Q: My 88-year-old father lives in his own home about 100 miles from us. He’s been living alone since my mother died five years ago. I thought he looked rather thin last time we saw him. I’m starting to feel worried about his nutrition. Should I be concerned? Would you recommend he start drinking a supplement such as Boost or Ensure?
A: This question comes up a lot for families. It is indeed very common for older adults to experience unexplained weight loss at some point in late life.
The brief answer is that yes, you should be concerned. But I wouldn’t recommend you jump to purchasing Boost or Ensure.
Now, in most cases, some nutritional supplementation is in order. But before focusing on this, you should first get help figuring out why your father is losing weight.
For doctors, unintentional weight loss is a major red flag when it comes to the health of an older person.
So in geriatrics, we usually recommend that an older person — or their caregivers — monitor weight regularly. This enables us to spot weight loss sooner rather than later.
Once we’ve spotted unexplained weight loss, the next step is to figure out what might be causing it. And then we’re in a better position to recommend a treatment plan, which might well include a nutritional supplement.
In this post, I’ll go over each of these steps in more detail.
Why you should monitor for unintentional weight loss
Unintentional weight loss means losing weight without dieting or otherwise deliberately trying to slim down.
This often goes hand-in-hand with malnutrition in aging. Now, they aren’t quite the same thing: it’s possible to be malnourished without obviously losing weight. But they tend to go together.
Both problems are common in older adults. One study found that 39% of hospitalized older adults were malnourished.
It’s important to detect and evaluate weight loss and malnutrition for several key reasons:
- They are often caused by underlying health problems which need to be diagnosed and managed.
- They leave older adults weakened and more vulnerable to additional illnesses and injuries.
- They may be a sign that an older person is impaired, or otherwise needs more support with daily life.
Fortunately, there’s an easy way to screen for these problems: tracking an older person’s weight.
How to track weight and nutrition in an older person
Tracking Weight:
This is a terrific quick-and-easy way to monitor overall health and nutrition in an older adult.
To track the weight of an older person who lives at home or in assisted-living, I usually recommend checking and recording the weight at least once a month.
(Note that nursing homes are usually required to weigh residents monthly; some assisted-living facilities may do so as well.)
You should keep records of the weight checks, preferably in a way that makes it easy to bring the information to the doctor’s office. Some families keep the information in a paper chart, but it’s potentially better to keep it in a shared computer file; see this article on keeping and organizing information for more details.
You can also consider one of the newer “connected” scales. These are devices that can wirelessly connect to a mobile device or even the home’s wifi. The weight record can then be accessed through an app or website.
Once you start tracking weight: at what point should you be concerned?
A general rule of thumb is that unintentionally losing 5% of one’s original body weight over 3-6 months is cause for concern. But it’s also reasonable to be worried if you notice a steady downward trend.
Once you’ve become concerned and documented a change in weight, you’ll want to bring it up with a doctor or other health professional.
Tracking Nutrition:
Monitoring for unexplained weight loss, as detailed above, is probably the easiest way to screen for nutrition problems.
Other red flags to take note of are:
- Loss of appetite.
- Decreased strength and/or ability to get around.
Note: The term “nutrition” can be used differently in different contexts. In geriatrics, the focus is often first on ensuring that an older person is getting enough calories and protein to maintain energy needs and muscle mass. Obviously, there is more to nutrition than just this; it’s also important that people meet their body’s needs for vitamins and minerals, and that they eat a “healthy diet.” Exact definitions of a “healthy diet” differ, but it’s generally one that promotes health and well-being, and doesn’t cause or aggravate health problems. A Mediterranean-style diet can work well for many people.
Common causes of weight loss and malnutrition
It’s important for an older person to get a clinical evaluation, once you’ve noticed weight loss or other signs of possible malnutrition. A simple initial assessment tool that many clinics will use is the Mini Nutritional Assessment.
(You can view and download a “Self-MNA” here.)
Many types of health problems can cause weight loss. According to this Canadian Medical Journal review article, common causes to consider are:
- Depression and other psychiatric conditions (9-42% of cases)
- Cancer (16-36%)
- Gastrointestinal disease (e.g. problems with the stomach or other parts of the digestive tract; 6-19%)
- Thyroid imbalances, diabetes, and other types of endocrine disorders (4-11%)
- Cardiovascular disease (2-9%)
- Alcoholism and other forms of nutritional disorders (4-8%)
- Chronic obstructive pulmonary disease (COPD) and other respiratory disorders (~6%)
- Neurologic disorders, including those that interfere with swallowing (2-7%)
- Medication side-effects (~2%)
- Unknown after extensive evaluation (10-36%)
Some additional issues that particularly come up in older adults include:
- Difficulty leaving the house to purchase food. This can be due to limited mobility (e.g. due to pain, fear of falling, etc), lack of transportation, or cognitive problems.
- Difficulty affording food. Some older adults live on a very limited income.
- Difficulty or pain with chewing and swallowing. Many seniors fall behind on dental care for various reasons. This can lead to painful mouth conditions, or a lack of suitable dentures.
- Constipation. This is quite common in older adults and can interfere with appetite and eating enough.
- Paranoia about food, due to dementia or a psychiatric condition. A fair number of older adults become suspicious of others during early dementia. Occasionally this leads them to not eat enough.
- Forgetting to eat or having difficulty organizing meal preparation. This is especially common for those with Alzheimer’s and other dementias, but can also be due to problems like depression or even mobility limitations.
- Unappetizing food. Sometimes the food is not to an older person’s taste, especially if it is a low-salt, low-fat, low-carb, low-sugar, or other medically “recommended” diet.
Generally, to sort through all these possibilities, doctors will need to interview the older patient and the family. For instance, they will want to know:
- How is the older person’s appetite? Do they like to eat or seem uninterested? How has this changed over the past year?
- Any pain or difficulty with chewing or swallowing?
- Any problems with nausea, vomiting, or feeling full easily? Any abdominal pain?
- Any problems with diarrhea or constipation?
- Who does the shopping for food? Who cooks the meal and organizes the time to eat? Does the older person do this alone or usually with someone else involved?
It’s also very helpful for the doctors to have as much information on what food — and how much food — the person is actually eating.
Last but not least, during the clinical evaluation, the doctor will physically examine the older person and then probably order some bloodwork as well.
How you can help doctors evaluate weight loss
The main way to help doctors is two-fold. One is to bring in a weight record, showing how the older person’s weight has changed over the past several months.
The other is to bring in information related to symptoms and ability to obtain food. You can do this by asking your older relative — and anyone else who is familiar with the person’s daily life — the interview questions listed above.
Of course, the doctor will still need to ask these questions, but it’s extremely helpful for patients and families to have thought through the questions ahead of time.
You can also download and complete the “Self-MNA” (self Mini-Nutritional Assessment) and bring it in to discuss with your health providers.
How to “treat” unintentional weight loss
The best treatment plans are based on a careful evaluation and correct diagnosis of what health problems — and social factors — are causing the weight loss.
Unfortunately, it’s common for many doctors to quickly turn to prescribing high-calorie supplements like Ensure, or even prescription appetite stimulants.
In fact, this is such a common problem that the American Geriatrics Society chose to address it in their Choosing Wisely recommendations:
Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia (loss of appetite) or cachexia (loss of muscle mass) in older adults.
Instead, optimize social supports, discontinue medications that may interfere with eating, provide appealing food and feeding assistance, and clarify patient goals and expectations.
(Learn more here: Choosing Wisely: 5 More Treatments For Older Adults You Should Question)
Now, even when social issues and medical problems are addressed, it’s often necessary to provide some extra nutritional support to those older adults who have been losing weight.
This usually means providing extra protein and extra calories. Fat is dense in calories, so this can be a good way to increase energy intake. Technically it’s better to provide “good fat” like olive oil, but in the short-term, I encourage people to consider whatever fatty foods the older person really likes to eat, which might mean ice-cream or peanut butter.
Research also suggests that many older adults may benefit from supplemental protein, especially if they’ve been showing signs of lean muscle loss. Many studies have used milk or whey protein.
So should you consider Ensure or Boost? You should discuss more with your father’s doctor, but my take is that such commercial supplements should be used only as a last resort. They are expensive, usually contain a lot of sugar, and contain various additives. So it’s better to make your own smoothies or otherwise provide nutrient-dense snacks and protein to your father, if at all possible.
Consider strength training and protein intake to counter frailty
Many older adults are also generally getting weak and losing muscle mass, which can lead to sarcopenia and frailty.
If your older loved one has been evaluated for weight loss and no major medical problems have been identified as the cause, then consider talking to the doctor about whether it would be appropriate to attempt some strength training, to build muscle mass.
I cover what to know about strength training and protein intake in this article: 4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging.
You can also learn more about aging with strength, independence, and vitality in this video:
Key take-home points on weight loss in older adults
I’ve provided a lot of information while answering your question, so let me summarize the most important take-aways.
- Tracking monthly weights is a good way to keep an eye on the health of an older adult. Put it on the calendar. A “connected” scale can make it easier to log and share the weight record.
- Unintended weight loss is a major red flag. Take action and consult a doctor if an older person loses 5% of more of their body weight, or if you’re otherwise concerned.
- Be sure to check for problems related to purchasing, preparing, and eating food. These are easily overlooked in older adults. They may be related to mobility difficulties, cognitive impairments, dental problems, depression, or unappetizing diets.
- Commercial supplements and/or appetite stimulants should be used only after careful consideration with the doctor, and after considering alternatives. They often feel like the “easiest” solution (assuming one can afford them) but they’re usually not the best way to maintain an older person’s nutrition and well-being.
If you want a more scholarly take on nutrition in aging, here are a few good articles:
- Assessment and management of nutrition in older people and its importance to health
- Nutrition in the very old
- Nutrition and the gut microbiome in the elderly
- Protein Requirements and Recommendations for Older People: A Review
- Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance?
- Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness
Have you been concerned about an older person’s weight loss? Post your questions and comments below.
[This article was reviewed & updated in August 2024.]
mjMich says
To share my recent weight loss & recovery, in the interests of helpful info (age 86): Several months ago a severe back problem played a role in losing significant weight. Problem turned out to be a compression fracture of one vertebra. 3 different medical sources (urgent care; ER; diagnostic appointment with doctor) verified this diagnosis primarily by X-rays. Some pain meds helped for awhile, but as I started to feel some recovery, I voluntarily went off of all pain meds. During the early difficult weeks, I had no appetite – none. Had access to food in our senior living complex, but just the thought of food, especially anything sugary, repelled me. Virtually quit eating for some time. I don’t know what my start weight was, but the early ER session determined 135 lbs. In about 8 or 10 weeks, was pushing 120, which my Dr. warned me about. Fortunately I started eating gradually, eventually back to full meals. Now vacillate between 125 -130. During all of this had a bone density scan which showed osteoporosis. Now being treated, had PT 2x week for a month, am happy to be recovering, though now & then some residual problems surface. Not quite sure what this contributes to the discussion, other than a type of condition that can foster weight loss. During the whole time I managed some caregiving for husband, whose weight & appetite are just fine.
Nicole Didyk, MD says
Pain can definitely affect appetite, along with sleep, mood, concentration, and enjoyment. Thanks for sharing your experience and I’m glad you’re back in the swing of things!
John B says
Hi! Thank you very much for the well-written article.
My father (65) has lost about 6 kg from 82 kg since May, so about 3 months. He has been eating normal, but has been golfing everyday (walking with pull-carts).
I get that he is very active and golfing does burn a lot of calories, but 6 kg for 3 months sounds a little too drastic for me, especially since he has never weighed less than 80 kg in his entire life.
Is that something I should be concerned with?
Thanks very much in advance.
Nicole Didyk, MD says
I can understand being concerned about weight loss, even if it’s slow and the older adult is otherwise healthy.
If your father went from a low activity level to golfing ever day, that could be the explanation. So many variables can be at play when it comes to a change in weight: medications, mood issues, activity level, other medical issues, and more.
A review by a primary care provider is a great place to start. I would also check in with your father to see if he’s concerned about his weight, or has been changing any other habits.
Hilary says
I’ve lost 5 klm in last 6 mints due to severe pain shoulder RA/ tern tendon. Been injected several times. Worn out severity pain – waiting nxt inj, – 2 months delay- I’m exhausted mentally physically lost appetite / energy- . Adm hosp urgently as Atrial fibrillation and BP out control. Had infusion vit min enzymes but now worried at home how to continue best foods as pain ongoing? Thnk you
Nicole Didyk, MD says
It sounds like you’ve had a rough time lately, and it’s no surprise you’re feeling tired.
I’m not an expert in nutrition, but I did find this study involving an “anti-inflammatory diet” and RA: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266686/
The diet included fish, low fat dairy, legumes, some whole grains and bananas, apples and pears. The investigators found that the diet was helpful in reducing blood tests associated with inflammation, and they plan to do more study to see if it helps with pain and other outcomes.
It sounds like a well-balanced diet plan in any case and should be suitable for almost any health concern. Low salt is recommended for those with high blood pressure as well.
NADIA KULL says
Hello! My Dad is 87, 5’9 and was about 170 lbs early May. He had to undergo anesthesia to have some bladder stones blasted out. Prior to this his bloodwork was perfect and he had pretty good energy. WAlks 2 miles per day. Post procedure he had a catheter and bled a lot! A whole week of pretty dark ruined that was bloody. He also became exhausted during this time. Now 7 weeks later he still has no appetite, feels nausea and has no energy so not doing his walking regime. He has lost almost 20 lbs. he’s gaining back a little appetite but only about 50%. Prior to this he was really good. Going to see gastroenterologist this week but I don’t see how bladder stone removal affects gi tract. Could it be anemia after all this time?
Nicole Didyk, MD says
A medical issue like the one you describe can be a significant setback for an older adult, even one who’s healthy. Anemia can take a while to correct, and some people need to take iron supplements, or even a blood transfusion if the hemoglobin is very low (usually below 70).
Bladder stones and gastrointestinal blood loss isn’t usually related, but it may be that the doctor is wondering about another cause for the symptoms, and is being thorough.
Some older adults need active rehabilitation to get back to their previous vigor, which could include an exercise regimen and some dietary changes. IF your dad gets a clean bill from his doctor, this would be a step to consider.
Dana Whitney says
Hi,I’ve lost over 150 lbs.in a year,I’ve gone off my Blood Press.pills,had all kinds of test,they can’t figure it out,I can’t eat Anything any more,no meat,veges,bread,nothing,can eat turkey,wheat thins and Graham crackers(sometimes with sugar free peanut butter),I feel ok, don’t sleep well,what do you think?
Nicole Didyk, MD says
That is a large weight loss, and it sounds like you’ve had a lot of investigation into it. A registered dietician would be able to review what you’re eating and give you some advice on how to stabilize and reverse this trend. You can find a dietician near you here: https://www.eatrightnc.org/find-a-registered-dietitian
Deeksha says
Hello Ma’am,
Greetings !!!
My name is Deeksha & I’m residing in India, my concern is related to my father who is 57 years old & a oral cancer survivor. He got detected with oral cancer in 2011 & gone through its treatment like chemo & radiation, till 2018 everything was perfect, but then by mid of 2018 my father started loosing his weight and till now he has lost around 25kgs. He had his all checkup done, including cancer checkup but everything is normal then now why he is loosing weight. Please help me our with this.
Nicole Didyk, MD says
I’m so glad to hear that your dad has survived oral cancer and that his check up was reassuring. I usually see people in a n older age group than your father, but a good place to start for someone in your situation is by documenting the oral intake and weight change. Sometimes when we get that kind of data, we can see how to add more calories, or that the weight is actually more stable than it seems. A medication review is a good idea as well. Good luck.
Deeksha says
Thank you so much Ma’am for the guidance.
Jennifer Vizcarra says
Hello! Same as most of the comments: My Mother is under doctors and nurses care for anemia dementia and neck pain. Due to covid her care is very under par and I feel I am on my own. I have been trying to get her psychotic meds reduced which make her have loss of appetite. My question to you is: “Besides Centrum Silver, isn’t there a B12 shot or supplements she can take to add nutrients to her system? She does eat, but not gaining weight.
Nicole Didyk, MD says
Hi Jenny and thanks for sharing your mom’s story. It sounds like you’re a great advocate for her health care, which must be challenging right now.
We usually don’t recommend additional “nutrients” for weight gain in older adults, unless there’s a specific deficiency. If your mom has had blood tests recently, her doctor may be able to tell you if there’s a low level of some mineral, like calcium or magnesium, or if her Vitamin B12 needs to be replenished.
Dietary supplements like Boost or Ensure can be a good way to get additional calories and protein, but they can sometimes satisfy the appetite such that a person has less hunger at meal times. Usually a small amount of a dietary supplement over a longer period of time (like taking 30ml five or six times a day) can add those extra calories that can stabilize or increase body mass.
You’re on the right track thinking about a medication review as well, although many antipsychotic meds tend to promote putting on the pounds.
Leslie says
My 87-year old father has dropped 30 pounds during the last two years, unintentionally. He has an incredibly robust appetite, eats way more than my husband, but can’t seem to gain weight. He’s been staying with us the last two months, so I know he’s eating well.
I took him to the doctor, they did thorough work up — blood tests, comprehensive questions, CT scans. They found nothing. It’s like he’s not absorbing nutrients, like malabsorption.
During this same time, he’s been suffering from mild cognitive impairment or mild dementia. Don’t know what to do at this point.
Nicole Didyk, MD says
Sorry to hear about your dad’s weight loss, and it’s great to hear that he’s eating well now.
Malabsorption in medical terms is usually related to a gastrointestinal issues, and may be detectable with bloodwork (for example, you may see low levels of fat soluble vitamins or other elements in the bloodstream), so some of that may have been ruled out with a “thorough workup”. Some medications can affect absorption of nutrients, so that may be worth reviewing in more depth.
Dementia can affect appetite and food intake, and it may be that your dad is eating well now that he’s living with you but wasn’t doing so on his own. He may also be more physically active now and burning more calories. In a situation like this, weekly weigh ins may be helpful to see if the weight loss is ongoing or stabilizing. If a pattern of ongoing loss is apparent, I would go back to the PCP for more advice.
Sanjana Das says
My father is 63-years old, and has slimmed down too much over the last few months. His weight at present is only about 48 kg. We got concerned and had him go through a full body check up, but all of his results seemed normal. And the doctor had nothing particular to add. I can’t feed him with eggs and other high calorie foods, since his cholesterol levels are pretty high as it is. But recently, he’s been losing weight again, and I’m unsure as to how to proceed. He himself insists that he’s alright at every turn, and gets irritated at my nagging. What would you suggest I do?
Nicole Didyk, MD says
I’m sorry to hear about your dad and not surprised that nagging isn’t helpful.
I often work with a registered dietician or nutritionist when there’s no obvious cause for weight loss and there are specific issues about supplements (like wanting to avoid eggs or other high cholesterol sources). Sometimes when individuals lose weight, their cholesterol levels normalize so that might be worth reviewing as well.
Stacey Littrell says
Hello,
My mom is 79 years old, 5’11” and recently had a physical and she weighs 95 pounds. She is also losing her memory. Her doctor is going to prescribe an appetite stimulant and also recommended for my parents to buy a protein supplement, I forget the name, but she only drinks 1 oz. in the am and 1 oz. in the pm.
My parents live in Florida and my family and I live in California. I feel helpless at this point and wanted to know what you would recommend for my mom.
Thank you for your time and for your help.
Sincerely,
Stacey
Nicole Didyk, MD says
Hi Stacey. It must be so hard to be worried about your mom from a distance. I’m glad to hear that your mom is seeing her doctor, because weight loss can be a cause or effect of memory changes, and that can be tough to iron out. If I saw an older person with the numbers that you shared, I would want to have a thorough assessment done, including bloodwork and some imaging. I see a lot of older adults with weight loss and reduced appetite in my practice, so asking for a Geriatrics referral if possible might be a good idea.
Many underlying conditions can contribute to weight loss, as Dr. Kernisan points out. If all of those underlying conditions have been ruled out, nutritional supplements may be used, and guidance from a registered dietician or nutritionist would be helpful.