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admin | Bodybuilding Training Program | 07.09.2015
The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis. Functional, social, and psychological disability as causes of loss of weight and independence in older community-living people. Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study. Most practitioners and researchers define unintentional weight loss as a 5% to 10% decrease in body weight over a period of 1 to 12 months.3-6 A clinically useful benchmark is 5% over a 6-month period. Patients may deny or not report weight loss, so look for clues suggesting it, such as loose-fitting clothing or oversized rings.
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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. In evaluating weight loss in the patient who resides in a long-term care facility, the physician may have to address some issues that can be unique to institutional care.Interviews with the caregivers and the dietary staff of the facility are crucial to understanding the problem.
While the work-up is proceeding or if a cause is not well defined, the goal is to prevent further weight loss. Because lean body mass tends to be replaced by fat, total body weight generally remains stable.
When patients state their weight loss is the result of dieting, probe for lifestyle changes. Depression and nonmalignant GI diseases are common reversible causes.8 Interventions used to reverse or minimize further weight loss include nonpharmacologic (Table 1) and pharmacologic (Table 2), the former being first-line. The risk of mortality was significantly higher in the men who lost weight than in those whose weight did not decrease. Initiating nutritional support early may help to avoid some of the complications related to weight loss.28The contributions of dietitians, speech therapists (for oropharyngeal and swallowing evaluations) and social services personnel cannot be overestimated because the efforts of these staff can improve many strategies to increase food intake. Maintaining weight loss is difficult, and if the patient is keeping the pounds off easily, dieting may be a coincidental occurrence.

Pharmacologic management results in short-term weight gain (approximately 3-7 lb)11 but does not improve long-term health and mortality. An approach to the diagnosis of unintentional weight loss in older adults, part one: prevalence rates and screening.
An approach to the nonpharmacologic and pharmacologic management of unintentional weight loss among older adults. A specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. Consequently, the total caloric intake of a patient may be compromised.Creative strategies are often needed when weight loss is due to environmental issues. Cyproheptadine and dronabinol may promote weight gain; central nervous system toxicity is a concern.
SNAQ (Simplified nutritional Appetite questionnaire) training tool can predict weight loss in the older patients. In some instances, weight loss in these patients with diabetes mellitus may reflect overzealous blood glucose control. Patients receiving megestrol and dronabinol usually gain weight, but weight is primarily adipose tissue, not lean body mass.12 Human growth hormone and other anabolic agents promote weight gain but are associated with increased mortality.
Also, family members may sometimes be more successful than nursing assistants in encouraging a patient to eat.Although the setting may be contributory, the physician should not simply assume that environmental factors are responsible for unintentional weight loss in an institutionalized elderly patient. Describe the components of inter-disciplinary approach in the management of unintentional weight loss in the older patient.
Food and Drug Administration has labeled no appetite stimulants for the treatment of weight loss in the elderly.
Food and Drug Administration has not labeled any of these drugs for use in elderly patients with weight loss.Treatment of depression may, in and of itself, cause weight gain.
Accurate evaluation is essential, however, because this problem is associated with increased morbidity and mortality.1,2 When a patient has multiple medical problems and is taking several medications, the differential diagnosis of unintentional weight loss can be extensive. A combination of these factors may be present.An interview with a knowledgeable care-giver is essential because the elderly patient may deny or be unaware of the weight loss or the aforementioned difficulties. Mirtazapine (Remeron) has been shown to increase appetite and promote weight gain while also treating the underlying depression.33Dronabinol (Marinol) is a cannabinoid indicated for the treatment of anorexia with weight loss in patients with acquired immunodeficiency syndrome (AIDS).

If the patient's measured weights over time are not available, the caregiver may be able to estimate the amount of weight that the patient has lost through changes in the patient's clothing size.A nutritional assessment should be performed. Lower dosages may be effective for stimulating weight gain in frail elderly patients, although this approach needs to be tested in randomized controlled trials. In one study,37 patients (median age: 65 years) who received cyproheptadine had a decrease in their rate of weight loss but no weight gain. However, this hormone is extremely expensive, and its adverse effects include carpal tunnel syndrome, headache, arthralgias, myalgias and gynecomastia.41Although medications may help promote appetite and weight gain in an elderly patient with unintentional weight loss, drugs should not be considered first-line treatment. Even if drugs are successful in inducing weight gain, long-term effects on quality of life are unknown.FEEDING TUBESContinued weight loss necessitates a discussion with the patient or family members about whether long-term tube feeding is desired.
Questions directed at identifying symptoms related to the pulmonary and digestive systems are important because lung and gastrointestinal cancers are the malignancies most likely to be implicated in unexpected weight loss. One study,26 although not performed in the elderly, found that simply asking the patient if he or she is depressed and has recently lost pleasure in doing things can reliably screen for depression.PHYSICAL EXAMINATIONThe physical examination of an elderly patient with unintentional weight loss is directed by the information gathered during the history-taking process.
It is particularly important to evaluate the oral cavity and the respiratory and gastrointestinal systems.Anthropometric measurements, specifically height and weight, are of prime importance and should be compared to minimum and maximum adult weights. The patient's body mass index (BMI) can be calculated by dividing the patient's weight in kilograms by the square of the patient's height in meters. As mentioned previously, formal assessment of mood may be necessary,25 particularly if the initial screen for depression is positive.Often, clues to the etiology of unintentional weight loss can be obtained by watching a patient eat part of a meal. Hence, a patient with a low albumin level is not necessarily malnourished or losing weight.
Similarly, prealbumin and transferrin levels may reflect nutritional status, but they can also be abnormal in elderly patients with chronic illnesses.29If the decision is made to provide nutritional supplementation in a patient with unintended weight loss, the serum prealbumin, transferrin or albumin level can be used to guide supplement selection.

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