Failure to Thrive Flashcards
Define Frailty
State of age-related physiologic vulnerability resulting from impaired homeostatic reserve & a reduced capacity to withstand stress
-Syndrome that results from a multi-system reduction in reserve to the extent that a number of physiological systems are close to or past the threshold of symptomatic clinical failure
Characteristics of Frailty
Extremes of old age
Unstable disability
Function fluctuates with minor stressors
Multiple chronic diseases and/or geriatric syndromes
Important Questions for Osteoporotic Fractures
Weight loss of 5+% over 2 years
Inability to stand 5 times without help from arms
Negative response to “do you feel full of energy”
Outcome Risks of Frailty
Falls Acute illness Hospitalizations Disability Dependency Institutionalization Death
Key Components of Frailty
Musculoskeletal function
Cognitive/integrative neurological function
Nutritional reserve: maintaining weight
Aerobic capacity
Signs/Symptoms of Frailty
Weight loss or malnutrition Decreased muscle mass Decreased bone mass Anemia Weakness Fatigue Anorexia Inactivity
Contributing Factors to Frailty
Heavy drinking Cigarette smoking Physical inactivity Depression Social isolation Multiple chronic medical problems Poor perceived health
Events that May Trigger Frailty
Chronic disease
Inactivity
Infection
Hip fracture
Evens that May Block Recovery Time
Depression medication interactions Malnutrition Fear of falling Underlying cognitive status Underlying functional status
Define Failure to Thrive
Near irreversible end of the natural history of the syndrome of frailty
What does failure to thrive mean?
Stop eating Immobile Losing muscle mass & weight Stiff Going down hill Depressed Not taking medications
What is the pathogenesis of failure to thrive?
Progression of aging with organs & medical problems getting worse
What are the signs & symptoms of failure to thrive?
Weight loss Loss of muscle mass Increased weakness Increased ability to walk steadily Increasing SOB due to CHF or COPD HTN
H&P & Failure to Thrive
Decreased ROM & strength Mini mental exam Heart Lungs Abdomen Senses
Labs for Failure to Thrive
CBC
CMP
TSH
Treatment for Failure to Thrive
Ensure
Social support
Evaluate for depression
Components of Failure to Thrive
Physical frailty
Disability
Impaired neuropsychiatric function
National Institue of Aging Definition of Failure to Thrive
Syndrome of weight loss, decreased appetite, poor nutrition, & inactivity often accompanied by dehydration, depressive symptoms, impaired immune function, & low cholesterol
Define Disability
Difficulty or dependency in completing tasks essential for self-care & independent living
Objective Assessment of Disability
ADLs
IADLs
Katz Index of Independence in ADLs
Bathing Dressing Toileting Transferring Continence Feeding
Lawton IADLs Scale
Ability to use telephone Shopping Food preparation Housekeeping Laundry Mode of transportation Responsibility for own medications Ability to handle finances
Impaired Neuropsychiatric Function
Delirium
Depression
Dementia
What can impaired neuropsychiatric function result from & contribute to?
Result of medical co-morbidities
Medication effects
Contribute to development of disability, malnutrition, & frailty
Sarcopenia & Failure to Thrive
Contributor to failure to thrive Loss of muscle with age Loss of lean body mass Diminishes the acute phase response to physiological stress Decreases immune competence
Signs & Symptoms of Failure to Thrive
Impaired physical functioning
Malnutrition
Depression
Cognitive impairment
3 Criteria of the Working Definition of Failure to Thrive
Biopsychosocial failure
Weight loss or undernutrition
No immediate explanation for the condition
Underlying Principles of Failure to Thrive
Baseline data is the foundation of elder care
Function declines at a variable rate predictably over time
Occur from organic or non-organic causes
History for Failure to Thrive
Provided by patient and CAREGIVER
Helps with onset of condition & uncovering potential triggers
Drug review: prescriptions, OTC, ETOH
Psychosocial history: increases memory loss, change in social structure
Physical for Failure to Thrive
R/O infection, constipation, exacerbation of chronic diseases (CHF, COPD, CAD, CA, TB, uncontrolled endocrine disorder, dementia, depression) Vitals HEENT JVD Breast mass Abdominal exam Skin Motor Mental status Labs: CBC, CMP, Albumin & cholesterol, TSH, fecal occult blood, U/A, Vitamin B12 & D levels, ESR, PPD
Importance of CBC in Failure to Thrive
Anemia
Vitamin deficiency
Infection
Hematopoietic or lyphoprolieferative disorder
Importance of CMP in Failure to Thrive
Hyper/hyponatremia Acid-base disorder Osmolality Renal function Dehydration Diabetes Hypoglycemia LFTs
Assessment & Plan for Failure to Thrive
Assess life expectancy
Symptoms/conditions reversible
Risk/benefit assessment
Provider, patient, & family collaboration
Palliative measures initiated
Maintain therapeutic relationship with patient & family
Team Approach to Failure to Thrive
Address advance directives
Medication reconciliation
Consultation with PharmD
Social services
Caregiver education & support/respite
Concerns about abuse/neglect discussed openly & frankly
Nutritional consult
