Evaluation and Treatment of Weight Loss in Adults with HIV Disease. Weight loss late in the course of human immunodeficiency virus (HIV) disease is common and often multifactorial. Nonetheless, treatment failure despite intensive antiretroviral therapy is not uncommon, and HIV disease activity may place patients at risk for significant weight loss. Loss of more than 30 percent of ideal body weight is associated with high mortality, 1 and weight loss of as little as 5 percent of the patient's usual weight is associated with more rapid progression of disease. Plasma HIV RNA is an independent predictor of wasting, 3 and effective suppression of HIV RNA with antiretroviral therapy may significantly forestall the onset of weight loss. Depression, dementia and substance abuse are also associated with decreased intake and should be considered in the differential diagnosis of wasting syndrome. A flow sheet correlating the patient's weight, CD 4+ cell count, HIV RNA level and other relevant laboratory results can be useful in detecting early signs of wasting syndrome. Routine physical examination of all HIV patients should focus on changes in body habitus and signs of opportunistic disease. Dental caries, gingivitis and periodontitis are common in patients with HIV disease and should be treated. Microscopic examination and culture of the stool may be warranted to exclude the presence of opportunistic pathogens in patients with diarrhea. Evaluation and Treatment of Weight Loss in HIV Disease. Algorithm for the evaluation and treatment of weight loss in patients with HIV disease. Quantitative plasma HIV RNA should be assessed, since active viral replication is associated with increased resting energy expenditure and may increase the amount of weight loss.
In a new study of 146 residents of an intermediate-care nursing home, scientists found that those patients who lost 10 percent or more of their body weight over a six-month period were significantly more likely to die in the next six months than residents who maintained a stable weight. For each patient, the researchers noted age, gender, principal medical problem and pattern of weight gain or loss. For patients who died during the study period, they noted the cause of death and the amount and duration of weight loss before death, if any. _ Almost two-thirds (62 percent) of residents who lost 10 percent of their body weight or more over a six-month period died in the next six months. But when the cancer victims were removed from the analysis, weight loss was still a strong predictor of death, Murden said. "Cancer was not the predictor of death for the group - weight loss was," he said. Murden said it's still unclear whether the effects of severe weight loss are reversible. However, he said, in the meantime, physicians and families who care for nursing home patients should take careful notice of patients who are losing weight. "A physician who notices a weight loss of 10 percent should look for causes that might have been missed and ways to interrupt it," he said.
Describe the risk factors and assessment strategies for falls in older adults. Discuss the risks, safety, and management of medications for older adults. Calcium and vitamin D are essential for bone health and reducing the risk of falls. The RDA for zinc is 11 mg for older men and 8 mg for older women. The RDA for vitamin B 6 is 1.7 mg for older men and 1.5 mg for older women. The RDA for B 12 is 2.4 micrograms for women and men. The RDA for vitamin E is 15 mg for both men and women. The following foods, fluids, and physical activities are represented on “My Plate for Older Adults”: Treat the patient with respect and dignity. Falls are one of the greatest threats to the health of older adults, and they can be life threatening.
Weight gain: Weight gain: Introduction. » Review Causes of Weight gain: Causes | Symptom Checker » Causes of Weight gain: The following medical conditions are some of the possible causes of Weight gain. Causes of Types of Weight gain: Review the causes of these more specific types of Weight gain: Weight gain: Symptom Checker. Weight gain Treatments. Weight gain: Animations. Weight gain: Comorbid Symptoms. Causes of Similar Symptoms to Weight gain. Misdiagnosis and Weight gain. See full list of 360 causes of Weight gain. How Common are these Causes of Weight gain?
· Activity Intolerance related to fatigue, exhaustion, and heat intolerance secondary to hypermetabololism; related to decreased metabolic rate and mucin deposits in joints and interstitial spaces. · Constipation related to GI hypomotility. · Disturbed Self-Esteem related to altered body image, emotional lability, and diminished physical capabilities. · Disturbed Sensory Perception: Visual related to visual changes secondary to hyperthyroidism. · Hypothermia related to cold intolerance. · Imbalanced Nutrition: Less than Body Requirements related to hypermetabolism and inadequate diet. · Imbalanced Nutrition: More than Body Requirements related to hypometabolism; related to increased appetite, high caloric content of foods, and inactivity. · Risk for Infection related to lowered resistance to stress and suppression of immune system. · Risk for Injury related to decreased blinking or inability to close eyelids secondary to exophthalmos.
Assess possible causes for adult FTT and treat any underlying problems such as depression, malnutrition, and illnesses that are caused by physical and cognitive changes. The characteristics of FTT in the elderly are malnutrition (undernutrition), loss of physical and cognitive function, and depression (Groom, 1993). Note if the client is irritable and is blaming others. Note changes in the elderly client's appetite and assess for depression. Provide appropriate nutrition for the client whose obesity may be affecting physical performance and thus has limited ability to perform ADLs, which leads to functional dependence. Assess for the influence of cultural beliefs, norms, and values on the family's or caregiver's understanding of FTT. Validate the family's feelings and concerns related to the FTT symptoms. Refer to home health aide services for assistance with ADLs throughout the duration of decreased participation. Refer for psychotherapy and possible medication if the etiology is depression. Treatment of the etiology is necessary; the previously mentioned are treatments that may be used for depression (Jamison, 1997).
You can go when you are nursing (and you get 10 extra points a day, I think) and lose weight Andi. I didn't gain much weight, but had enough fat for the little one and myself. I didn't gain much weight during the pregnancy (about 25lbs) and I lost alot in the first 3 weeks after my son was born. And just in case you think lost weight is always good, about 10 pounds of the weight lost was due to dehydration. I wasn't thin to begin with, and am now a size 10, so I definitely don't look too thin, but there was a period of time where I was really worried about the weight loss. I was wondering about that, too, but my apetite really did decrease once I stopped nursing (and I lost more weight). Breastfeeding in and of itself is the perfect weight loss plan. The first time I worried that when I weaned my 'nursing eating' would continue and I'd gain a ton of weight. I'm sorry to all of you 'too thin from breastfeeding' posters, but I just have to add this: Although my weight was in the normal range, between losing babyweight and breastfeeding my son (18 years ago), I lost about 50 pounds, weighing in at around 100 lbs at 5'6'. I now that hormon levels are very low when nursing and the female hormon estrogen is the kind of hormon which makes you gain weight. I always struggled with my weight and was shocked when the weight came off so easily after birth. I lost lots of weight when nursing my first one and I assume the same will happen with the second. I hate to tell you, but after a few months when I stopped nursing (when the baby was about 7 months old), I put all of the weight back on. Otherwise, I think that once you stop nursing you'll just have to be cautious about what you eat and how you maintain a healthy lifestyle if you want to stay in the area of your current weight.
The risks and benefits of treatment with DALIRESP in patients with a history of depression and/or suicidal thoughts or behavior should be carefully considered. No evidence of tumorigenicity was observed in mice at roflumilast oral doses up to 12 and 18 mg/kg/day in females and males, respectively (approximately 10 and 15 times the MRHD, respectively, based on summed AUCs of roflumilast and its metabolites). No effect on female fertility was observed up to the highest roflumilast dose of 1.5 mg/kg/day in rats (approximately 24 times the MRHD on a mg/m² basis). DALIRESP induced stillbirth and decreased pup viability in mice at doses corresponding to approximately 16 and 49 times, respectively, the maximum recommended human dose (MRHD) (on a mg/m² basis at maternal doses > 2 mg/kg/day and 6 mg/kg/day, respectively). DALIRESP induced post- implantation loss in rats at doses greater than or equal to approximately 10 times the MRHD (on a mg/m² basis at maternal doses ≥ 0.6 mg/kg/day). No treatment-related effects on embryo-fetal development were observed in mice, rats, and rabbits at approximately 12, 3, and 26 times the MRHD, respectively (on a mg/m² basis at maternal doses of 1.5, 0.2, and 0.8 mg/kg/day, respectively). DALIRESP has been shown to adversely affect pup post-natal development when dams were treated with the drug during pregnancy and lactation periods in mice. These studies found that DALIRESP decreased pup rearing frequencies at approximately 49 times the MRHD (on a mg/mg2 basis at a maternal dose of 6 mg/kg/day) during pregnancy and lactation. DALIRESP also decreased survival and forelimb grip reflex and delayed pinna detachment in mouse pups at approximately 97 times the MRHD (on a mg/m² basis at a maternal dose of 12 mg/kg/day) during pregnancy and lactation. DALIRESP should not be used during labor and delivery. DALIRESP induced delivery retardation in pregnant mice at doses greater than or equal to approximately 16 times the MRHD (on a mg/m² basis at a maternal dose of > 2 mg/kg/day). The safety and effectiveness of DALIRESP in pediatric patients have not been established. Of the 4438 COPD subjects exposed to DALIRESP for up to 12 months in 8 controlled clinical trials, 2022 were > 65 years of age and 471 were > 75 years of age. DALIRESP is not recommended for use in patients with moderate or severe liver impairment (Child-Pugh B or C) [see CONTRAINDICATIONS and CLINICAL PHARMACOLOGY ]. In twelve subjects with severe renal impairment administered a single dose of 500 mcg roflumilast, the AUCs of roflumilast and roflumilast N-oxide were decreased by 21% and 7%, respectively and Cmax were reduced by 16% and 12%, respectively.
Careful communication with the patient and healthcare proxy, with adequate documentation of options for treatment, provides a basis for defense. The living will should be as detailed as possible, and a physician should review the contents with the patient, if possible, to ensure understanding. The least restrictive method of physical restraint is the most desirable for patients and facilities. A speech therapist will evaluate the patient's swallowing ability and can test for sensory deficits. Zinc deficiency is common in the institutionalized and homebound elderly patient. Patients should be weighed and have a BMI calculated weekly; this can decrease to monthly as the patient stabilizes. Any behavior problems should be reviewed with the patient, family, and staff. When hospice services are recommended as an option, the patient and proxy may be shocked by the seriousness of the patient's condition. The patient and family members should be supported through the dying process. The patient displays no focal deficit, and cranial nerves are normal. The patient is referred to several specialists for evaluation of potential causes of weight loss and continued failure to thrive. The blood pressure is below normal and may be responsible for the patient's dizziness. The physician instructs Patient E and her family to continue on the current plan of care. The patient has progressed well and is discharged home to her apartment.
An approach to the management of unintentional weight loss in elderly people. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Voluntary weight loss among elderly patients is also associated with increased risk of death 17 and of hip fracture, 19 which highlights the importance of maintaining weight with age. 43 , 44 Many elderly patients with unintentional weight loss are experiencing concomitant malnutrition 45 and thereby have cachexia. Unintentional weight loss is common in elderly people and is associated with significant adverse health outcomes, increased mortality and progressive disability. Unexplained weight loss in the ambulatory elderly. Unintentional weight loss: diagnosis and prognosis. Unintentional weight loss in the ambulatory setting: etiologies and outcomes [abstract]. Evaluating and treating unintentional weight loss in the elderly.
The presentation will depend on the underlying cause. A thorough history and examination are essential in establishing the underlying cause and identifying appropriate investigations. Renal function and electrolytes: may indicate chronic kidney disease, Addison's disease. Other investigations will depend on the context of the weight loss. Possible further investigations may include HIV serology, endoscopy and autoimmune disease screen. Management is otherwise directed at the cause of weight loss and may include physical, psychological and social (eg, 'meals at home scheme', respite care) interventions. Elderly patients with unintentional weight loss are at higher risk of infection and depression.
) is the final result of infection with a retrovirus, the human immunodeficiency virus(HIV). HIV infection is a progressive disease leading to AIDS, as defined by the CDC (January 1994): “persons with CD 4 cellcount of under 200 (with or without symptoms of opportunistic infection) who are HIV-positive are diagnosed as having AIDS.”Research studies in 1995 showed that HIV initially replicates rapidly on a daily basis. Therefore, the immune response is massive throughout the course of HIV disease. Evidencesuggests the cellular immune response is essential in limiting replication and rate of disease progression. Controlling thereplication of the virus to lower the viral load is the current focus of treatment. The rate of infection is most rapidly increasing among minority women and is increasingly adisease of persons of color. Data depend on the organs/body tissues involved, the current viral load, and the specific opportunistic infection (OI) or cancer. History of high-risk behavior, e.g., having sex with a partner who is HIV-positive, multiple sexual partners, unprotected sexual activity, and anal sex Loss of libido, being too sick for sex; being afraid to engage in any sexual activities Inconsistent use of condoms Use of birth control pills (enhanced susceptibility to virus in women who are exposed because of increased vaginal dryness/friability) Problems related to diagnosis and treatment, e.g., loss of family/SO, friends, support; fear of tellingothers; fear of rejection/loss of income Isolation, loneliness, close friends or sexual partners who have died of or are sick with AIDSQuestioning of ability to remain independent, unable to plan for needs. Changes in family/SO interaction pattern Disorganized activities, difficulty with goal setting. Usually requires assistance with finances, medications and treatments, skin/wound care,equipment/supplies; transportation, food shopping and preparation; self-care, technicalnursing procedures, homemaker/maintenance tasks, child care; changes in livingarrangements Refer to section at end of plan for postdischarge considerations.
We often assume weight loss is good and healthy. A slow steady intentional weight loss using nutritional change and exercise is associated with beneficial effects on the heart, blood pressure , and cholesterol levels . In addition, weight loss can reduce "i nsulin resistance" and make muscles and fat tissues more sensitive to circulating insulin levels in the blood. As a result, a vicious cycle occurs, the higher the insulin levels are, the harder it is to lose weight (insulin is anabolic, and is a hormone that likes to store fat). While intentional weight loss in people with diabetes is usually a good thing, unintentional weight loss is not. If blood sugars are very high, patients with diabetes tend to urinate a lot, and this results in dehydration as a possible cause of weight loss. Actually, many patients with diabetes present for the first time to their doctor's office because of unexplained loss of weight. In addition to diabetes, there are other concerning causes of unexpected weight loss which should be explored such as thyroid disease and cancers. This is why all exercise and weight loss programs should be started only after discussion with a physician. Any unexplained weight loss, in patients with or without known diabetes may be a sign of high blood sugars or another serious illness.
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Unintentional weight loss is loss of 10 pounds OR 5% of your normal body weight over 6 to 12 months or less without knowing the reason. Chronic digestive system problems that decrease the amount of calories and nutrients your body absorbs, including: Your health care provider may suggest changes in your diet and an exercise program depending on the cause of your weight loss. You or a family member loses more weight than is considered healthy for their age and height. You have lost more than 10 pounds OR 5% of your normal body weight over 6 to 12 months or less, and you do not know the reason. You have other symptoms along with the weight loss. The health care provider will do a physical exam and check your weight. You will be asked questions about your medical history and symptoms, including: How much weight have you lost? When did the weight loss begin? Has the weight loss occurred quickly or slowly? Do you have occasional uncontrollable hunger with palpitations , tremor, and sweating ? Do you have increased thirst or are you drinking more? Are you pleased or concerned with the weight loss?
Evaluating and Treating Unintentional Weight Loss in the Elderly. Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. Food and Drug Administration has labeled no appetite stimulants for the treatment of weight loss in the elderly. Unintentional weight loss in the elderly patient can be difficult to evaluate. Selected Medications Associated with Unintentional Weight Loss in the Elderly. The use of formal screening instruments for depression, such as the Geriatric Depression Scale, 25 may be necessary in the elderly patient with unintentional weight loss. However, none are specifically indicated for the treatment of weight loss in elderly patients, and few have been studied in this population. Food and Drug Administration has not labeled any of these drugs for use in elderly patients with weight loss. Although medications may help promote appetite and weight gain in an elderly patient with unintentional weight loss, drugs should not be considered first-line treatment. Low body weight and weight loss in the aged. Unexplained weight loss in the ambulatory elderly. Diagnosis and management of weight loss in the elderly.
Given that unintentional weight loss is a common condition among older adults and is associated with adverse outcomes, our objective was to review the evidence regarding risk factors, differential diagnosis, prognosis, investigation and treatment of unintentional weight loss in this population. Based on evidence from a large cohort study that involved 4010 persons aged 65 years and older from 11 cities in Europe, the most common independent factors associated with unexplained weight loss are those related to food intake. A chart review of 10 000 patients in seven family practice centres in the southeastern United States, where 45 patients (with an average age of 72 years and 30 of whom were women) were identified as having substantial, unexplained weight loss, showed that a comprehensive history and physical examination have the greatest potential for eliciting the cause or causes of weight loss. Another prospective trial randomized 29 dieticians to the provision of usual nutritional care or a new medical nutritional therapy protocol for prevention and treatment of unexplained weight loss among long-term care residents. One study also looked at the use of dronabinol for unexplained weight loss. Medications that are not clearly required and that may be contributing to the weight loss should be discontinued or appropriate alternatives considered. The role for specific nutritional interventions targeted at increasing caloric intake and improving weight is unclear. What is the prognosis for those with unintentional weight loss? Assessment of unintentional weight loss should start with a comprehensive history, including questions about associated factors, and a physical examination. Although treatment remains a challenge, clinicians should attempt to identify and address factors that may be contributing to the weight loss. A comprehensive history and physical examination has the greatest potential for eliciting the cause(s) of weight loss.
Given that unintentional weight loss is a common condition among older adults and is associated with adverse outcomes, our objective was to review the evidence regarding risk factors, differential diagnosis, prognosis, investigation and treatment of unintentional weight loss in this population. Based on evidence from a large cohort study that involved 4010 persons aged 65 years and older from 11 cities in Europe, the most common independent factors associated with unexplained weight loss are those related to food intake. 10 In multivariate analysis, only difficulties in bringing food to the mouth and chewing were significantly associated with weight loss. A chart review of 290 medical records from many centres in the United States that included long-term care residents and home care clients found six factors to be associated with unexplained weight loss. A cross-sectional study of 68 community-dwelling older adults in the midwestern United States (with an average age of 86 years and 51 of whom were women) showed that depression (using the Geriatric Depression Scale) was independently associated with weight loss (OR 1.65, 95% CI 1.12–2.43). 12 Another prospective study (n = 309) found that psychiatric and psychological diseases are one of the primary reasons for unexplained weight loss. Another prospective trial randomized 29 dieticians to the provision of usual nutritional care or a new medical nutritional therapy protocol for prevention and treatment of unexplained weight loss among long-term care residents. One study also looked at the use of dronabinol for unexplained weight loss. Medications that are not clearly required and that may be contributing to the weight loss should be discontinued or appropriate alternatives considered. What is the prognosis for those with unintentional weight loss? Although treatment remains a challenge, clinicians should attempt to identify and address factors that may be contributing to the weight loss. A comprehensive history and physical examination has the greatest potential for eliciting the cause(s) of weight loss.
The Issue: The nursing home, (“Nursing Home”) received deficiencies during the annual survey because residents had unexplained weight loss, and weights and food intake were not accurately and consistently documented. What Nursing Home did: The QA Committee developed a Plan of Correction, which contained the following components: Re-weighing all residents, and updating the weight records for the affected residents; in-servicing the Nursing Department on obtaining and documenting weights and intake. They stated they would conduct 3 monthly audits of weight and intake records, with results reported to the QA committee. The Issue: During the monthly QAPI meeting at “Nursing Home“, staff discovered a trend of unexplained weight loss among several residents over the last two months. Although other issues and opportunities for improvement were identified at the meeting, the QAPI Steering Committee decided to launch a Performance Improvement Project (PIP) on the weight loss trend because unexplained weight loss posed a high-risk problem for residents. What Nursing Home did: The QAPI Steering Committee chartered a PIP team composed of a CNA, charge nurse, social worker, dietary worker, registered dietitian, and a nurse practitioner. Residents reported the food was not appetizing. Development of a protocol for identifying residents at risk for weight loss to be done on admission and with each care plan. The program would include identification of food preferences and accurate documentation of meals – laminated badge cards with pictures of meal percentages were distributed to all CNAs. The PIP team collected data from dietary (food wasted and supplement use), CNAs (observation of resident satisfaction and meal percentages), residents (satisfaction surveys), and weights. After 3 months, they found that 5 residents gained weight, 15 remained stable, and 5 lost weight, but the weight loss was not unexpected and consistent with their clinical condition. “Nursing Home” decided to adopt and expand the changes to other areas of the facility.
Effect of dietary supplements and physical exercise on sensory perception, appetite, dietary intake and body weight in frail elderly subjects. J Amer Geriatr Soc 1992;40:155-62. J Amer Geriatr Soc 2003;51:85-90. J Amer Geriatr Soc 1995;43:835-6. J Amer Geriatr Soc 2000;48:485-92. Evaluating and treating unintentional weight loss in the elderly. J Amer Geriatr Soc 1994;42:1100-2. J Amer Geriatr Soc 1998;46:1378-86. J Amer Geriatr Soc 2001;49:1309-18. The effects of improved oral hygiene on taste perception and nutrition of the elderly. Effect of flavor enhancement of foods for the elderly on nutritional status: food intake, biochemical indices, and anthropometric measures. Flavor enhancement of food improves dietary intake and nutritional status of elderly nursing home residents. Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation.
Investigation and management of unintentional weight loss in older adults. Get access to this article and to all of thebmj.com for 14 days. 2 Department of Medicine for the Elderly, Monklands Hospital, Airdrie, UK. 3 Department of Medicine for the Elderly, Glasgow Royal Infirmary, Glasgow, UK. Unintentional weight loss is common in elderly people and is associated with considerable morbidity and mortality. Weight loss may be the presenting problem or an incidental finding during a consultation for other reasons. There are no published guidelines on how to investigate and manage patients with unintentional weight loss, and responses range from doing nothing (if it is viewed as a normal part of the ageing process) to extensive blind investigation because of the fear that it represents underlying cancer. We review the available evidence (mainly epidemiological and observational studies) and outline a structured approach to investigation and management of the older patient with unintentional weight loss.
Bilateral axillary lymphadenopathy is present with nodes that measure approximately 1 cm on the left and 1.5 cm on the right. These results are consistent with anemia, thrombocytopenia, leukocytosis, and lymphocytosis. This article reviews the function of lymphocytes and discusses what lab results like those for Mr. The two main groups of WBCs (also called leukocytes) are granulocytes and agranulocytes. (See A closer look at leukocytes.) Lymphocytes, the most common type of agranulocyte, play a major role in the body's immune response, including antibody production and cell-mediated immunity. For a summary of WBC types and functions, see Five infection fighters. Lymphocytes are classified into three main types: B lymphocytes, T lymphocytes, and natural killer cells. * B lymphocytes (B cells) produce five distinct classes of immunoglobulins (Igs) and mediate humoral immunity. Humoral immunity is the part of the immune response that eliminates extracellular microbes and microbial toxins, including bacteria and viruses. Lymphocytopenia and lymphocytosis. WBCs are categorized as granulocytes (neutrophils, basophils, and eosinophils) and agranulocytes (monocytes and lymphocytes). * Monocytes are the largest WBCs; they act as a second line of defense against bacterial infections and inflammatory responses. * Lymphocytes are the main cells of the immune system; they control the intensity and specificity of the immune response.