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. But something was wrong, says Wilhelm. Her father, a lifelong 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. Wilhelm had discovered one of the most important elder care warning signs a caregiver should look out for.
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. Fabius lists a few: depression and dementia; gastrointestinal track issues such as malabsorption conditions; inflammatory bowel disease; and hyperthyroidism and other diseases that trigger the body to burn calories too quickly.
How common are these symptoms? 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, insisted that her father go to the hospital; but he wouldn’t hear of it. “He said this is 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 together.”
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 brain.
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 stages.”
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 [20 pounds per year, for example].”
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.”
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 live.
- 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 concern.
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,” he says.
While cancer can be devastating and life threatening, another frequent cause of sudden weight loss in the elderly is the “loss of a will to live.” Whether caused by isolation or grief over the loss of a spouse or close friends, such depression can result in lack of appetite and a food-purchasing mentality that Fabius describes as “I’m not going to spend money on myself.”
The good news, however, is that these cases present the best recovery success rates. Whether prescribing the patient anti-depressant medication, providing counseling services, encouraging them to try cognitive therapy (playing bridge, reading, or other activities that stimulate the mind), or connecting them with a senior center, home, or adult “day-care” center, Fabius and other geriatricians often have success improving the health of such patients. “When they have a reason to live, suddenly their appetite improves,” notes the doctor. “I’ve seen complete turnarounds in a matter of three months.”
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 version.” And when the 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—before the cancer had spread.
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.”
Today, Wilhelm says her heart still aches for her father. “When you lose a parent your life really changes,” she says. “I was daddy’s little girl, and even though I know he’s not here anymore, sometimes I still pick up my phone and dial his number wanting to tell him about a funny experience that I had during the day. People often comment that when they lose a limb, they still think that it is there. That is what losing a parent is like—you never knew life without them in it and when they are gone it never seems to sink in.”
