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Key questions about diet, appetite and weight should be on the menu of any Comprehensive Geriatric Assessment." /> <meta name="abstract" content="Nutritional status can be easily assessed, and problems can often be addressed quickly. Key questions about diet, appetite and weight should be on the menu of any Comprehensive Geriatric Assessment." /> <link rel="canonical" href="https://www.bgs.org.uk/resources/17-cga-in-primary-care-settings-weight-loss-and-nutrition-issues" /> <link rel="shortlink" href="https://www.bgs.org.uk/node/4168" /> <meta http-equiv="content-language" content="en" /> <meta property="og:site_name" content="British Geriatrics Society" /> <meta property="og:title" content="17. CGA in Primary Care Settings: Weight loss and nutrition issues | British Geriatrics Society" /> <meta property="og:description" content="Nutritional status can be easily assessed, and problems can often be addressed quickly. 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CGA in Primary Care Settings: Weight loss and nutrition issues </div> </h1> <span property="dc:title" content="17. CGA in Primary Care Settings: Weight loss and nutrition issues" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="0" datatype="xsd:integer" class="rdf-meta element-hidden"></span> <div class="resource-header-details"> <div class="card-resource-type-i"> <div class="card-resource-type"> Good practice guide </div> <div class="resource-type-i-icon">i</div> <div class="resource-type-info-arrow"></div> </div> <div class="resource-type-info"><div class="resource-type-info-text">Good practices guides focus on providing information on a clinical topic.</div></div> </div> <div class="node-header-details"> <div class="card-authors-wrapper"><div class="label">Authors:</div><div class="author-details">British Geriatrics Society</div></div> <div class="card-topics-wrapper"><div class="label">Topics:</div><a href="/taxonomy/term/2935">Comprehensive Geriatric Assessment (CGA) in community settings</a>, <a href="/taxonomy/term/860">Nutrition</a></div> <div class="node-header-dates"> <div class="card-date-wrapper"><div class="label">Date Published:</div><div class="card-date"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-29T00:00:00+00:00">29 January 2019</span> </div> </div> <div class="card-date-updated"> <div class="label">Last updated: </div> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-29T00:02:00+00:00">29 January 2019</span> </div> </div> </div> <div class="card-resource-summary"> <p>Recognition of nutritional problems in older people is important as these are associated with poor prognosis but are potentially treatable. Any assessment of frailty should include some key questions about diet, appetite and weight, as these can indicate specific problems related to nutrition as well as being markers of other underlying medical conditions.</p> </div> </div> <div class="view view-sections view-id-sections view-display-id-main view-dom-id-66a3f1a27bc7f422dadd14f8d2f63d22"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <h2 class="sidebar-nav">Assessment</h2> <p>Nutritional status can be easily assessed using some basic tools such as the weight (or change in weight), BMI or MUST score (see below). These are non-specific but reasonably sensitive. The mini nutritional assessment (MNA) is useful in care homes as it includes hydration and allows for a care plan to be created.</p> <p>Note that some patients will have a raised BMI due to excess body fat – this neither rules out frailty nor poor nutritional status – protein/energy deficiency and sarcopenia are common in older people including those with raised BMI (in fact body fat can make significant loss of muscle bulk difficult to spot). Unintentional weight loss is also an important marker of problems with nutrition or undiagnosed systemic illness such as malignancy or heart failure.</p> <p>Frequently used risk factors for malnutrition are:</p> <ul> <li>Involuntary weight loss (more than 5% over the last month or more than 10% over the last six months).</li> <li>BMI less than 20 for elderly (≥ 65y).</li> <li>Decreased appetite or reduced food intake.</li> </ul> <p>Other related issues include:</p> <ul> <li>Assessment of oral health (including dentures).</li> <li>Change in taste – older people can respond to a change in taste ‘everything tastes salty/sweet’ by not eating. Some drugs especially night sedation (the Z drugs) can alter taste sensation.</li> <li>Swallowing problems – asking about choking and things getting ‘stuck’ are often more productive than ‘difficulty in swallowing’ (Always refer swallowing issues for further investigation).</li> <li>Thyroid function.</li> <li>Alcohol intake.</li> <li>Bowel habit, as constipation can lead to reduced appetite. </li> <li>Older people are more likely to have B12 or folate deficiency due to diet or malabsorption which may be difficult to detect clinically. </li> <li>Also of value are assessment of mood (loss of appetite as a marker of depression) and cognition / function (inability to prepare or obtain adequate diet). </li> <li>Loss of appetite can also be a feature of dementia but generally only in the late stages – unless dementia is severe a change in appetite is more likely a marker of an acute illness, behavioural/psychological symptoms of dementia or undiagnosed systemic problem (eg constipation or malignancy).</li> </ul> <h2 class="sidebar-nav">Management</h2> <p>Referral to the local dietetics service can be a cost-effective way of managing poor nutrition once secondary causes have been excluded. Oral protein and energy supplementation does result in weight gain and may also slightly improve survival in undernourished older people. Medications to stimulate appetite are unlikely to be effective. Decisions about supplemental feeding in patients unable to take this orally (ie by enteral tube feeding) are complex. The effects of increased nutrition may be negligible (and possibly harmful) in advanced frailty and dementia.</p> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-7d8f28b1385b3a9b7b1eefe43d247bf3"> </div> </div> </div> </div> </div> </div> <div class="view view-sections view-id-sections view-display-id-additional view-dom-id-b7a28e5e222e727c623495b822c9ab29"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <h2 class="sidebar-nav">Further information</h2> <p>More about nutrition in general: Alibhai SMH, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people (Canadian Medical Association Journal. 2005;172(6):773-780. doi:10.1503/cmaj.1031527) <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC552892/" rel="nofollow">NCBI</a>.</p> <p>To access the core tools: </p> <p>BMI <a href="https://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx" rel="nofollow">online calculator</a> (weight(kg)/height2(m2)):</p> <p>MUST <a href="http://www.bapen.org.uk/screening-for-malnutrition/must/must-toolkit/the-must-itself" rel="nofollow">Toolkit</a>.</p> <p>MUST <a href="https://itunes.apple.com/gb/app/must/id442917800" rel="nofollow">app</a>.</p> <p>Mini Nutritional Assessment <a href="http://www.mna-elderly.com/" rel="nofollow">MNA</a>.</p> </div> </div> </div> </div> </div> </article> </div> <div class="content-additional"> <div id="block-webform-client-block-227" class="block block-webform"> <h2 class="resource-feedback-toggle">Feedback on this resource?</h2> <div 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class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 1: CGA in Primary Care</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/1-cga-in-primary-care-settings-introduction">Introduction</a><br /> <a href="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process">The elements of CGA</a>:<br /> - <a href="/resources/3-cga-in-primary-care-settings-physical-assessment">Physical assessment</a><br /> - <a href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment">Functional, social and environmental assessment</a><br /> - <a href="/resources/5-cga-in-primary-care-settings-psychological-components">Psychological components</a><br /> - <a href="/resources/6-cga-in-primary-care-settings-medication-review">Medication review</a><br /> - <a href="/resources/7-cga-in-primary-care-settings-creating-a-problem-list">Creating a problem list</a><br /> <a href="/resources/8-cga-in-primary-care-settings-care-and-support-planning">Care and support planning</a><br /> <a href="/resources/9-cga-in-primary-care-settings-involving-social-services">Involving Social Services</a></p> </div> </div> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last side-row "> <div class="section-inner"> <div class="card-title"> <h2 class="field-content">Section 2: Specific Presentations</h2> </div> <div class="side-row-wrapper"> <div class="card-body"> <p><a href="/resources/10-cga-in-primary-care-settings-patients-presenting-with-mobility-and-balance-issues">Mobility and balance</a><br /> <a href="/resources/11-cga-in-primary-care-settings-bone-health">Bone health</a><br /> <a href="/resources/12-cga-in-primary-care-settings-patients-at-risk-of-falls-and-fractures">Falls</a><br /> <a href="/resources/13-cga-in-primary-care-settings-patients-presenting-with-depression">Depression</a><br /> <a href="/resources/14-cga-in-primary-care-settings-patients-presenting-with-confusion-and-delirium">Confusion/delirium</a><br /> <a href="/resources/15-cga-in-primary-care-settings-mental-capacity-issues">Mental capacity</a><br /> <a href="/resources/16-cga-in-primary-care-settings-patients-presenting-with-urinary-incontinence">Urinary incontinence</a><br /> <strong>Weight loss and nutrition (you are here)</strong><br /> <a href="/resources/18-cga-in-primary-care-settings-end-of-life-care-issues">End of life care</a></p> </div> </div> </div> </div> </div> </div> </section> </div> </aside> </div> </main> <section class="postscript-first"> <div class="postscript_first"> <section class="block block-views postscript-section-row-block"> <h2 class="block-title">Other resources in this series</h2> <div class="view view-resource-series view-id-resource_series view-display-id-block section-row row-max-4 view-card-default-palette view-dom-id-89f160811189081ef1769b4b1e3cca64"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first"> <a class="card resource-card" href="/cgatoolkit"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>1. CGA in Primary Care Settings: Introduction</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> An introduction to CGA in primary care settings. This toolkit was developed by the British Geriatrics Society and has been endorsed by the ANCD for Older People and Integrated Person-Centred Care and by the Council of British Geriatrics Society, Scotland. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-2 views-row-even"> <a class="card resource-card" href="/resources/2-cga-in-primary-care-settings-the-elements-of-the-cga-process"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>2. CGA in Primary Care Settings: The elements of the CGA process</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> An overview of how Comprehensive Geriatric Assessment (CGA) is done in the primary care setting, and what to consider when conducting the assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-3 views-row-odd"> <a class="card resource-card" href="/resources/3-cga-in-primary-care-settings-physical-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>3. CGA in Primary Care Settings: Physical Assessment </h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Examination of older patients incorporates all the typical aspects of clinical examination, although there are some general considerations and emphases that should be borne in mind, and specific examinations that may be more relevant in older people. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> <div class="views-row views-row-4 views-row-even views-row-last"> <a class="card resource-card" href="/resources/4-cga-in-primary-care-settings-functional-and-social-assessment"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>4. CGA in Primary Care Settings: Functional and social assessment</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2019-01-28T00:00:00+00:00">28 Jan 2019</span> </div> <div class="card-summary"> <div class="card-summary-wrapper"> <div class="card-summary"> Functional assessment examines factors like mobility and daily living activities, and social assessment looks at social circumstances. Asking what the older person does and what environment they live in adds context to any Comprehensive Geriatric Assessment. </div> </div> </div> </div><div class="card-footer"> <div class="card-resource-series"> In a series </div> <div class="card-resource-type"> Good practice guide </div> </div></div></a> </div> </div> <div class="view-footer"> <div class="card-feed-link"><a href="/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners">See all resources in this series</a></div> </div> </div> </section> </div> </section> <footer id="site-footer" role="contentinfo"> <section class="footer-first"> <div class="outer-wrapper"> <section class="block block-views"> <div class="view view-footer-sections view-id-footer_sections view-display-id-orgs view-display-grid view-dom-id-51eb3fad571474f2c90ba13b50e5c5c3"> <div class="view-header"> <script> if(jQuery('#Main.CRM_Contribute_Form_Contribution_Main').length > 0){ jQuery('#Main.CRM_Contribute_Form_Contribution_Main').on('submit',function(e){ setTimeout(function(){ e.preventDefault(); 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