Q: My 88-year-old father lives in his own home about 100 miles from us. He’s been living alone since my mother died five years ago. I thought he looked rather thin last time we saw him. I’m starting to feel worried about his nutrition. Should I be concerned? Would you recommend he start drinking a supplement such as Boost or Ensure?
A: This question comes up a lot for families. It is indeed very common for older adults to experience unintentional weight loss at some point in late life.
The brief answer is that yes, you should be concerned. But I wouldn’t recommend you jump to purchasing Boost or Ensure.
Now, in most cases, some nutritional supplementation is in order. But before focusing on this, you should first get help figuring out why your father is losing weight.
For doctors, unintended weight loss is a major red flag when it comes to the health of an older person.
So in geriatrics, we usually recommend that an older person — or their caregivers — monitor weight regularly. This enables us to spot weight loss sooner rather than later.
Once we’ve spotted unintentional weight loss, the next step is to figure out what might be causing it. And then we’re in a better position to recommend a treatment plan, which might well include a nutritional supplement.
In this post, I’ll go over each of these steps in more detail.
Why you should monitor for unintentional weight loss
Unintentional weight loss means losing weight without dieting or otherwise deliberately trying to slim down.
This often goes hand-in-hand with malnutrition in aging. Now, they aren’t quite the same thing: it’s possible to be malnourished without obviously losing weight. But they tend to go together.
Both problems are common in older adults. One study found that 39% of hospitalized older adults were malnourished.
It’s important to detect and evaluate weight loss and malnutrition for several key reasons:
- They are often caused by underlying health problems which need to be diagnosed and managed.
- They leave older adults weakened and more vulnerable to additional illnesses and injuries.
- They may be a sign that an older person is impaired, or otherwise needs more support with daily life.
Fortunately, there’s an easy way to screen for these problems: tracking an older person’s weight.
How to track weight and nutrition in an older person
Tracking Weight:
This is a terrific quick-and-easy way to monitor overall health and nutrition in an older adult.
To track the weight of an older person who lives at home or in assisted-living, I usually recommend checking and recording the weight at least once a month.
(Note that nursing homes are usually required to weigh residents monthly; some assisted-living facilities may do so as well.)
You should keep records of the weight checks, preferably in a way that makes it easy to bring the information to the doctor’s office. Some families keep the information in a paper chart, but it’s potentially better to keep it in a shared computer file; see this article on keeping and organizing information for more details.
You can also consider one of the newer “connected” scales. These are devices that can wirelessly connect to a mobile device or even the home’s wifi. The weight record can then be accessed through an app or website.
Once you start tracking weight: at what point should you be concerned?
A general rule of thumb is that unintentionally losing 5% of one’s original body weight over 3-6 months is cause for concern. But it’s also reasonable to be worried if you notice a steady downward trend.
Once you’ve become concerned and documented a change in weight, you’ll want to bring it up with a doctor or other health professional.
Tracking Nutrition:
Monitoring for unintended weight loss, as detailed above, is probably the easiest way to screen for nutrition problems.
Other red flags to take note of are:
- Loss of appetite.
- Decreased strength and/or ability to get around.
Note: The term “nutrition” can be used differently in different contexts. In geriatrics, the focus is often first on ensuring that an older person is getting enough calories and protein to maintain energy needs and muscle mass. Obviously, there is more to nutrition than just this; it’s also important that people meet their body’s needs for vitamins and minerals, and that they eat a “healthy diet.” Exact definitions of a “healthy diet” differ, but it’s generally one that promotes health and well-being, and doesn’t cause or aggravate health problems. A Mediterranean-style diet can work well for many people.
Common causes of weight loss and malnutrition
It’s important for an older person to get a clinical evaluation, once you’ve noticed weight loss or other signs of possible malnutrition. A simple initial assessment tool that many clinics will use is the Mini Nutritional Assessment.
(You can view and download a “Self-MNA” here.)
Many types of health problems can cause weight loss. According to this Canadian Medical Journal review article, common causes to consider are:
- Depression and other psychiatric conditions (9-42% of cases)
- Cancer (16-36%)
- Gastrointestinal disease (e.g. problems with the stomach or other parts of the digestive tract; 6-19%)
- Thyroid imbalances, diabetes, and other types of endocrine disorders (4-11%)
- Cardiovascular disease (2-9%)
- Alcoholism and other forms of nutritional disorders (4-8%)
- Chronic obstructive pulmonary disease (COPD) and other respiratory disorders (~6%)
- Neurologic disorders, including those that interfere with swallowing (2-7%)
- Medication side-effects (~2%)
- Unknown after extensive evaluation (10-36%)
Some additional issues that particularly come up in older adults include:
- Difficulty leaving the house to purchase food. This can be due to limited mobility (e.g. due to pain, fear of falling, etc), lack of transportation, or cognitive problems.
- Difficulty affording food. Some older adults live on a very limited income.
- Difficulty or pain with chewing and swallowing. Many seniors fall behind on dental care for various reasons. This can lead to painful mouth conditions, or a lack of suitable dentures.
- Constipation. This is quite common in older adults and can interfere with appetite and eating enough.
- Paranoia about food, due to dementia or a psychiatric condition. A fair number of older adults become suspicious of others during early dementia. Occasionally this leads them to not eat enough.
- Forgetting to eat or having difficulty organizing meal preparation. This is especially common for those with Alzheimer’s and other dementias, but can also be due to problems like depression or even mobility limitations.
- Unappetizing food. Sometimes the food is not to an older person’s taste, especially if it is a low-salt, low-fat, low-carb, low-sugar, or other medically “recommended” diet.
Generally, to sort through all these possibilities, doctors will need to interview the older patient and the family. For instance, they will want to know:
- How is the older person’s appetite? Do they like to eat or seem uninterested? How has this changed over the past year?
- Any pain or difficulty with chewing or swallowing?
- Any problems with nausea, vomiting, or feeling full easily? Any abdominal pain?
- Any problems with diarrhea or constipation?
- Who does the shopping for food? Who cooks the meal and organizes the time to eat? Does the older person do this alone or usually with someone else involved?
It’s also very helpful for the doctors to have as much information on what food — and how much food — the person is actually eating.
Last but not least, during the clinical evaluation, the doctor will physically examine the older person and then probably order some bloodwork as well.
How you can help doctors evaluate weight loss
The main way to help doctors is two-fold. One is to bring in a weight record, showing how the older person’s weight has changed over the past several months.
The other is to bring in information related to symptoms and ability to obtain food. You can do this by asking your older relative — and anyone else who is familiar with the person’s daily life — the interview questions listed above.
Of course, the doctor will still need to ask these questions, but it’s extremely helpful for patients and families to have thought through the questions ahead of time.
You can also download and complete the “Self-MNA” (self Mini-Nutritional Assessment) and bring it in to discuss with your health providers.
How to “treat” unintentional weight loss
The best treatment plans are based on a careful evaluation and correct diagnosis of what health problems — and social factors — are causing the weight loss.
Unfortunately, it’s common for many doctors to quickly turn to prescribing high-calorie supplements like Ensure, or even prescription appetite stimulants.
In fact, this is such a common problem that the American Geriatrics Society chose to address it in their Choosing Wisely recommendations:
Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia (loss of appetite) or cachexia (loss of muscle mass) in older adults.
Instead, optimize social supports, discontinue medications that may interfere with eating, provide appealing food and feeding assistance, and clarify patient goals and expectations.
(Learn more here: Choosing Wisely: 5 More Treatments For Older Adults You Should Question)
Now, even when social issues and medical problems are addressed, it’s often necessary to provide some extra nutritional support to those older adults who have been losing weight.
This usually means providing extra protein and extra calories. Fat is dense in calories, so this can be a good way to increase energy intake. Technically it’s better to provide “good fat” like olive oil, but in the short-term, I encourage people to consider whatever fatty foods the older person really likes to eat, which might mean ice-cream or peanut butter.
Research also suggests that many older adults may benefit from supplemental protein, especially if they’ve been showing signs of lean muscle loss. Many studies have used milk or whey protein.
So should you consider Ensure or Boost? You should discuss more with your father’s doctor, but my take is that such commercial supplements should be used only as a last resort. They are expensive, usually contain a lot of sugar, and contain various additives. So it’s better to make your own smoothies or otherwise provide nutrient-dense snacks and protein to your father, if at all possible.
Key take-home points on weight loss in older adults
I’ve provided a lot of information while answering your question, so let me summarize the most important take-aways.
- Tracking monthly weights is a good way to keep an eye on the health of an older adult. Put it on the calendar. A “connected” scale can make it easier to log and share the weight record.
- Unintended weight loss is a major red flag. Take action and consult a doctor if an older person loses 5% of more of their body weight, or if you’re otherwise concerned.
- Be sure to check for problems related to purchasing, preparing, and eating food. These are easily overlooked in older adults. They may be related to mobility difficulties, cognitive impairments, dental problems, depression, or unappetizing diets.
- Commercial supplements and/or appetite stimulants should be used only after careful consideration with the doctor, and after considering alternatives. They often feel like the “easiest” solution (assuming one can afford them) but they’re usually not the best way to maintain an older person’s nutrition and well-being.
If you want a more scholarly take on nutrition in aging, here are a few good articles:
- Assessment and management of nutrition in older people and its importance to health
- Nutrition in the very old
- Nutrition and the gut microbiome in the elderly
- Protein Requirements and Recommendations for Older People: A Review
- Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance?
- Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness
Have you been concerned about an older person’s weight loss? Post your questions and comments below.
[This article was reviewed & updated in October 2022.]
K K JOARDAR says
My wife age 68 yrs. We are from India and living in a joint family. She is a patient of High blood pressure but we’ll controlled. She is having type II Diabetes also under controlled. She lost 07 kilogram for last 03 years.
Lot of Medical tests have already been conducted and found suffering from Gastritis. She is being treated by Gastroenterologist and other concerned doctors. But her health is not at all improving and she is gradually moving towards depression. Request your advise for her weight gain.
Leslie Kernisan, MD MPH says
Impossible to say over the internet what might be causing her weight loss and what should be done. If she is not improving under the care of her current health providers, I would recommend considering a second opinion.
You could also ask her doctors to clarify what conditions they feel they have ruled out, and what do they think is the likely cause of her weight issue. Good luck!
sandra J Rendon says
My girlfriend’s almost 26th four months ago she took 96 sleeping pills when I found her they said she her body was shutting down they saved her every since then she has lost so much weight almost 3 to 4 lb a week what should I do I’m trying to look for something to read up on it so I can call the doctor
Leslie Kernisan, MD MPH says
Oh, this sounds terribly sad and must have been very scary for you.
Unfortunately, I have no information to share regarding this type of situation, as she’s not an older person and her situation sounds a bit exceptional.
I would certainly recommend bringing this up with her usual health care providers and asking lots of questions about what might be going on. Good luck!
Anonymous says
I have moved fromNJ,to be close to my father,and mother permanently.
Prior to such,dad was at a healthy 170 or so pds, eating well,and still is… Last few weigh-ins, (also was diagnosed as still competent and gets around but healing from light to mild stroke, (Dec.2017) active 82 years,
He,since then dropped a few pounds,but is eating quite normal.
Three to four or so meals a day adding in snacks,(he love his ginger snap cookies, and other snacks his grapes,and he is again having NO LOSS OF APPETITE.)Dad, again in January last weighed in on or about the last week of January 2018 (At his shoulder/arm dr., after his fall) was at 162 pds.
–
Dad, with late onset(diagnose late)Dementia/ALZ has been eating so well. He also gets out at least 1x to 2x a day.He really enjoy going out and i ensure/making sure i do just that to get him out the house each day, with the exception of bad weather, snow and or rain storms etc.al., and he is always happy, laughing, and enjoying his days regularly, and has ZERO issue with bowels et.al.,but again he is now as of tonight, (i did a weigh-in) and am going to keep doing so at least once or twice a week,he is down to 159.2 pounds.” I shall schedule a dr.’s check-up,regular primary physician appt., tomorrow for this week.
I would like your feedback please as to the feasible underlying issue involving weight loss with the elderly, as i am researching thoroughly, insofar as such relevance. I even learned some with such illness,diagnosis that this does not happen to him/her and i hoping you’re able to help til’ i reach his doctor, thank you very much.
Dad is early eighties.
Always was/is healthy such a long time.
Thank you so much in advance for your courtesies and care when responding.Good day now.
God bless us all.
Leslie Kernisan, MD MPH says
Hello, I had to edit down your comment as it was too long to be posted in its entirety.
It sounds like your father has been diagnosed with dementia and has lost 10 pounds recently. Also sounds like his appetite is good and he has no particular complaints.
Although it’s great if he’s feeling well, I think you are right to be concerned and to ask the doctor to look into things. Based on your father’s past medical history, and current findings on physical exam and when your family is interviewed for symptoms, his health providers should be able to determine whether any of the common causes for weight loss appear likely in his case.
Regardless of what the health provider finds, it would probably be a good idea to continue to track your father’s weight, as you are doing.
good luck!
phyo zaw oo says
My grandpa is losing weigh about 10 kg in one year
Also has macrocytic anemia.He doesn’t lose appetite but has issues with dental problems.
underlying diseases are polycystic kidney disease and hypertension.
Leslie Kernisan, MD MPH says
10 kg is a very substantial amount of weight to lose in a year.
I would strongly recommend that he see his doctors. Your family can ask about evaluation for all the common causes of weight loss and malnutrition that I list in the article.
I also cover the evaluation of anemia here:
Anemia in the Older Adult: 10 Common Causes & What to Ask
Macrocytic anemia can be caused by deficiencies in vitamin B12 or folate, but he may well have other causes for his weight loss (or anemia).
Good luck!
phyo zaw oo says
heartfelt thanks
Mary Spangler says
My husband who is 72 has had a weight loss recently and his Doctor is sending him to an endocrinologist.
Why?
Leslie Kernisan, MD MPH says
I would recommend you ask the doctor to clarify the reasons for the referral to endocrinology.
You might also ask: Were there abnormal laboratory test results? And does the doctor think the potential endocrine problem is the main cause for the weight loss?
I explain many commonly done tests in this article: Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults. Good luck!
Melissa says
My mom was about 180lbs at 5’3 and over the course of the past two years, lost 40lbs by dieting. She’s been complaining lately (she’s 83 now) that she has no appetite, so isn’t eating enough and has lost another 5-10lbs. She feels a little sick after she eats, but it passes. She is also depressed because my brother and I are trying to move her cross country with us and she has to sell the house we grew up in. I’m making her go to the Dr on Monday, but I’m sooooooo worried she has something seriously wrong with her. Could she be in ketosis and burning the small amounts she’s eating quickly? Any advice is greatly appreciated! She would be living with me already but is so stubborn!
Leslie Kernisan, MD MPH says
Loss of appetite, weight loss, and feeling unwell after eating does sound worrisome, so a visit to the doctor is a good next step.
I don’t know much about ketosis in older adults, it doesn’t strike me as something that most geriatricians would think about as part of evaluating someone like your mom. But I suppose you could see what the doctor thinks of this possibility, and perhaps it will be possible to check your mom’s urine for ketones.
Normally, what we would do is a careful history and physical exam, and then some blood tests.
You can help your mom get a thorough evaluation by asking the doctor to clarify, at the end of the visit, what he/she thinks might be the cause of the weight loss, and what are the next steps in exploring this. Basically, the doctor should have a plan for checking for the common causes of weight loss that are in the article; if he/she isn’t checking for one of them, ask for more information on why they’ve concluded it’s unlikely.
Your mother may well be experiencing some depression and this can cause lack of appetite and weight loss. But it’s important to not conclude this is the main cause of weight loss until other causes are checked for and ruled out. good luck!
Felecia Brozena says
Keep this going please, great job!
Jason lewis says
Long article
No answer
Leslie Kernisan, MD MPH says
There are few simple answers, when it comes to the health of older adults. If you are concerned about unintentional weight loss, you should consult a health professional. The article aims to help older adults and families prepare, so that they can get better help.
Victoria Davis says
So very true.
I applaud your, as always, calm and methodical approach, bringing to light avenues which could easily have been overlooked.
In this case, especial thanks for moving the easy fix supplements way down the list of things to consider!
THank you.
Eliza says
This is a very well thought out article about the complexities of unexplained, sudden weight loss in older adults. You are good to point out that it is first of all important to discover the cause(s) and not jump to conclusions, or a solution, before really delving in. Especially if an older adult is living on his/her own, far away from adult children who can help and monitor. Make sure the social supports are in place, including hiring help if necessary or enlisting neighbors and friends, if possible. This is really, really complex.
But just dumping in the calories is probably not the best idea. I realize that providing cases of Ensure seems really simple especially if you live far away from your aging parent, but it does not help increase health. It detracts from health. It would be better to thoroughly examine the person’s diet, enlist the help of a nutritionist, keep a detailed food log, and go for nutrient dense foods rather than “protein” or “fat” to put on weight.
Maybe spend some extended time with your father who lives 100 miles away, not just a short visit, but enough time to get a grasp on the problem from up close.
Sherri says
I’m concerned because when I mention it to the doctor he just brushes it off. Having to get these sweet protein drinks because she really likes them, but even with that and eating more sweets, she is still losing weight. Over the course of ten months she has lost over thirty five pounds. She eats about 60 percent of the amount on the plate. Wondering if we need to find a doctor who will take it more seriously?
Would a digestive enzyme help?
Leslie Kernisan, MD MPH says
A 35 pound weight loss sounds worrisome. The doctor should not leave you feeling brushed off. If he has evaluated it, he should explain what he did, what he found, and what his conclusions are regarding why your relative has lost weight. I would try asking him to explain what he thinks is going on.
If you are not satisfied that he has looked into it enough, or if it’s hard to communicate with him, then a second opinion certainly might help.
I wouldn’t expect digestive enzymes to help in most cases, but you never know. For now I say you need to find out more about why she isn’t eating much and why she is losing weight. Then you’ll be better positioned to counter the problem.
Ludean Carter says
I am almost 91 years of age and I am losing weight slowly.
I have always weighed between 120 and 130 in my later years.
I slowly lost down to 110, now in the last month I have lost down to 108.
I eat well balanced meals, lots of fruits and vegetables.
Leslie Kernisan, MD MPH says
This amount of weight loss does sound concerning. I would definitely recommend that you see a health provider and ask for an evaluation. An initial evaluation for this type of weight loss can be done during a primary care visit. Good luck!
Marie jones says
Father 94 years old blood test and urine test normal. He has lost 60 lbs in three years. Doctor said she will check for lung and pancreatic cancer. He eats 2,000 calories a day. Should I be concern?
Leslie Kernisan, MD MPH says
Losing 60 pounds in 3 years is quite a lot, so I’m glad the doctor is evaluating him. If your father is eating 2000 calories per day and still losing weight, I would recommend you keep asking the doctor questions about what they have checked for and how they plan to evaluate further. Good luck!
Marie Sosnowski says
It’s now recommend that older adults keep some weight on themselves . How tall are you . I lost 96 pounds over 25 years ago and I’m 4”11 and now weigh 112 pounds.
Narayan says
Hello Leslie,
Greetings from me!
My mother age 70, weight 35 kilos. She feels weakness, nausea every day. It’s been 3 years she has diabetes and arthritis rheum. Please advise.
God bless you, Thank you
Nicole Didyk, MD says
Hello and thanks for your kind greeting! That sounds like your mom has a low body weight, but you don’t mention her height or how much weight she has lost, and over what time frame. Diabetes and rheumatoid arthritis, and the medications used to treat those conditions, can interfere with appetite and have side effects that include nausea. If I were giving advice to someone in your situation, I would start by looking at the medications and other health issues, probably also ordering some screening bloodwork.
Atiya says
My mother weight is dramatically declining, she is in a nursing home and her weight is around 67 pounds. She has always been thin but around 110 pounds. Is there anything that can be done in helping her gain more weight?
Nicole Didyk, MD says
That sounds like a dramatic change in weight, but it’s also vital to consider the rate of loss, other health issues and medications that a person is taking. I would strongly advise tracking the weight of someone with that much of a change and consulting with the health care team at the nursing home, including a dietician if possible.