NSG6420 discussion – unintentional weight loss

NSG6420 discussion – unintentional weight loss

You are evaluating a 78 year old white male who comes to your office today with unintentional weight loss of 10lb in the last year, self-reported exhaustion weakness based on grip strength, and slow walking speed, and low physical activity. Notes that he has been feeling worse over the past 6 months and just does not have the strength to do anything anymore. The patient states they are not currently on any medications except a multivitamin. He notes that he lives alone and does not want to leave his house. Answer the following questions with supportive rationale:

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What questions should you as the patient/family to further assess?
What screening tools would be appropriate in this case?
Do you have concerns with fraility in this patient? If so why?
What referrals should be made if any on this patient?

NSG6420 Discussion – Unintentional Weight Loss

In evaluating a 78-year-old white male presenting with unintentional weight loss of 10lb in the past year, self-reported exhaustion weakness, slow walking speed, and low physical activity, along with declining strength and motivation, several key questions and considerations arise:

1. Further Assessment Questions:
– Have there been any changes in your appetite, diet, or eating habits?
– Are you experiencing any pain, discomfort, or difficulty swallowing?
– Have you noticed changes in your bowel habits, such as diarrhea or constipation?
– Are you experiencing any shortness of breath or chest pain?
– Have there been any recent changes in your mental or emotional well-being?

2. Appropriate Screening Tools:
– Geriatric Depression Scale (GDS): To assess for depression and its potential impact on weight loss and motivation.
– Mini Nutritional Assessment (MNA): To evaluate the patient’s nutritional status and identify potential malnutrition.
– Timed Up and Go Test (TUG): To assess mobility and risk of falls.
– Handgrip Strength Test: To further assess muscle strength and potential frailty.
– Mini-Cog: To screen for cognitive impairment that might impact self-care and dietary habits.

3. Concerns with Frailty:
Yes, there are concerns with frailty in this patient based on the reported symptoms of exhaustion weakness, slow walking speed, and low physical activity. These signs suggest a decline in physical function and overall vitality, which are characteristic of frailty in older adults. Frailty increases the risk of adverse health outcomes, including falls, hospitalizations, and decreased quality of life.

4. Referrals:
– Primary Care Physician: To conduct a comprehensive medical evaluation and address potential underlying causes of the symptoms.
– Registered Dietitian: To assess nutritional status, provide dietary recommendations, and develop a plan to address weight loss and malnutrition.
– Physical Therapist: To create an exercise program aimed at improving strength, balance, and mobility.
– Geriatrician or Geriatric Specialist: To provide specialized care for older adults, including management of frailty and addressing age-related health concerns.
– Mental Health Professional: To assess and manage depression, which can contribute to weight loss and diminished motivation.

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In conclusion, the presented case of unintentional weight loss, exhaustion weakness, and declining physical function in an elderly patient necessitates a comprehensive assessment, including further questioning, appropriate screening tools, evaluation for frailty, and referrals to address potential underlying issues and improve the patient’s overall well-being.