Why unexpected weight loss in older people should not be ignored

Nurses need to debunk the myths about weight and appetite in older age

Nurses need to debunk the myths about weight in older age and protect patients from malnutrition

Older person tucks into a roast meal. Unexpected weight loss in older people should not be ignored
Picture: Alamy

‘My GP told me that everyone loses weight when they get older. It’s a normal part of ageing.’

‘I never drink after 6pm; I have to keep getting up in the night to go to the toilet.’

‘Well she is 87, you wouldn’t expect her to eat much.’

As a nurse with more than 30 years’ experience and a nutrition nurse for 12 years, I have heard statements like those above and others like them many times. Nutrition and hydration in older people appear to be shrouded in myths for nurses and older people alike.

The reality is that it is not normal to lose weight as we age. If unintended weight loss occurs, it should be investigated. 

Tips for nurses when investigating unintended weight loss

Whether in the community or a hospital setting, there are some questions and observations nurses can ask and make before performing a nutrition screen. They can use the LEARN mnemonic that I developed to use with my patients:

Look at your patient – do they look thin? Are their rings or clothes loose fitting?

Engage with them – are they chatty? How do they manage their food budget? Are they independent? Do they need help?

Ask your patient – how is your appetite? Is there any food that you do not like? Is cooking a chore?

Relatives – do they have any? If so, do their relatives have any concerns about their eating and drinking?

Needs – do they have any particular nutrition needs? Are they on a special diet? Do they have problems eating due to poor dentition? Do they struggle to cook or cut up their food?

Nurses need to act as advocates for older patients 

These questions should be part of any nursing assessment. If an older person has fallen, or has been admitted to hospital with an infection, malnutrition or dehydration could be a contributory factor.

Many long-term conditions common in older people such as chronic obstructive pulmonary disease, depression and neurological disorders have a significant effect on how they can manage to eat and drink. By asking these questions, being mindful of patients’ pre-existing conditions and then performing a nutrition screen, nurses can support older people to make that first all-important step towards recovery and maintaining their independence.

Patients trust nurses. We develop close relationships with them quickly and we are their advocates. It would be great if nurses could raise the profile of the consequences of poor nutrition and hydration for older people with our fellow healthcare professionals and the public. Good nutrition is everyone’s job – let’s lead by example!

Liz Anderson, @nutritionlizA, is lead nurse for nutrition, Buckinghamshire Healthcare NHS Trust and patient experience officer, British Association for Parenteral and Enteral Nutrition

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