Failure to Thrive in the Geriatric Patient

Question 1

geriatric failure to thrive

Answer 1

Defined as:

• Ongoing State of Decline
• Multifactorial
• Chronic Concurrent Diseases
• Functional Disarray (Declining Activities of Daily Living, Impaired Instrumental Activities of Daily Living)

Question 2

costs of failure to thrive

Answer 2

o Prevalence Increases with Age
o High Morbidity and Mortality
o Cost of Medical Care of Patients who are Failing to Thrive Escalates

Question 3

How many elders are failing to thrive

Answer 3

o Community 5-35%
o Nursing Home 25-40%
o Hospital 50-60%

Question 4

Institute of medicine nutrition criteria for failure to thrive

Answer 4

o Weight Loss >5% of Baseline
o Anorexia
o Poor Oral Intake
o Consequences: Inactivity, Pressure Ulcers, Impaired Immunity, Increased Surgical Mortality

Question 5

contributing factors for failure to thrive

Answer 5

o Impaired Activities of Daily Living: Ambulation, Bathing, Eating, Dressing, Toileting
o Instrumental Activities of Daily Living
o Falls

Question 6

underlying physical issues

Answer 6

o	Chronic Heart Disease
o	Chronic Lung Disease
o	Dysphagia
o	GI: Reflux, Constipation
o	CANCER

Question 7

underlying neurological disease

Answer 7

o Parkinson’s
o Stroke
o Multiple Sclerosis
o ALS

Question 8

psychological factors

Answer 8

o DEPRESSION
o Dementia
o Delirium
o Chronic Mental Illness: Schizophrenia, Bipolar Disorder, Paranoid Disorders

Question 9

medications for failure to thrive

Answer 9

o Any Rx can cause Failure to Thrive
o Major Culprits: Psychotropics: Anticholinergics: Antidepressants
o Over the counter
o Alternative nutritional supplements

Question 10

failure to thrive work up

Answer 10

o Complete, comprehensive history and physical examination
o Mental Status Screening
o Depression Screening
o Functional Status Screening
o Medication Review: Prescription, Nonprescription

Question 11

Tests for failure to thrive

Answer 11

• CBC = Anemia, Infection
• CMP = Malnutrition, Renal Failure, Dehydration
• ESR, C-Reactive Protein = Inflammation
• CXR = Infection, Neoplasm, TB
• PPD = TB

Question 12

acute onset of failure to thrive

Answer 12

o Infections: Urinary Tract Infection, Pneumonia, HIV, Tuberculosis
o New Medication
o Unable to Afford Rx
o Elder Abuse/Neglect

Question 13

acute onset underlying chronic disease

Answer 13

o Change of Status: Diabetes, COPD, Bowel “Problems”, Dehydration, Electrolyte Disturbance

Question 14

frailty requirements

Answer 14

Frailty: Three of Five

• Weight Loss (unintentional)
• Self-reported Exhaustion
• Weakness (Decreased Grip Strength)
• Slow Walking Speed
• Low Physical Activity

Question 15

failure to thrive chronic disease

Answer 15

o	Anemia
o	Cirrhosis
o	Impaired Renal Function
o	Congestive Heart Failure
o	Chronic Obstructive Pulmonary Disease
o	Thyroid Disease
o	Arthritis

Question 16

failure to thrive: cancer

Answer 16

o Before Diagnosis: “Dwindles”, “Poorly”, “Weak”, “Wind out of my sails”
o Beware anger if cancer diagnosis is delayed
o Treatment Induced Failure to Thrive: Chemotherapy, Radiation, Alternate Therapies
o Interventions: Psychological, Dietitian, Spiritual

Question 17

failure to thrive and dementia

Answer 17

o Anticipated or Additional Disease?

o Health Care Decision Making: POLST, Ethics Committee, The “Solo” Elderly

Question 18

failure to thrive and dementia interventions

Answer 18

• Treat underlying depression
• Appetite stimulants
• Support “slow eating”
• Nutritional supplements
• Tube Feeding