Adult failure to thrive Flashcards
What three things are needed to be categorized as failure to thrive?
Disability
Impaired neuropsych function
Physical frailty- needs to be present
Frailty
need 3 or more
malnutrition- weight loss exhaustion weakness slow walking speed decreased physical activity
SOF scale (study of osteoporotic fractures)
need 2/3
weight loss > 5% over 2 years
inability to stand from chair 5x without using arms to push up
No to “do you feel full of energy?”
Weight loss
goal is 24-29kg/m2
Cachexia
catabolic state- burning of a lot of calories- seen in end-stage diseases
characteristics- anorexia, weight loss, inflammation, and insulin resistance
nutrition does not help
Sarcopenia
loss of muscle mass that occurs with aging
Disability
independent risk for
mortality, hospitalization, and need for long term care
Neuropsychiatric impairment
delirium
depression
dementia
delirium
acute cognitive decline, different from baseline that results from different factors (illness, hospitalization)
rapid fluctuate over the course of day days to weeks intermittent disorientation LOC- fluctuates sleep/wake cycle- reversed
depression
cause of AFTT
slow stable- new baseline years persistent disorientation LOC- alert and stable sleep/wake cycle- fragment
Geriatric depression scale
1-5 normal
4-10 mild depression
10-15 depression
NOTE: xerostomia
dry mouth
NOTE: odynophagia
painful swallowing
Labs to consider for geriatrics
CBC CMP UA TSH vit B12 and folate levels albumin and total cholesterol (malnutrition marker) vit B level
Consultants for geriatrics
speech therapy
dietician
PT
OT
Tx
discuss goals of care multidisciplinary approach optimize chronic illness management eliminate unnecessary medications - BEERS criteria
Tube feeding
does not have a survival benefit compared to hand feeding in those with severe cognitive impairment
Appetite stimulants
not approved or recommended
have significant s/e
megestrol acetate (megace) dronabinol (marinol)
megestrol acetate (megace) (FTT)
appetite stimulants
negatives- increase CHF, edema, thrombotic events, death
dronabinol (marinol) (FTT)
appetite stimulants
for weight
negatives- sedation, fatigue, hallucinations
tx for frailty (FTT)
exercise (PT)
calorie and protein support
vitamin d supplementation (for bone mineral density)
reduction of polypharmacy
tx for dementia (FTT)
meds- aricept, namenda (see dementia lecture for full meds)
social intervention
hospice- if dementia is severe
tx for depression
remeron (also increases appetite and weight gain)
Avoid what medications for depression? (FTT)
zoloft, prozac, wellbutrin- (antidepressants)
cause anorexia & weight loss more than others
