Last Updated: April 29, 2015
Three years ago, when Nicole Wilhelm, a public relations
executive in Jacksonville, Florida, was in the throes of wedding
planning, she visited her 68-year-old father in Lucerne Valley,
California. It quickly became apparent that something was wrong,
Her father, a life-long skier who was normally muscular and fit,
now looked frail and weak.
"I noticed that he was definitely thinner, but not so much as to
cause great concern," she says. Still something didn't seem right
to Wilhelm, so she asked her father about his weight loss."He said
he had been to his doctor, so I didn't worry," she explains. "He
was his usual upbeat self."
What Wilhelm didn't know was that in six months, her father
would be fighting for his life.
Sudden Weight Loss
Though sometimes downplayed or even ignored by elderly patients,
sudden weight loss is a serious cause for concern says Dr. Barry
Fabius, medical director of geriatrics at Holy Redeemer Health
System in Philadelphia, Pennsylvania. "My radar goes up," says
Fabius. "I immediately wonder if I'm dealing with cancer."
But beyond the ominous "c" word, there are a host of other
serious conditions that quick-onset weight loss can signal,
including depression, dementia, gastrointestinal issues and
According to Fabius, sudden weight loss is a frequent health
problem in elderly populations. Judging by his own practice, he
estimates that as many as 15 percent of seniors have or will suffer
from such a condition.
Wilhelm's father fit into that statistic. "Two days before my
wedding, my father showed up, and this time he had a dramatic loss
in weight," she says, estimating that he lost an additional 30
pounds, adding to the 20 pounds lost in previous months. "I could
not believe how frail he looked--I had never seen him this skinny.
I could not believe the man looking at me was the father that used
to put me on his shoulders when I was a little girl. I really had
no idea what to do."
With her wedding just days away, Wilhelm tried to get to the
bottom of her father's alarming transformation. Because he was
diabetic, his primary care physician assumed the weight loss was diabetes-related
and treated the problem as such. Wilhelm, worried that the
condition might be more serious, tried insisting that her father go
to the hospital, but he wouldn't hear of it.
"He said this was the most important time of my life, and he
needed to be there for it," she says. "I told him that it is just a
wedding and weddings can be rescheduled." Her father's response:
"I'm fine, honey."
But everything wasn't fine. At the rehearsal dinner, while
family and friends celebrated, Wilhelm's father hardly touched his
food. And by the day of the wedding, he was so weak that she says
it was heartbreaking to look at him. "At the reception when my
father and I danced together, I had my husband cut in, and my
bridesmaid take my father back to his seat. I would have been
devastated if he were to have fallen while we were dancing
Four months later, he was diagnosed with terminal lung cancer.
The sudden weight loss had been a signal of a distressing problem,
but neither he nor his physicians caught it in time. He and his
doctors had missed or ignored one of the fundamental elder care
warning signs-his weight loss--and now the cancer had spread to his
The Importance of Early Detection
In cases like Wilhelm's father's experience, early action, says
Fabius, is key. Though such weight loss isn't always a signal of
cancer, it is always a cause for concern. At the first sign of
unhealthy weight loss, says Fabius, "get them to see a physician as
soon as possible. Most cancers are treatable in their earliest
How much weight loss is considered dangerous? "As little as 10
pounds over a month would concern me," he says. "I'm also concerned
about weight loss that is slow and progressive."
After an initial visit to the doctor, he recommends that his
patients, possibly with assistance from family members, weigh
themselves twice weekly and keep an accurate "food diary." "Most
diagnostic work occurs in your history taking," he explains. Such a
diary, says the doctor, will show an accurate picture of a
patient's caloric intake. "It's important to see, in that history
taking, how many calories they're actually burning." Some important
questions Fabius and other practitioners ask as they're reviewing a
patient's caloric record keeping are: Is the patient taking in
enough calories? If so, is the patient still losing weight? Is
there an appetite? "If a patient is meeting or exceeding their
caloric needs," says Fabius, "that's going to make me suspect
hyperthyroidism or a malabsorption syndrome."
Top Warning Signs of Failing Senior Health
When it comes to weight loss in the elderly, experts say to
watch for a few key elder care warning signs:
- Depression: Sudden weight loss can be
associated with depression, social withdrawal, or loss of a will to
- Loss of smell and taste: Though a normal part
of the aging process, loss of these senses can be exacerbated by
medication or disease, which can result in anorexia.
- Constipation: A common complaint, constipation
can be a result of a diet that is lacking adequate nutrients and
fluids. Though there are several over-the-counter remedies for
constipation, Fabius also recommends combating poor nutrition with
a daily multivitamin and possibly a dietary beverage supplement
such as Ensure.
- Loss of appetite: Whether a result of chewing
problems or disease, a sudden disinterest in food is a cause for
Fabius encourages friends and family members to step in and help
a loved one who is reluctant to seek medical assistance. He
emphasizes that this should be done in a "compassionate manner, so
they know you are trying to give them the best advice possible.
That connectedness is vital."
Though there are medications available to treat appetite issues,
Fabius isn't a fan of many of them. However, he says there is
pharmaceutical research in progress that could change that. "There
are promising drugs in the pipeline that can stimulate appetite,"
Sadly, Wilhelm's father's condition wasn't treatable, and he
passed away a few months after being diagnosed with terminal
cancer; but not before Wilhelm spent her weekends being his
caregiver. "Taking care of my father was not easy on my new
marriage, or myself," she says, "but I would not change a thing. I
did what would make my father the happiest. We have to make
sacrifices for family."
And yet those final days provided the father-daughter time she
had always longed for. "I made meals for him, did his laundry,
cleaned the house, drank beer on the porch with him, and just
enjoyed his undivided attention," she remembers. "We listened to
his jazz records, and a lot of Louis Prima, and he told me stories
about the 'Old Vegas' and how much better that was than today's
When my father's final hour came, Wilhelm says, "I kissed my
father on the cheek and told him I loved him. He grunted so I knew
he heard me." Saying goodbye, she says, was heartbreaking,
especially knowing that there may have been more doctors could have
done to help her father (at least before the cancer had
Though Wilhelm's ordeal with her father was painful and
confusing, she has important advice for others. "People just
totally rely on what the doctor says," she says, wishing her father
had a more attentive and proactive geriatrician. "We are not really
a society that challenges a doctor's advice; we seem to just be
very accepting of what the doctor says."
Still, when all was said and done, Wilhelm knew there was
nothing more she could have done, given the circumstances. "Never
have regret," she says. "Just remember that at the end of the day,
if you feel like you have honestly done everything in your power to
help, then you have."