Possible contributing conditions

Focused approach

Fatigue

Depression, sleep apnea, CHF, COPD, anemia, hypotension, hypothyroidism, vitamin B12 deficiency

1. Conduct or request a medication review to assess for drugs that could be causing fatigue or weight loss, medication adherence, and proper medication administration (eg, inhalers)

2. On review of systems, ask about depression, sleep, appetite, weight loss, pain, and social isolation

3. On social history, ask about alcohol intake, financial concerns or difficulty making ends meet, and concerns of elder abuse

4. On examination, obtain supine and standing blood pressure, looking for overt or postural hypotension

5. Calculate the patient’s STOP BANG score (www.stopbang.ca) and refer for sleep study as appropriate

6. Order blood tests for CBC, calcium, albumin, TSH, and vitamin B12 and liver function tests. Consider echocardiography or pulmonary function testing if indicated by the overall clinical picture

Weight loss

Alcohol abuse, swallowing or oral problems, malabsorption, cholecystitis, low-salt/low-cholesterol diet, hyperthyroidism, hypercalcemia, hypoadrenalism, poverty, shopping and meal preparation problems, elder abuse, medication adverse effects