh: Leith Community Treatment Centre – Geriatric Medicine
- North West Edinburgh: Western General Hospital- Geriatric Medicine
- South Edinburgh: Liberton Hospital – Geriatric Medicine
- Midlothian: Liberton Hospital – Geriatric Medicine
- East Lothian: East Lothian Community Hospital– Geriatric Medicine
- West Lothian: St John’s Hospital – Geriatric Medicine
Primary Care Assessment and Management
- An up to date weight is vital (Note diurnal body weight can fluctuate by +/- 2kg)
- Dietary history
- Examination:
- Chest
- Abdomen
- Breast tissue for masses
- Digital rectal examination for obvious masses (if alteration in bowel habit)
- Assess for lymphadenopathy – cervical, axillary, inguinal
- Investigations
- FBC, U&Es, LFTs, Albumin, Calcium, TFTs, CRP, Blood glucose
- Myeloma screen
- Consider Anti-tissue Transglutaminase (anti- tTG) antibodies (Coeliac screen) (if new anaemia +/- change in bowel habit)
- Consider PSA (if new LUTS symptoms as well as DRE)
- Urinalysis for haematuria, proteinuria or glycosuria
- Review of mood and cognition
- CXR (if not done in past 6 months)
- Consider CT Chest Abdomen and Pelvis- See refhelp guidelines GP Access to CT for Suspected Cancer (No Clinically Obvious Primary).aspx
- Consider referral to community dietician or provision of “Food First” Leaflet (see Resources)
