Failure to thrive in the elderly is a syndrome and not a diagnosis. According to the institute of medicine, failure to thrive symptoms include. Geriatric failure to thrive in this issue, shum et el1 studied the prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Geriatric failure to thrive ftt is a serious issue that affects between 5% and 35% of communitydwelling seniors and between 25% and 40% of residents who are living in nursing homes. I believe that sarkisian and lachs 1 too readily discount an important value in the concept of failure to thrive in the elderly. We became interested in this topic after encountering many older patients who had received a diagnosis of failure to thrive. Geriatric failure to thrive american family physician. This condition is not simply part of the aging process and can often lead to death. Failure to thrive, a syndrome better known in the world of pediatrics, refers to the physical and emotional deprivation that signifies a deficiency in growth and healthy functioning. The term failure to thrive has recently been applied to the elderly braun, 1988, with particular reference to weight loss and malnutrition hazzard, 1990, to what is considered a downward.
By the last half of the 20th century, mainstream thinking held that ftt developed by one of two alternative mechanisms. The cause may be an identified medical condition or may be related to environmental factors. Ftt is a longterm condition and your child may continue to. A baby who has failed to thrive may seem slow to develop physical skills, such as rolling over, standing, and walking.
Recently it has appeared in the medical literature in relation to malnutrition, weight loss and depression. An elderly person experiencing a failure to thrive may refuse to take their medication, aggravating their medical problems. Chromosome abnormalities, such as down syndrome and turner syndrome. Dec 03, 2015 failure to thrive in elderly persons is defined by the institute of medicine as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, immune dysfunction, and low cholesterol. The diagnosis should prompt discussion of endoflife care options to prevent needless interventions. While many anthropometric standards have been employed to define growth, bmi, weight, or weightforheight zscores, serially comparing a child to appropriate standard growth curves is now commonly employed. I believe that sarkisian and lachs too readily discount an important value in the concept of failure to thrive in the elderly. The prevalence of failure to thrive is unclear, but it appears to be common in the aging population. Hospital care, including the use of feeding tubes, can provide extra nourishment in severe cases. Failure to thrive is defined by the institute of medicine as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, immune dysfunction, and low cholesterol.
Dec 02, 2016 failure to thrive is an interruption in the normal pattern of growth, usually seen in younger children. But in some cases, elderly individuals may be experience a more distinct state of decline known as adult failure to thrive. Dec 14, 2012 an elderly adult whose health is severely debilitated, and with a failure to thrive life expectancy of 6 months or less, may be admitted to hospice. Jun 03, 20 the prevalence of failure to thrive is unclear, but it appears to be common in the aging population. Geriatric failure to thrive gftt is a syndrome associated with functional decline, depression and malnutrition. Rather than being a diagnosis that stigmatizes older patients, it should raise the concerns of physicians and caregivers as it does when a child is so labeled. Failure to thrive is a term used to describe a child who seems to be gaining weight or height more slowly than other children of his or her age and sex. Hospital care, including the use of feeding tubes, can. Failure to thrive symptoms, diagnosis and treatment. Functional abilities which are essentially the capacity to perform self.
Failure to thrive is a common diagnosis in geriatrics. The concept failure to thrive ftt has been in the pediatric and child developmentchild psychiatry literature for many years. When failure to thrive has a connection to problems at home, your doctor may consult social services. Dependent patients and those from a residential setting were particularly at risk. In some circumstances, the diagnosis is given upon initial evaluation of a patient in decline who has subsequent identification of a treatable illness eg, depression, grief, thyroid disorder. The condition requires a comprehensive evaluation as both medical and psychosocial problems may contribute. Residents of skilled nursing facilities are at special risk. He may also have memory loss, trouble thinking, and trouble with daily activities. Many people dont know that older adults can be admitted to hospice care following an afft diagnosis, but it can be a great option for care and increased comfort.
It is caused by physical and psychological impairments that over time, slowly decrease an individuals functional abilities. Geriatric failure to thrive is not one particular disease or condition, but a state of decline in overall health that may be caused by chronic concurrent diseases and functional impairments. As it pertains to the geriatric population, adult failure to thrive aftt or failure to thrive in. The institute of medicines definition of geriatric failure to thrive ftt is a syndrome manifested by weight loss greater than 5% of baseline, decreased appetite, poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol levels. Malnutrition was a common occurrence and associated with increased mortality. It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.
The term was borrowed from pediatrics in the 1970s to describe a similar syndrome that affected geriatric patients. The icd9cm codes for adult failure to thrive for billing purposes are as follows. He may not be interested in other people or social activities. Offer healthy snacks and nutritional supplements between meals. Failure to thrive ftt is a familiar diagnosis to those working with pediatric patients. Geriatric failure to thrive is a diagnosis commonly used in geriatrics, and the four chief characteristics are impaired physical function, malnutrition. Jul 25, 2012 when failure to thrive has a connection to problems at home, your doctor may consult social services. Geriatric failure to thrive overview the institute of medicines definition of geriatric failure to thrive ftt is a syndrome manifested by weight loss greater than 5% of baseline, decreased appetite, poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol levels. Evaluation of older adults hospitalized with a diagnosis of. This article focuses on the relationship among the problems of malnutrition, depression, confusional states, and its role in failure to thrive ftt in the elderly. Failure to thrive in older adults annals of internal. Failure to thrive ftt happens when an older adult has a loss of appetite, eats and drinks less than usual, loses weight, and is less active than normal. Failure to thrive in elderly persons is defined by the institute of medicine as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, immune dysfunction, and low cholesterol.
Fried and others published frailty and failure to thrive find, read and cite all the research you need on researchgate. Failure to thrive ftt is a term used to describe a gradual decline in physical andor cognitive function of an elderly patient, usually accompanied by weight loss and social withdrawal, that occurs without immediate explanation. Feb 03, 2020 failure to thrive ftt is when your child does not gain weight or grow as fast as he should. Reviewing the medical literature, we discovered that failure to thrive is a complex construct derived from many overlapping bodies of literature. Failure to thrive symptoms, diagnosis and treatment bmj. In children, it is usually defined in terms of weight, and can be evaluated either by a low weight for the childs age, or by a low rate of increase in the weight. Ftt is a longterm condition and your child may continue to need treatment and monitoring as he grows up. Failure to thrive ftt is a term used to describe a gradual decline in physical andor cognitive function of an elderly patient, usually accompanied by weight loss and social withdrawal, that. Failure to thrive ftt merck manuals professional edition. The united states national institute of aging described ftt as a syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol. Failure to thrive is not a single disease or medical condition.
In elderly patients, failure to thrive describes a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments. Failure to thrive ftt indicates insufficient weight gain or inappropriate weight loss in pediatric patients unless the term is more precisely defined. Revisiting geriatric failure to thrive request pdf. Ftt in older adults may represent a final common pathway toward. Geriatric failure to thrive may be caused by a single, medical condition but in most cases, there are multiple issues, some treatable and some not. Adverse drug reactions are cited as one of the most common causes of gftt. Consider this diagnosis if the frail elderly patient has. Failure to thrive syndrome among older persons nih guide, volume 21, number 42, november 20, 1992 pa. An elderly adult whose health is severely debilitated, and with a failure to thrive life expectancy of 6 months or less, may be admitted to hospice.
Standardizing inpatient failure to thrive management darren fiore, md with input from steve wilson, md, arpi bekmezian, md, and karen sun, md hospital medicine, helen sang, otr occupational therapy, and hanna kirsch, rd registered dietician discussed and approved by consensus at phm division meeting 129 1. Standardizing inpatient failure to thrive management. Undesired weight loss and malnutrition in the elderly are significant problems, leading to increased morbidity and mortality. Evaluation of older adults hospitalized with a diagnosis. Failure to thrive in older adults what you need to know. Mar 01, 2011 failure to thrive ftt or growth failure has long been a major focus of attention and critical thought for pediatricians. A retrospective study of 82 elderly failure to thrive ftt inpatients suggests that ftt is diagnosed when the elderly patients functional ability to live with multisystem diseases, cope with. Approach to elderly patients with failure to thrive robert lam, md ccfpcoe, fcfp care of the elderly physician, geriatric rehabilitation program, toronto rehabilitation institute. To illustrate the danger of failure to thrive in the older population, consider the following examples. It encompasses a number of conditions characterized by progressive weight loss and decrease in function. Failure to thrive ftt is when your child does not gain weight or grow as fast as he should. Failure to thrive discharge care what you need to know. As it pertains to the geriatric population, adult failure to thrive aftt or failure to thrive in the elderly is a diagnosis that signals significant. Identifying this syndrome is challenging and often clinicians will confuse failure to thrive with the normal aging process.
There are multiple medical causes of failure to thrive. Failure to thrive is weight consistently below the 3rd to 5th percentile for age and sex, progressive decrease in weight to below the 3rd to 5th percentile, or a decrease in the percentile rank of 2 major growth parameters in a short period. How to help prevent failure to thrive in older adults. Approach to elderly patients with failure to thrive. Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity. Unexplained weight loss resulting in a body mass index bmi of 22 kgm2 or less, and. Two distinct drugrelated issues should be considered. Failure to thrive ftt or growth failure has long been a major focus of attention and critical thought for pediatricians. Aginggerontology nutritiondietetics depression immunology pathophysiology national institute on aging national institute of mental health purpose recently, a geriatric syndrome termed failure to thrive has been described, consisting of weight loss. Failure to thrive is not classified as a singular disease but instead refers to a manifestation of combined underlying physical, psychosocial, andor mental conditions. Geriatric failure to thrive geriatric failure to thrive is a complex condition that affects millions of the elderly. Elder care a diagnostic model for failure to thrive. In evaluation of a child with ftt, the diagnostic efforts should be directed toward determining whether the child has one or a combination of the following factors contributing to the etiology. Over many years, consensus has evolved about its cause, outcome, diagnosis, and management.
For purposes of diagnosis and treatment, failure to thrive can be divided into nonorganic and organic causes. Failure to thrive in older adults is a serious condition that affects up to 35% of older adults in general, up to 40% of nursing home patients, and up to 60% of hospitalized veterans. The diagnosis of failure to thrive ftt requires a careful assessment of growth parameters weight, lengthheight, and head circumference over time. Jul 15, 2004 in elderly patients, failure to thrive describes a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments. Failure to thrive ftt is a somewhat confusing term that has been used to describe patients with varied clinical scenarios.
Use of this term as it applies to older adults fttoa is still a relatively new concept in gerontology. Associate professor, department of family medicine, university of toronto. The role of medications in geriatric failure to thrive. Use herbs, spices, and flavor enhancers to add flavor to foods. Failure to thrive may result from a variety of organic and nonorganic causes for a combination of both. Certain elderly patients develop failure to thrive for reasons that are not clearly understood, but the prevalence of the problem seems to increase with age.
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