The unintentional weight loss of the old man

introduction
Weight loss, malnutrition and malnutrition is a common problem in the elderly.

methods
Selective literature, according to current guidelines.
Results / conclusion
The causes for undesired weight loss in the elderly are varied. In addition to chronic consumptive diseases come from dementia or mental health problems, such as depression, into consideration. Physical causes can be a no more kaufähiges teeth , a change in smell and taste , and gastrointestinal disorders. Also, the inability to adequately buy food and prepare yourself , is a possible reason . Poverty and isolation are to be considered as social causes in history. If there is a malnutrition , it should be recognized early and treated consistently . For this purpose , in practice, a good New Context staging system available, from established general measures on the regulation of drinking and supplementary food to a supportive artificial nutrition via a PEG tube . Meta-analyzes demonstrate the high efficiency of drinking water and additional food . A supportive artificial nutrition needed in addition to the medical always an ethical indication and must be decided individually .
Keywords
Weight loss, age, supplementary feeding, percutaneous endoscopic gastrostomy (PEG), enteral nutrition
An unintended weight loss in old age is a common and medically highly relevant phenomenon. The clinical consequences of malnutrition have been known for many years. The rate of malnutrition and malnutrition is independently living healthy seniors in the range of 10 to 20%. It rises in the elderly in managed facilities such as retirement, nursing home or hospital to about 40 to 60%.

Causes of weight loss in the elderly
The causes of weight loss are varied and detailed in Box 1 (gif ppt) listed (1, 2). With the old man special circumstances and conditions to be considered, which may lead among other things to a reduced food intake:

- Too little own and / or damaged teeth
- An ill-fitting dentures
- Smell and taste disorders (dysgeusia)
- Side effects of medications

The oropharyngeal causes include: dysphagia after cerebral insults as well as in Parkinson's disease, myasthenia gravis or muscular disorders. Cause of esophageal dysphagia are tumors, strictures, achalasia, narrowing from the outside through an aortic dilatation or lymph node enlargement.

Bacterial overgrowth of the small intestine and malassimilations-associated diseases can lead to diarrhea in old age. These include the non-tropical sprue, chronic pancreatitis, inflammatory bowel disease and hyperthyroidism. Furthermore, chronic diseases such as COPD / asthma, and congestive heart failure can cause a loss of body weight.
The oropharyngeal causes include : dysphagia after cerebral insults as well as in Parkinson's disease , myasthenia gravis or muscular disorders . Cause of esophageal dysphagia are tumors , strictures , achalasia, narrowing from the outside through an aortic dilatation or lymph node enlargement .

Bacterial overgrowth of the small intestine and malassimilations -associated diseases can lead to diarrhea in old age. These include the non-tropical sprue , chronic pancreatitis, inflammatory bowel disease and hyperthyroidism. Furthermore, chronic diseases such as COPD / asthma, and congestive heart failure can cause a loss of body weight.

In addition, mental disorders are often the cause. In many cases it is depression in old age, which may be initially difficult to detect (4-6) .

Often the weight loss is also caused social. The aged widower may be depressed not only the loss of his partner , he has also perhaps never learned in his life to make yourself hot meals and thus to feed properly. The widow in old age may have lost with her partner , a higher pension , perhaps trying to keep the home together , and can therefore spend less money on meals . Also Visual loss or the fear of falling in icy or rain cause old people no longer go to shopping malls to get an adequate supply of food (3). In addition to the problems of adequate food procurement often occur in a very practical problems in food preparation , for example by arthritic / arthritic hand deformations , blurred vision , tremors, and cognitive disorders .

Based on a selective review of the literature and considering the current guidelines, the diagnostically and therapeutically relevant medical aspects are explained in this post. 6 systematic studies (4-9) - one exclusively dedicated to the old patients (7 ) - consistently show that an unintended weight loss is due only in 10-38 % of cases of malignancy and do not outweigh malignant diseases. In malignant and non-malignant diseases of the gastrointestinal tract diseases are very common ( 3-5). Psychological causes such as dementia , depression or alcoholism are responsible for the weight loss in 9-42 %. In 5 to 26 % of cases, the cause of weight loss remains unknown ( 4-9).