Your mother has gotten noticeably smaller this year. Nobody put her on a diet, she has not been trying, and the way you found out was a coat that stopped fitting her. She has watched you go through a weight-care evaluation of your own, and now she is asking how she would go about starting one herself. So what does an ordinary doctor's appointment do with a year of weight nobody asked for, and what can you bring to it that she would not think to bring on her own?
Weight that comes off an older adult who was not trying is a finding to explain, and it goes to whoever looks after her health in person. Her question about starting is the same appointment: the National Institute on Aging tells anyone her age to talk to a doctor before trying to lose or gain weight. You can put both into one booking, and you can arrive with the history that appointment runs on.
Good news, or a symptom
Treat it as a symptom until a doctor has looked at it. Sudden, unintended loss in an older adult can be a sign of a serious medical problem such as cancer, gastrointestinal disorders, and even some neurological diseases, and the move that follows is a call to a health care professional to find out whether there is a medical cause.
Contact a health care provider if she has lost more than 10 pounds (4.5 kilograms) or 5% of her usual body weight over 6 to 12 months or less and nobody knows the reason, if she has lost more than is healthy for her age and height, or if anything else has appeared alongside it. Any one of the three is enough on its own to be worth the appointment, and she does not have to look ill for it to count.
A lower number carries its own risk at her age. A low body mass index may make medical problems such as osteoporosis and anemia more likely, and may make it harder to recover from an illness or an infection, and healthy weight ranges for older adults are different from the ones used for everyone else — an older adult at a normal weight may carry more fat and less muscle than someone slightly heavier. So what the appointment works from is the change and the speed of it, rather than the figure standing on her scale.
What her doctor needs before anything gets added
Describing the loss comes before adding anything to it, and most of that description exists only in your head and hers. Expect the visit to open on how much weight has gone, when it started, and whether it went quickly or slowly. After that: whether she is eating less or eating different food, whether she has been ill, whether her teeth or her mouth are sore, whether she has vomited or fainted, how her bowels and her thirst have been, what she takes, and whether she feels sad or depressed. Those are among the questions her provider works through, and every one of them is answerable at a kitchen table a week beforehand.
Appetite is where most of this starts, and it is worth pulling apart before you get there — eating enough when nothing appeals is its own problem at any age. Older adults commonly eat less because of less appetite, difficulty leaving the house to buy food, pain when chewing or swallowing, or forgetting to eat — four different problems, and which one it is changes who can fix it. A decreased appetite is often seen in older adults, and often no physical cause is found. That is a real result of the visit rather than a wasted trip, and it is worth telling her so before she goes.
One item on that list has a route of its own. Depression in an older adult shows up as noticeable changes in mood, energy level, or appetite, trouble sleeping or sleeping too much, irritability, persistent pain, hopelessness, or thoughts of suicide — and that appetite change is the same one her weight loss has been running on. Where she is struggling, or you are, the Suicide and Crisis Lifeline answers a call or a text at 988, and a chat at 988lifeline.org. Dial 911 instead if the situation is life-threatening.
Inside the appointment she books
What the booking buys is a physical exam, a weight on the practice's scale, and a long run of questions. That weight is often the first anyone has actually measured. Her answers to the questions sort between the three families of cause behind it rather than pointing at one of them.
| What the answers are sorting for | What sits under it |
|---|---|
| Something has taken her appetite | Feeling depressed, cancer, a long-running infection, a chronic illness, medicines she is on, stress or anxiety |
| Food is going in and not being absorbed | Celiac disease, diarrhea or an infection that has lasted a long time, chronic inflammation of the pancreas, part of the small intestine removed, overuse of laxatives |
| Something else again | An eating disorder not yet diagnosed, diabetes not yet diagnosed, an overactive thyroid gland |
Which column her answers land in decides what gets ordered. Imaging such as an x-ray or an ultrasound, and blood and urine tests, may be ordered from there, and a dietitian may be brought in for the eating side. That runs across more than one visit, which is the argument for booking the first one now rather than waiting to see whether the next few months look different.
Enough for one appointment
- Write down roughly how much weight has gone and when you first noticed it. Clothes, photographs and a weight recorded at some past appointment all count if nobody has been weighing her.
- Note whether it came off quickly or slowly, and whether anything else started at the same time.
- Ask her which of the four is true: less appetite, harder to get out and buy food, pain when she chews or swallows, or the meal simply getting forgotten.
- Copy her medicine list off the labels rather than from memory or from a repeat slip.
- Book the doctor who holds her records, and name unplanned weight loss as the reason at the time you book it.
- Take her question about starting treatment into that same visit, and let it be answered there.
She may not want you in the room, and that is hers to decide; what you wrote down goes in with her either way. The year she has had is the part nobody at that practice can reconstruct from her chart, and it fits on one side of a sheet of paper. A doctor holding it spends the visit on the cause, and her question about starting gets its answer in the same room.
