While Murphy et al are clear in their findings and robust in their recommendations,1 they appear to regard malnutrition (and particularly undernutrition) as a diagnosis to be treated in its own right, rather than a clinical sign with potential resolvable causes. Context is all!
While I would agree that weight measurement is under-recognised and under-used by practitioners as a diagnostic tool, serial weights from first presentation being particularly useful, it is vital to appreciate the causes of weight loss, which may extend across physical, psychological, and social parameters, many remediable. A much neglected cause of malnutrition in the elderly is ill-fitting dentures, which may cause pain, gum erosions, and inevitably poor intake. Poor fitting is exacerbated by further weight loss. A vicious circle ensues; the remedy is clear.
We would not expect ideal mobility from a patient with ill-fitting, painful shoes.
Let’s not embrace more protocols (with possible inappropriate treatment) to the exclusion of sound clinical assessment, diagnosis, and patient management.
- © British Journal of General Practice 2018
REFERENCE
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