Evaluation and Treatment of Unintentional Weight Loss - Term Paper Example

Names of each of the Members Name of Unit Name of Lecturer Date Due Table of Contents Table of Contents 2 Abstract 4 1.0 Introduction 5 2.0 Literature Review 5 2.1 Introduction 5 2.2 Unintentional weight loss and elderly person health/disease 5 2.3 Unintentional weight loss and depression 6 2.4 Physical nature of a patient and unintentional weight loss 7 2.5 Normal aging and weight loss 7 2.6 Impact of unintentional weight loss 8 2.7 Diagnostic evaluation 8 2.8 Treatment 9 3.0 Research Questions and variables 10 3.1 Sub-questions and variables 11 3.2 Significance of the research question 11 4.0 Definition of concepts 11 5.0 Ethical Statement 12 6.0 Research Design 13 7.0 Sampling Technique 13 8.0 Questionnaire design 14 9.0 Pilot Study 15 9.1 Sample analysis 15 9.2 Disadvantage and Advantage of Questionnaires 16 9.3 Corrections for future research 16 10.0 Results 17 Section 1: Demographics 17 Section 2: Result from survey 17 11.0 Conclusion 19 12.0 References 19 13.0 Appendix 22 13.1 Appendix A: Questionnaire 22 13.2 Appendix B: Information sheet 23 13.3 Appendix B: Consent Form 24 Table of Figures Figure 1: Gender representation 17 Figure 2: Age of participants 17 Figure 3: Depression contribute to weight loss 18 Figure 4: Unintentional weight loss cause health issue 18 Figure 5: Effect of teeth on consumption 18 Figure 6: Effects of drugs on unhealthy eating habits 19 Abstract The aim of this study is to analyse unintentional weight loss in elderly care homes/institution. The issue of unintentional weight loss within these institutions are common and therefore it is important to investigate what causes the issue. Numerous causes of unintentional weight loss have been mentioned, which include health condition, physical nature of a patient, depression, and normal aging. Moreover, the paper has analysed normal aging in association with unintentional weight loss. Diagnostic evaluation and treatment of unintentional weight loss have been discussed. The paper utilised quantitative approach in collecting appropriate information and the instrument utilised is a questionnaire. A pilot study was carried out that involved five patients of whom three were male while two were female. From the analysis, it is evident that appropriate formulation of a questionnaire ensures that information is collected and analysed effectively. Key words: unintentional, weight, loss 1.0 Introduction Unintentional weight loss is a common incident in elderly care institutions. The research paper is based on causes of unintentional weight loss since it is reported in numerous elderly care homes. The aim of elderly care homes is to ensure that the elderly persons enjoy the last days of their lives but unintentional weight loss causes depression, stress, death, and other diseases associated with weight loss. 2.0 Literature Review 2.1 Introduction The issue of unintentional weight loss is a common condition within elderly care homes (McBurney & White, 2009). Those patients who suffer from unintentional weight loss are at a higher risk for infection, depression and even death. Conditions that may be associated with unintentional weight loss include appetite problems, cardiac disorders, cancer and depression. This section analyses literature on unintentional weight loss in elderly care homes. 2.2 Unintentional weight loss and elderly person health/disease Acute illness may contribute to weigh loss within a short period while chronic illnesses may contribute to the condition immediately (McMinn, Steel, Bowman, 2011). These illnesses may be associated with normal appetite issues e.g. malabsorption, diabetes mellitus and hyperthyroidism or appetite reduction because of chronic infections, renal disease, cardiovascular, pulmonary or even cancer (Elisabeth, Judy, Merrilyn & Michelle, 2012). Cancer is the most common contributor to weight loss, and weight loss can be one of the signs of malignancy before emergency of cancer symptoms (Catherine, Douglas, & Claire, 2011). Malignancies of hematologic, hepatobiliary, gastrointestinal, genitourinary, breast, prostate, ovarian and breast are the causes that are associated with weight loss (Davis et al. 2011). In the pathogenesis of cachexia cancer, some hormones, cytokines, neuropeptides, neurotransmitters have been associated with the condition (Bray, 2010). Thus, disease and health of a person may contribute to unintentional weight loss. Patients diagnosed with dementia have a higher chanced of development of problems that are related to nutrition. Institutionalised patients with dementia have been reported that it contributes to more that a half persons reported with unintentional weight loss (Catherine, Douglas, & Claire, 2011). In addition, conditions such as Alzheimer’s disease contributes to unintentional weight loss. In the case of dementia, its pathogenesis is not well known but may be associated with combination of numerous factors (Chen et al. 2010). These factors may include forgetting to prepare meals, agnosia, apraxia, paranoid ideas about food, anosmia, and due to movement disturbances, increased caloric needs may be reported (Ritchie et al. 2008). In the elderly population, weight loss and anorexia is a common cause that is directly associated with drugs. These drugs can decrease appetite either peripherally or centrally (McMinn, Steel, Bowman, 2011). Some of the drugs that operate centrally and may contribute to the condition include serotoninergics, dopaminergics, catecholaminergics, and endorphin modulators (Elisabeth et al. 2012). Those drugs that operate peripherally include those that prevent bulking agents and gastric emptying (Wu et al. 2011). Other drugs that have been implicated in contributing to unintentional weight loss include iron and potassium supplements, digoxin, antibiotics and anti-inflammatory drugs (Graser et al. 2009). In addition, gastrointestinal disorders are organic and non-malignant causes of unintentional weight loss. These may include dysmotility syndromes, inflammatory bowel disease, peptic ulcers disease, celiac disease, chronic pancreatitis and mesenteric ischemia (Davis et al. 2011). Moreover, other conditions such as malabsorption in the elderly persons may contribute to weight loss (Catherine, Douglas, & Claire, 2011). Examples of malabsorption causes include celiac sprue, pancreatic exocrine deficiency and bacterial overgrowth. 2.3 Unintentional weight loss and depression Depression is also associated with unintentional weight loss. Depressive symptoms are associated with those people living within the community and are frequently reported while depressive disorder is frequently reported. Moreover, institutionalised elderly persons are associated with higher incidence of depression, and depression is a common diagnosis associated with unintentional weight loss (Elisabeth et al. 2012). In addition, bereavement is also associated to incidents of weight loss in men compared to in women. Depression also may introduce features and conditions that may contribute to weight loss. Alcoholism is associated with depression and alcoholism may contribute to weight loss (Catherine, Douglas, & Claire, 2011). 2.4 Physical nature of a patient and unintentional weight loss Dental, oral and swallowing problems contribute to insufficient calories consumption that may contribute to weight loss (Davis et al. 2011). Dental and oral problems contribute immensely to problems associated with unintentional weight loss (McMinn, Steel, Bowman, 2011). Swallowing problems may also contribute to unintentional weight loss in the elderly persons due to functional and structural conditions (Elisabeth et al. 2012). Physical disability also contributes to weight loss. Movement from one location to the other especially to elderly persons with disability inhibits them from either eating healthy or may contribute to depression resulting in unintentional weight loss (Catherine, Douglas, & Claire, 2011). Elderly persons with disabilities such as inhibiting movement or hands preventing them from putting food into the mouth also contributes to weight loss (Richman & Stampfer, 2010). Another problem associated with weight loss is lack of teeth, which may be associated with ineffective chewing and eating strategies. Some foods requires chewing and a person without teeth or strong teeth may find it difficult to consumer certain foods contributing to weight loss (McMinn, Steel, Bowman, 2011). 2.5 Normal aging and weight loss Small decrement in weight loss is associated with aging. This is attributed to decline in food intake and certain changes within the body of the aging person. For example, gastrointestinal function changes occur due to aging translating in weight loss. Delayed gastric emptying in the elderly person may contribute to stomach distension, which contributes to appetite problems (Catherine, Douglas, & Claire, 2011). In the elderly persons, evidence of reduction in gastric fundus ability results in ineffective adaptive relaxation (Davis et al. 2011). This contributes to rapid antral filling that result in early satiation (Elisabeth et al. 2012). Moreover, cholecystokinin may contribute to early satiation because it modulates directly antral stretch. Plasma cholecystokinin is higher in older healthy persons compared to younger persons and sensitivity to cholecystokinin becomes more sensitive to satiation effects because of increase in age. Decline in appetite and early satiety changes contributes to a condition known as anorexia of aging. Olfactory deficits and altered taste because of chemosensory losses associated with age also plays an important role in anorexia condition in older persons. From numerous studies, it is evident that olfactory sensitivity is reduced by age compared to taste sensitivity (Catherine, Douglas, & Claire, 2011). These alterations associated with age based on smell and taste may influence the kind of food taken and thus may translate to weight loss (McMinn, Steel, Bowman, 2011). In addition, treatments and medication conditions can contribute to effect on smell and taste and may contribute to risks associated with malnutrition (Elisabeth et al. 2012). Some of the drugs associated with these challenges include allopurionl, captopril, antihistamines, lithium, levodopa and carbamazepine. 2.6 Impact of unintentional weight loss Unintentional weight loss patients who are elderly have concomitant malnutrition. Conditions such as cachexia is associated with the loss of skeletal muscle rather that body fat (Tyrrell-Price, Hills & Varey, 2011). Other conditions associated with loss of lean body mass include loss of visceral protein, cardiac and skeletal muscle wasting, and physiologic functions alterations. The loss of body weight is associated with huge losses of visceral protein that contributes towards impairment of numerous physiologic functions (Capuano et al. 2008). Cachexia is also associated with increased cytokine concentrations, systematic inflammatory response and impaired immunity, which translates into adverse outcomes that may include death (Elisabeth et al. 2012). In addition, protein energy malnutrition results in impairment of both humoral immunity and cell-mediated immunity, which contributes to increased rates of infection in the elderly persons. 2.7 Diagnostic evaluation Despite the frequency in which the condition is reported, no clear guidelines are in place that determines how weight loss in elderly persons can be evaluated. Some studies indicate that the loss of weight should not be more than five percent within a period of between six and twelve months, and if such condition is reported it is important to seek clinical evaluation (Tyrrell-Price, Hills & Varey, 2011). The loss of weight should be verified through numerous strategies that may include change in size of clothes and reviewing of medical records. Another strategy that can be utilised is measuring the body mass index (BMI) that is calculated through division of patient’s weight versus the height of the individual in terms of kilograms and metres (Elisabeth et al. 2012). The optimum BMI in elderly persons should be between 24 and 29 kg/m. In addition, it is imperative to carry out a thorough nutritional assessment for each individual through strategies that include biochemical, anthropometric, dietary, clinical, immunologic factors, and clinical. An indicator of malnutrition can be analysed through assessment of weight loss and body weight (Catherine, Douglas, & Claire, 2011). Physical and historical examination is important and the examination should be based on psychosocial and pharmacologic factors (Wernette, White & Zizza, 2011). Moreover, standardised tools that are used for detecting depression and dementia are paramount in determining onset of these conditions (Elisabeth et al. 2012). Moreover, diagnostic work-up should be encouraged such as assessment of functional impairments, access to food, assistance needs and caloric intake (Tyrrell-Price, Hills & Varey, 2011). It is also important to evaluate functional and sight assessment of daily activities in order to determine functional impairments. Screens tests are also important for example complete blood count, urinalysis, liver and renal function tests, electrolytes, thyroid function tests, glucose, stool occult blood, calcium and chest radiography will ensure that the causes are detected or provide direction for further investigations (Bales & Ritchie, 2009). Other screening strategies such as lower and upper gastrointestinal endoscopies and barium studies may be carried out (Bourke & Rosario, 2011). The importance of these strategies is that they have high diagnostic yields and may be utilised in those scenarios that further tests are required after basic screening tests (Harrington, Gibson & Cottrell, 2009). 2.8 Treatment Acute stress levels in elderly persons prevent full regaining of weight loss (Elovainio et al. 2009). This means it is important to detect and provide appropriate attention to nutrition in those periods of acute illness (Davis et al. 2011). Treatment is based on understanding the cause of the situation and it is important to review any medication provided and sanction appropriate measures to counter the issues (Tyrrell-Price, Hills & Varey, 2011). In the management of unintentional weight loss, it is important to inform and utilise dietician and nutritional supplements (Elisabeth et al. 2012). These supplements should be provided between meals to increase its effectiveness. The elderly persons with unintentional weight loss may be deficient in vitamin supplements, mineral and micronutrients (Campbell & MacLaughlin, 2010). Multidisciplinary assessment is paramount ranging from oral health to psychological condition is invaluable (Ingram & Mussolino, 2010). Physical, speech and occupational therapists may play a major role provide the conditions contributing to weight loss are known (Tyrrell-Price, Hills & Varey, 2011). In addition, it is paramount to analyse social circumstances of an elderly person in terms of day care, assisted living, home health aides or depending on therapists’ assessment (Elisabeth et al. 2012). Moreover, it is important to treat some conditions such as depression since it contributes immensely in regaining appetite and intake. Improvement in intake and appetite can be achieved through encouraging physical exercise. 3.0 Research Questions and variables 1. How different genders experience unintentional weight loss (Males and females) a. Independent variable: Gender b. Dependent variable: Unintentional weight loss 2. How old are you a. Independent variable: Age b. Dependent variable: 3. How does unintentional weight loss affect the health of the elderly person a. Independent variable: Health b. Dependent variable: Unintentional weight loss 4. What is the relationship between unintentional weight loss and depression on an elderly person a. Independent variable: Depression b. Dependent variable: Unintentional weight loss 5. How is unintentional weight loss associated with physical nature of the patient a. Independent variable: Physical nature of the patient b. Dependent variable: Unintentional weight loss 3.1 Sub-questions and variables 1. What diseases are associated with unintentional weight loss a. Independent variable: Diseases b. Dependent variable: Unintentional weight loss 2. Does previous occupations affect unintentional weight loss a. Independent variable: Occupations b. Dependent variable: Unintentional weight loss 3.2 Significance of the research question Choosing research questions is the first approach in determining the success and credibility of any research study (Blessing & Chakrabarti, 2009). Appropriate research questions helps in obtaining the right information that contributes in reflecting on what is happening within the elderly care homes (McBurney & White, 2009). The information gathered will help in formulating and implementing policies that aids in ensuring that unintentional weight loss is mitigated. This will ensure that the last days of the elderly persons are cared for effectively. 4.0 Definition of concepts In any research, it is paramount to define the concepts and important terms that are used frequently on the paper. Thus, some of the concepts and definitions include: Elderly patient – this is a person who is more than 65 years and sick Care home/institution – this is a place where elderly people are placed and taken care off by specialised persons Depression – it is a condition that someone feels unhappy, feeling sad or miserable Unintentional weight loss – this is a decrease in body weight that does not take place voluntary Diseases – this is an abnormal condition that affects the body of an individual Physical conditions – physical condition may include ability to utilise an individual parts that ranges from the teeth to the legs Normal aging – this is the aging process that takes place during a person’s lifespan 5.0 Ethical Statement Human research is a sensitive topic and it possesses numerous issues ranging from confidentiality to risks associated with the research. Some of the values championed by National Health and Medical Research Council (2007) include research merit and integrity, human beings, beneficence and justice. The aim of this approach is to ensure that ethical equality, mutual responsibility and trust is encouraged in any research involving humans. Moreover, other important factors emphasised by the policy include respect for cultural diversity, contributing to community goals and altruism. These guidelines are crucial in ensuring that any research study is credible and is within the limits of law. In the case of the current research, the views and aspirations of National Health and Medical Research Council are encouraged. For example, participants will be informed in advance on what is supposed of them and the limits in which the information gathered will be utilised. This means that the elderly persons and the management of the institution will be involved in informing the elderly person and determine whether the participant accepts to proceed with the research. In addition, the participants will be requested to clarify whether they understand the questions, and all this is done based on confidentiality, respect and understanding the position the person is in. 6.0 Research Design Quantitative research will be used in carrying out the research (McBurney & White, 2009). The instrument that will be used will be a questionnaire because it has numerous benefits compared to other instruments. Questionnaires allow standardisation of information and objectivity of the participants in presenting their views. Moreover, utilisation of a questionnaire ensures that information is collected quickly and information can be received from a wide audience base. 7.0 Sampling Technique The aim of sampling is to select subset of participants that will represent a statistical population to estimate population characteristics (Blessing & Chakrabarti, 2009). Importance of sampling include faster data collection, lower cost and since the data collected will be small, it contributes to improvement on accuracy and homogeneity (Bales & Ritchie, 2009). In addition, sampling technique should factor the application of the information, and how the information will be utilised statistically. Regarding the research on unintentional weight loss in elderly home care, information will be collected from ten different elderly care homes (McBurney & White, 2009). From each of the homes, information will be collected from five participants. After compiling the information, the information will be analysed as a group rather than been specific to certain homes. This will ensure that information gathered reflects on conditions and characteristics of different homes. The information gathered will be analysed with the help Microsoft Excel software. The information will be presented in terms of tables, charts and graphs. This approach ensures that information can be synthesised easily by persons requiring utilising the information. 8.0 Questionnaire design The important point to be known so that an effective questionnaire can be designed is what the researcher wants to find out. The type of questionnaire utilised and the efficiency of the questionnaire itself determine the success of a research (Blessing & Chakrabarti, 2009). In creating a good questionnaire, it is important to analyse the purpose and structure of the questionnaire and also the wording of the questionnaire (Bales & Ritchie, 2009). It is important to understand the purpose of the questionnaire because a questionnaire is only good if the questions in it are good (McBurney & White, 2009). Moreover, it is important to know the usefulness of each question based on what the research aims to achieve. Thus, it is paramount to prioritise items on the questionnaire to ensure that the entire process is credibly. It is important also to understand and structure the questionnaire in a manner that the participants can understand it. The questionnaire should contain an introduction line that explains the purpose of the question and how the data collected will be utilised (Blessing & Chakrabarti, 2009). Questions should be structure according meaning the general questions should start and the questionnaires ends with questions that are specific to the research, and the questions should be grouped in terms of similarity (Bales & Ritchie, 2009). It is crucial to determine the type of questionnaire to be utilised: either open or closed questionnaire. The closed type of questionnaire has numerous disadvantages that may include bias and ineffective data collection process while an open questionnaire allows for objective information from the respondents because they are not limited to the views presented by the researcher (McBurney & White, 2009). Wording is also important in creating a good questionnaire. Wording of the questionnaire items is paramount to ensure ineffectiveness such as through bias in the questionnaire is avoided (McBurney & White, 2009). Moreover, in drafting the questionnaire, it is important to avoid technical or jargon terms that are unlikely to be understood by the respondents (Blessing & Chakrabarti, 2009). It is also important to avoid those questions that are ambiguous since the answers that will be received will not have any importance. Combination of questions, e.g. utilisation of and should be avoided in those questions that a research expects either a ‘yes’ or ‘no’ answers. In wording the question, it is important to avoid double negatives, leading question and avoid loaded questions. Loaded questions sometimes contain information that may make answers to be biased (Bales & Ritchie, 2009). In addition, it is important to allow the respondents to answer the questions in simple manner e.g. ticking an appropriate answer rather than deleting what does not apply. From the analysis, it is paramount to ensure that the purpose, structure and wording of a questionnaire should be easily understood and answers the research objective (McBurney & White, 2009). Thus, in formulating research questions and structuring the questionnaire, I ensure that I do not use words that are difficult to understand, questions that avoid biasness and leading. In addition, I ensured that the questionnaire is structured in a manner that is easy to follow and the questions on the questionnaire are effectively aimed at answering the research problem. 9.0 Pilot Study This is a small experiment/study designed to gather information or to test logistics before proceeding into a larger study (Blessing & Chakrabarti, 2009). The aim of pilot study is to ensure that efficiency and quality is improved on the actual research. Carrying out a pilot study helps in revealing deficiencies in the proposed procedure and it allows for correction of these weaknesses before proceeding with the actual research to avoid wastage of both resources and time (McBurney & White, 2009). To ensure that a study is successful, it is important to carry out a pilot study that allows for a good research strategy. A pilot study is smaller in comparison to the actual study. The information collected from a pilot study and because of its limited information on the magnitude and resources, capacity may provide minimal information on the study (McBurney & White, 2009). Before proceeding with a pilot study, it is important to review literature to allow for information that defines variability (Bales & Ritchie, 2009). Nevertheless, pilot study allows for collection of important information on the severity of aimed procedures. 9.1 Sample analysis I informed my friends that I aimed to carry out a research on factors contributing to unintentional weight loss in elderly persons who stay in elderly care homes or institutions. Five friends accepted to fill the questionnaire of which three were male and two were female. After they filled the questionnaire, I used the information collected to draft results. I would improve the research study through increasing the number of participants. Moreover, I could have expanded on the participants through not involving my immediate friends but also other participants whom could have accepted to fill the questionnaire. 9.2 Disadvantage and Advantage of Questionnaires Face-to -face approach allows an interviewer to identify the appropriate interviewee to complete the questionnaire. In addition, face-to-face questionnaires allow for a more detailed collection of information and it takes a shorter time to collect the required information (Blessing & Chakrabarti, 2009). Moreover, questionnaires are standardised meaning that information that is more objective can be gathered to fulfil the requirements of the research study. Face-to-face questionnaire ensures that validity and reliability is encouraged because any researcher can collect information easily (Bales & Ritchie, 2009). The disadvantage of face-to-face questionnaire is tome consuming, costly and other times labour intensive compared to other methods used for collecting information (McBurney & White, 2009). Moreover, utilisation of a questionnaire does not measure other forms of information that may include feelings, behaviour and changes of emotions. The participants may read the questions on the questionnaire and interpret them differently meaning that subjectivity is compromised. 9.3 Corrections for future research For future research, some changes are supposed to be made on the questionnaire. For example, I will draft the questionnaires and ask someone to assist me in refining the questions to ensure that both objectivity and subjectivity are championed. Utilising a second drafter means that framing and wording the questionnaire will be better compared to the original paper. In addition, I will increase the number of questions asked and I will determine the sequence in which the questions will be asked. Moreover, I will ensure that the different people from different backgrounds are requested to fill the questionnaire to ensure diversity is encouraged. I utilised my friends meaning that the information that they gave could be secretive and thus they could not have answered the questions objectivity (Bales & Ritchie, 2009). Sometimes, friends may hide some details and thus the information presented could miss some details. 10.0 Results Section 1: Demographics Figure 1: Gender representation Section 2: Result from survey Age (0-18) (19-35) (36-50) (51-65) (66 and above) Male 3 Female 2 5 Figure 2: Age of participants Strongly agree Agree Disagree Strongly disagree Male 1 2 Female 1 1 Total 1 3 1 Figure 3: Depression contribute to weight loss Strongly agree Agree Disagree Strongly disagree Male 2 1 Female 1 1 Total 3 2 Figure 4: Unintentional weight loss cause health issue Figure 5: Effect of teeth on consumption Strongly agree Agree Disagree Strongly disagree Male 1 1 1 Female 1 1 Total 1 2 2 Figure 6: Effects of drugs on unhealthy eating habits 11.0 Conclusion Unintentional weight loss is a common condition in elderly population. Thus, the report analysed the causes of unintentional weight loss in elderly care homes that resulted in numerous causes. Some of the causes analysed include depression, physical nature of the patient, health condition and normal aging. Moreover, diagnostic evaluation strategies have been discussed and treatment measures have been proposed. 12.0 References Bales, C., & Ritchie, C. (2009). Redefining Nutritional Frailty: Interventions for Weight Loss Due to Undernutrition. Nutrition and Health, 2, 1-26 Blessing, L., & Chakrabarti, A. (2009). DRM, a Design Research Methodology. London: Springer Bourke, L., & Rosario, D. (2011). Weight Loss and Exercise in Obese Older Adults. The New England Journal of Medicine, 364, 2466-2468 Bray, G. (2010). Obesity: Maintenance of weight loss: setting our goals higher. Nature Reviews Endocrinology, 6, 657-658 Campbell, K., & MacLaughlin, H. (2010). Unintentional Weight Loss Is an Independent Predictor of Mortality in a Hemodialysis Population. Journal of Renal Nutrition, 20(6), 414-418 Capuano, G., Pavese, I., Satta, F., Tosti, M., Palladino, A., Grosso,A.,& Palma, M. (2008). Correlation between anaemia, unintentional weight loss and inflammatory status on cancer-related fatigue and quality of life before chemo and radiotherapy. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 3(4), e147-e151 Catherine, W., Douglas, W., & Claire, Z. (2011). Signaling Proteins that Influence Energy Intake may Affect Unintentional Weight Loss in Elderly Persons. Journal of the American Dietetic Association, 111(6), 864-873 Chen, S., Peng, L., Lin, M., Lai, H., Hwang, S., & Chen, L. (2010). Evaluating probability of cancer among older people with unexplained, unintentional weight loss. Archives of Gerontology and Geriatrics, 50(1), S27-S29 Davis, I., Marek, S., Sridhar, S., Wilkins, T., & Chamberlain, S. (2011). Unintentional Weight Loss as the Sole Indication for Colonoscopy is Rarely Associated with Colorectal Cancer. Journal of the American Board of Family Medicine, 24(2), 218-219 Elisabeth, I., Judy, B., Merrilyn, B. & Michelle, M. (2012) Managing malnutrition: Identifying and treating unintentional weight loss in adults. Medicine Today, 13(3), 67-72. Elovainio, M., Shipley, M., Ferrie, J., Gimeno, D., Vahtera, J., Marmot, M., & Kivimaki, M. (2009). Obesity, unexplained weightloss and suicide: The original Whitehall study. Journal of Affective Disorders, 116(3), 218-221 Graser, A., Stieber, P., Nagel, D., Schäfer, C., Horst, D., Becker, CR. (2009). Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut, 58, 241-248 Harrington, M., Gibson, S., & Cottrell, R. (2009). A review and meta-analysis of the effect of weight loss on all-cause mortality risk. Nutrition Research Reviews, 22(1), 93-108 Ingram, D., & Mussolino, M. (2010). Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. International Journal of Obesity, 34, 1044-1050 McBurney, D., & White, T. (2009). Research Methods, 8th Ed. London: Cengage Learning McMinn, J., Steel, C., Bowman, A. (2011). Investigation and management of unintentional weight loss in older adults. British Medicine Journal, 342, d1732 National Health and Medical Research Council. (2007). National Statement on Ethical Conduct in Human Research 2007 - Updated 2009. Retrieved from http://www.nhmrc.gov.au/guidelines/publications/e72 Richman, E., & Stampfer, M. (2010). Weight loss and mortality in the elderly: separating cause and effect. Journal of Internal Medicine, 268(2), 103-105 Ritchie, C., Locher, J., Roth, D., McVie, T., Sawyer, P. & Allman, R. (2008). Unintentional Weight Loss Predicts Decline in Activities of Daily Living Function and Life-Space Mobility Over 4 Years Among Community-Dwelling Older Adults. The Journals of Gerontology, 63(1), 67-75 Tyrrell-Price, J., Hills, A., & Varey, A. (2011). Unintentional weight loss: Investigation of unintentional weight loss. British Medical Journal, 342, d2737 Wernette, C., White, B., & Zizza, C. (2011). Signaling Proteins that Influence Energy Intake may Affect Unintentional Weight Loss in Elderly Persons. Journal of the American Dietetic Association, 111(6), 864-873 Wu, J., Lin, M., Peng, L., Chen, L., & Hwang, S. (2011). Evaluating diagnostic strategy of older patients with unexplained unintentional body weightloss: A hospital-based study. Archives of Gerontology and Geriatrics, 53(1), e51-154 13.0 Appendix 13.1 Appendix A: Questionnaire The aim of this questionnaire is to gather information on what contributes to unintentional weight loss in elderly persons in care homes Please, tick the appropriate answer 1. What is your gender (Male) (Female) 2. How old are you? (Tick only one) (0-18) (19-35) (36-50) (51-65) (66 and above) 3. Do you think depression contributes to unintentional weight loss (Strongly agree) (Agree) (Disagree) (Strongly disagree) 4. Does unintentional weight loss cause health issues? (Strongly agree) (Agree) (Disagree) (Strongly disagree) 5. Does loss of teeth affect how someone can consume food (Strongly agree) (Agree) (Disagree) (Strongly disagree) 6. Do some drugs contribute to unhealthy eating habits? (Strongly agree) (Agree) (Disagree) (Strongly disagree) 13.2 Appendix B: Information sheet PARTICIPANT INFORMATION SHEET FOR TEACHERS TITLE: Research Study in Unintentional Weight Loss in Elderly Care Homes PURPOSE OF THE RESEARCH This is a request to participate in a study conducted by the university. The aim of the research is to investigate the causes of unintentional weight loss in elderly persons in elderly care homes/institution. The study also aims in formulating evaluation strategies and treatment of the condition. INVESTIGATORS Student No. 1 Student No. 2 Student No 3 METHOD AND DEMANDS ON PARTICIPANTS If you accept our invitation, you are requested to fill the questionnaire provided. Moreover, before proceeding with the questionnaire you will be asked to participate in a ten minute training whereby you will be advised on how to complete the questionnaire. In addition, you are requested to ask for assistances from the people who take care of you. POSSIBLE RISKS, INCONVENIENCES AND DISCOMFORTS Apart from the few minutes required to fill the form, we do not foresee any risks. Nevertheless, since the involvement is voluntary you may request to withdraw your contribution and information already presented will also be withdrawn. Taking this approach will not affect relationship between your and the investigators or any other party. ETHICS REVIEW AND COMPLAINTS The study has been analysed and reviewed by Human Research Ethics Committee of the university. However, if you have any complain or concerns, you are requested to inform the university. Thank you for your interest in this study. 13.3 Appendix B: Consent Form Research Ethics: Consent Form TITLE: Research Study in Unintentional Weight Loss in Elderly Care Homes Investigators Names Investigator 1 Investigator 2 Investigator 3 1. I accept that I have understood the information on the information sheet and I accept to fill the questionnaire 2. I understand that I participate in the research voluntary meaning I can withdraw without giving any reasons 3. I accept to participate on the above study --------------------------------------- ------------------------- --------------------------- Name of participant Date Signature --------------------------------------- -------------------------- ----------------------------- Name of Researcher Date Signature Read More