Adult failure to thrive

Question 1

What three things are needed to be categorized as failure to thrive?

Answer 1

Disability
Impaired neuropsych function
Physical frailty- needs to be present

Question 2

Frailty

Answer 2

need 3 or more

malnutrition- weight loss
exhaustion 
weakness 
slow walking speed 
decreased physical activity

Question 3

SOF scale (study of osteoporotic fractures)

Answer 3

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?”

Question 4

Weight loss

Answer 4

goal is 24-29kg/m2

Question 5

Cachexia

Answer 5

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

Question 6

Sarcopenia

Answer 6

loss of muscle mass that occurs with aging

Question 7

Disability

Answer 7

independent risk for

mortality, hospitalization, and need for long term care

Question 8

Neuropsychiatric impairment

Answer 8

delirium
depression
dementia

Question 9

delirium

Answer 9

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

Question 10

depression

Answer 10

cause of AFTT

slow 
stable- new baseline 
years 
persistent disorientation 
LOC- alert and stable 
sleep/wake cycle- fragment

Question 11

Geriatric depression scale

Answer 11

1-5 normal
4-10 mild depression
10-15 depression

Question 12

NOTE: xerostomia

Answer 12

dry mouth

Question 13

NOTE: odynophagia

Answer 13

painful swallowing

Question 14

Labs to consider for geriatrics

Answer 14

CBC
CMP 
UA 
TSH 
vit B12 and folate levels 
albumin and total cholesterol (malnutrition marker) 
vit B level

Question 15

Consultants for geriatrics

Answer 15

speech therapy
dietician
PT
OT

Question 16

Tx

Answer 16

discuss goals of care 
multidisciplinary approach 
optimize chronic illness management 
eliminate unnecessary medications 
- BEERS criteria

Question 17

Tube feeding

Answer 17

does not have a survival benefit compared to hand feeding in those with severe cognitive impairment

Question 18

Appetite stimulants

Answer 18

not approved or recommended
have significant s/e

megestrol acetate (megace) 
dronabinol (marinol)

Question 19

megestrol acetate (megace) (FTT)

Answer 19

appetite stimulants

negatives- increase CHF, edema, thrombotic events, death

Question 20

dronabinol (marinol) (FTT)

Answer 20

appetite stimulants
for weight
negatives- sedation, fatigue, hallucinations

Question 21

tx for frailty (FTT)

Answer 21

exercise (PT)
calorie and protein support
vitamin d supplementation (for bone mineral density)
reduction of polypharmacy

Question 22

tx for dementia (FTT)

Answer 22

meds- aricept, namenda (see dementia lecture for full meds)
social intervention
hospice- if dementia is severe

Question 23

tx for depression

Answer 23

remeron (also increases appetite and weight gain)

Question 24

Avoid what medications for depression? (FTT)

Answer 24

zoloft, prozac, wellbutrin- (antidepressants)

cause anorexia & weight loss more than others

Question 25

FTT prognosis

Answer 25

death
palliative care
hospice care