Unintended Weight Loss in Older Adults

UWL: Association With Outcomes (2009)

Unintended Weight Loss in Older Adults Evidence Analysis Project

Nutrition Assessment

Please select an item from the menu on the left.

• Assessment
  What is the evidence that underweight or weight loss is associated with depression in adults over age 65?

  • Conclusion

    12 studies were evaluated regarding the association between underweight or weight loss and depression in adults over age 65. Four studies report an association between weight loss or poor nutritional status and depression, while two studies report no association between low BMI and depression. Additional studies report that weight loss may be common in depressed individuals with Alzheimer's disease, individuals who are recently widowed, demented individuals and individuals on antidepressant therapies. Further research is needed in this area.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight and weight loss is associated with depression in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Callen BL, Wells TJ. Screening for nutritional risk in community-dwelling old-old. Public Health Nurs. 2005;22(2):138-146.
      • Chen CC, Chang CK, Chyun DA, McCorkle R. Dynamics of nutritional health in a community sample of American elders: A multidimensional approach using Roy Adaptation Model. ANS Adv Nurs Sci. 2005; 28 (4): 376-389.
      • Crogan NL, Pasvogel A. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci. 2003; 58 (2): 159-164.
      • Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
      • Rigler SK, Webb MJ, Redford L, Brown EF, Zhou J, Wallace D. Weight outcomes among antidepressant users in nursing facilities. J Am Geriatr Soc. 2001; 49(1): 49-55.
      • Schulz R, Beach SR, Lind B, Martire LM, Zdaniuk B, Hirsch C, Jackson S, Burton L. Involvement in caregiving and adjustment to death of a spouse: Findings from the Caregiver Health Effects Study. JAMA. 2001; 285(24): 3,123-3,129.
      • Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13 (2): 189-199.
      • Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
      • Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093. 
      • Thomas P, Hazif-Thomas C, Clement JP. Influence of antidepressant therapies on weight and appetite in the elderly. J Nutr Health Aging. 2003; 7(3): 166-170.
      • Thomas DR, Zdrowski CD, Wilson MM, Conright KC, Lewis C, Tariq S, Morley JE. Malnutrition in subacute-care. Am J Clin Nutr. 2002; 75: 308-313.
      • Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty:  Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.
  • Search Plan and Results: Weight Loss and Depression 2006
     
  What is the evidence that underweight and/or weight loss is associated with prevalence of infection in adults over age 65?

  • Conclusion

    All seven studies that were evaluated report an association between underweight, weight loss and poor nutrition status and prevalence of infection in adults over age 65.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight and/or weight loss is associated with prevalence of infection in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Barreto SM, Passos VM, Lima-Costa MF. Obesity and underweight among Brazilian elderly: The Bambui Health and Aging Study. Cad Saude Publica. 2003; 19(2): 605-512. 
      • Dambach B, Salle A, Marteau C, Mouzet JB, Ghali A, Favreau AM, Berrut G, Ritz P.  Energy requirements are not greater in elderly patients suffering from pressure ulcers.  J Am Geriatr Soc 2005;53:478-482.
      • Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002; 17(4): 298-307.
      • Paillaud E, Herbaud S, Caillet P, Lejonc JL, Campillo B, Bories PN. Relations between undernutrition and nosocomial infections in elderly patients. Age and Ageing. 2005; 34: 619-625.
      • Rothan-Tondeur M, Meaume S, Girard L, Weill-Engerer S, Lancien E, Abdelmalak S, Rufat P, Le Blanche AF. Risk factors for nosocomial pneumonia in a geriatric hospital: A control-case one-center study. J Am Geriatr Soc. 2003; 51: 997-1,001.
      • Schmaltz HN, Fried LP, Xue QL, Walston J, Leng SX, Semba RD. Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older women. J Am Geriatr Soc. 2005; 53(5): 747-754. 
      • van der Steen JT, Ooms ME, Mehr DR, van der Wal G, Ribbe MW. Severe dementia and adverse outcomes of nursing-home acquired pneumonia: evidence for mediation by functional and pathophysiological decline. J Am Geriatr Soc. 2002; 50 (3): 439-448.
  • Search Plan and Results: Weight Loss, Wound Healing and Infections 2006
     
  What is the evidence that underweight or weight loss is associated with decreased appetite in adults over age 65?

  • Conclusion

    Eight studies were evaluated regarding the association between underweight or weight loss and decreased appetite in adults over age 65. Studies report an association between reduced appetite and poor protein and energy intake, resulting in weight loss and poor nutritional status.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight or weight loss is associated with decreased appetite in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • de Castro JM. Age-related changes in the social, psychological and temporal influences on food intake in free-living, healthy, adult humans. J Gerontol A Biol Sci Med Sci. 2002; 57 (6): M368-M377.
      • Knoops KTB, Slump E, de Groot LCPGM, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005; 60 (4): 536-539.
      • Mowe M, Bohmer T. Reduced appetite. A predictor for undernutrition in aged people. J Nutr Health Aging. 2002; 6 (1): 81-83.
      • Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology, 2005; 51 (3): 192-198.
      • Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13 (2): 189-199.
      • St. Arnaud-McKenzie D, Paquet C, Kergoat MJ, Ferland G, Dube L. Hunger and aversion: drives that influence food intake of hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci 2004;59(12):1304-1309.
      • Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
      • Suzana S, Earland J, Suriah AR, Warnes AM. Social and health factors influencing poor nutritional status among rural elderly Malays. J Nutr Health Aging 2002;6(6):363-369.   
  • Search Plan and Results: Weight Loss and Appetite 2006
     
  What is the evidence that underweight or weight loss is associated with a decrease in the activities of daily living in adults over age 65?

  • Conclusion

    15 studies were evaluated regarding the association between underweight or weight loss and a decrease in the activities of daily living in adults over age 65. All studies report an association between poor nutritional status, frailty, underweight or weight loss with a decrease in the activities of daily living.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight and/or weight loss is associated with a decrease in the activities of daily living in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Al Snih S, Raji M, Markides K, Ottenbacher K, Goodwin J. Weight change and lower body disability in older Mexican Americans. J Am Geriatr Soc. 2005; 53: 1,730-1,737. 
      • Boyd CM, Xue QL, Simpson CF, Guralink JM, Fried LP. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med. 2005; 118: 1,225-1,231.
      • Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
      • Huang Y, Wueng S, Ou C, Cheng C, Su K. Nutritional status of functionally dependent and nonfunctionally dependent elderly in Taiwan. J Am College Nutr. 2001; 20: 135-142.
      • Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002; 50: 889-896. 
      • Kikafunda JK, Lukwago FB. Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi district of central Uganda. Nutrition 2005; 21 (1): 59-66.
      • Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T.  Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.   
      • Ottenbacher KJ, Ostir GV, Peek MK, Snih SA, Raji MA, Markides KS. Frailty in older Mexican Americans. J Am Geriatr Soc. 2005; 53(9): 1,524-1,531.
      • Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. Journal of Clinical Epidemiology. 2000; 53: 579-587.
      • Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K.  Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
      • Richardson J, Bedard M, Weaver B. Changes in physical functioning in institutionalized older adults. Disabil Rehabil. 2001; 23(15): 683-689.
      • Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
      • Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty:  Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.
      • Zuliani G, Romagnoni F, Volpato S, Soattin L, Leoci V, Bollini MC, Buttarello M, Lotto D, Fellin R. Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. J Gerontol A Biol Sci Med Sci. 2001; 56(4): M212-M216.
  • Search Plan and Results: Weight Loss and ADLs 2006
     
  What is the evidence that underweight and weight loss is associated with neurological disease in adults over age 65?

  • Conclusion

    Twenty-six studies were evaluated regarding the association between underweight and weight loss and neurological disease in adults over age 65. All studies report an association between underweight and weight loss in patients who have cognitive impairment, including Alzheimer's disease and other dementia disorders, Parkinson's disease and stroke. 

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight and weight loss is associated with neurological disease in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bedard M, Molloy DW, Bell R, Lever JA. Determinants and detection of low body mass index in community-dwelling adults with Alzheimer's disease. International Psychogeriatrics. 2000; 12(1): 87-98.
      • Brubacher D, Monsch AU, Stahelin HB. Weight change and cognitive performance. Int J Obes Relat Metab Disord. 2004; 28(9): 1,163-1,637. 
      • Buchman AS, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA.  Change in body mass index and risk of incident Alzheimer disease. Neurology. 2005; 65(6): 892-897.
      • Chen H, Zhang SM, Hernan MA, Willett WC, Ascherio A. Weight loss in Parkinson's disease. Ann Neurol. 2003; 53(5): 676-679.
      • Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
      • Faxen-Irving G, Basun H, Cederholm T. Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders. Age Ageing. 2005; 34(2): 136-141.
      • Guerin O, Andrieu S, Schneider SM, Milano M, Boulahssass R, Brocker P, Vellas B. Different modes of weight loss in Alzheimer disease: A prospective study of 395 patients. Am J Clin Nutr. 2005; 82: 435-441.
      • Guerin O, Soto ME, Brocker P, Robert PH, Benoit M, Vellas B, REAL.FR Group. Nutritional status assessment during Alzheimer's disease: Results after one year (the REAL French Study Group). J Nutr Health Aging. 2005; 9(2): 81-84. 
      • Holm B, Soderhamn O. Factors associated with nutritional status in a group of people in an early stage of dementia. Clin Nutr. 2003; 22: 385-389. 
      • Hu X, Okamura N, Arai H, Higuchi M, Maruyama M, Itoh M, Yamaguchi K, Sasaki H. Neuroanatomical correlates of low body weight in Alzheimer's disease: A PET study. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(7-8): 1,285-1,289.
      • Johnson DK, Wilkins CH, Morris JC. Accelerated weight loss may precede diagnosis in Alzheimer disease. Arch Neurol. 2006; 63(9): 1,312-1,317. 
      • Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr. 2005; 82: 784-791.
      • Keller HH, Ostbye T. Do nutrition indicators predict death in elderly Canadians with cognitive impairment? Can J Public Health. 2000; 91(3): 220-224.
      • Knoops KTB, Slump E, de Groot LCPGM, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005; 60 (4): 536-539.
      • Lorefalt B, Ganowiak W, Palhagen S, Toss G, Unosson M, Granerus AK. Factors of importance for weight loss in elderly patients with Parkinson's disease. Acta Neurol Scand. 2004; 110(3): 180-187. 
      • Lorefalt B, Ganowiak W, Wissing U, Granerus AK, Unosson M. Food habits and intake of nutrients in elderly patients with Parkinson's disease. Gerontology. 2006; 52: 160-168.
      • Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T.  Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.   
      • Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K.  Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
      • Poels BJ, Brinkman-Zijlker HG, Dijkstra PU, Postema K. Malnutrition, eating difficulties and feeding dependence in a stroke rehabilitation centre. Disabil Rehabil. 2006; 28(10): 637-643. 
      • Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
      • Shatenstein B, Kergoat MJ, Nadon S. Anthropometric changes over five years in elderly Canadians by age, gender and cognitive status. J Gerontol A Biol Sci Med Sci. 2001; 56(8): M483-M488. 
      • Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093. 
      • Stewart R, Masaki K, Xue QL, Peila R, Petrovitch H, White LR, Launer LJ. A 32-year prospective study of change in body weight and incident dementia: The Honolulu-Asia Aging Study. Arch Neurol. 2005; 62: 55-60.
      • Wang PN, Yang CL, Lin KN, Chen WT, Chwang LC, Liu HC.  Weight loss, nutritional status and physical activity in patients with Alzheimer's Disease: A controlled study. J Neurol. 2004; 251: 314-320. 
      • White HK, McConnell ES, Bales CW, Kuchibhatla M. A six-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects. J Am Med Dir Assoc. 2004; 5: 89-97.
  • Search Plan and Results: Weight Loss and Neurological Disease 2006
     
• Diagnosis
  What is the evidence that underweight or unintended weight loss is associated with increased mortality in adults over age 65?

  • Conclusion

    Five studies support an association between underweight or unintended weight loss and increased mortality, but the definition is inconsistent. One study reported that mortality was 50% for subjects with a BMI under 20kg/m², but additional research suggests that the current BMI thresholds may not apply to the elderly. Two studies report that weight loss was associated with a two- to 10-fold increased risk for death and one study reported that those who were severely underweight were four times more likely to have unintentional weight loss of 10 lbs in six months. Further research is needed in these areas.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support that underweight and/or unintended weight loss is associated with increased mortality in adults over age 65?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Martin CT, Kayser-Jones J, Stotts NA, Porter C, Froelicher ES. Risk for low weight in community-dwelling, older adults. Clinical Nurse Specialist. 2007; 21: 203-211.
      • Martin CT, Kayser-Jones J, Stotts NA, Porter C, Froelicher ES. Risk for low weight in community-dwelling, older adults. Clinical Nurse Specialist. 2007; 21: 203-211.
      • Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology, 2005; 51 (3): 192-198.
      • Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology, 2005; 51 (3): 192-198.
      • Sanchez-Garcia S, Garcia-Pena C, Duque-Lopez MX, Juarez-Cedillo T, Cortes-Nunez AR, Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health. 2007; 7: 2-11.
      • Sanchez-Garcia S, Garcia-Pena C, Duque-Lopez MX, Juarez-Cedillo T, Cortes-Nunez AR, Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health. 2007; 7: 2-11.
      • Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
      • Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
      • Sullivan DH, Johnson LE, Bopp MM, Roberson PK. Prognostic significance of monthly weight fluctuations among older nursing home residents. J Gerontol A Biol Sci Med Sci. 2004; 59(6): M633-M639.
      • Sullivan DH, Johnson LE, Bopp MM, Roberson PK. Prognostic significance of monthly weight fluctuations among older nursing home residents. J Gerontol A Biol Sci Med Sci. 2004; 59(6): M633-M639.
  • Search Plan and Results: Nutrition Screening 2008