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Malnutrition and unintentional weight loss in older adults
Unintentional loss of 5% or more of body weight within 6–12 months in an older adult is a warning sign that requires a search for the cause (disease, depression, drugs, teeth and swallowing, loneliness and poverty) and early nutritional intervention, not acceptance as "part of ageing".
Why it matters in the exam
The exam presents an older adult who has lost weight and asks about the work-up (blood count, chemistry, thyroid function, age-appropriate screening tests, assessment of depression and cognition, medication review), the screening tool (MNA) and the GLIM definition of malnutrition. About a quarter of cases remain without a clear cause even after work-up.
Recurring points: albumin mainly reflects inflammation and illness, not nutritional status; oral nutritional supplements (at least 400 kcal and 30 g protein a day, for at least a month) improve weight and reduce complications; megestrol is not recommended in older adults (thrombosis, fluid retention, mortality); and tube feeding in advanced dementia does not prolong life or prevent aspiration — careful hand feeding is preferred.
Undernutrition is especially common in hospitalised and institutionalised older adults, and it raises the risk of infections, pressure injuries, falls, prolonged admission and death. The exam also asks about "simple" factors that are missed: ill-fitting dentures, dry mouth from drugs, loss of taste and smell, difficulty shopping and cooking, and a restricted diet "because of sugar or cholesterol" that no longer suits the person's age. In very old age dietary restrictions are often lifted to preserve weight and the enjoyment of food.
Key points
- 5% or more in 6 months — significant loss requiring work-up.
- GLIM: one phenotypic and one aetiologic criterion.
- Albumin reflects illness and inflammation, not nutrition.
- Oral supplements: 400 kcal and 30 g protein a day, for at least a month.
- In advanced dementia — hand feeding, not a tube; no megestrol.
Summary table
| Issue | The rule | Values |
|---|---|---|
| Significant loss | Unintentional, measured and investigated | 5% or more in 6 months, or 10% or more beyond 6 months |
| GLIM — phenotype | Weight loss, low BMI, low muscle mass | BMI below 22 from age 70 |
| GLIM — cause | Reduced intake or absorption, inflammation or disease | One criterion from each group is needed |
| Requirements | Energy and protein | About 30 kcal/kg/day; protein at least 1.0 g/kg/day |
| Oral supplements | For a patient at risk or malnourished | At least 400 kcal and 30 g protein a day, for at least a month |
| Tube feeding | Only when there is a reasonable chance of improvement | Not in advanced dementia |
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Sources
- ESPEN guideline on clinical nutrition and hydration in geriatrics, 2022 — Screening, assessment, oral nutritional supplements and tube feeding
- GLIM criteria for the diagnosis of malnutrition, 2019 — Phenotypic and aetiologic criteria
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Malnutrition and unintended weight loss
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.