Geriatric Failure to Thrive Overview Key Points

1 Geriatric Failure to Thrive Overview The Institute of Medicine s 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. Key Points Geriatric FTT describes a state of decline that is multi-factorial. Possible causesinclude but are not limited to concurrent diseases and functional impairments. Geriatric FTT can be a terminal condition which qualifies a patient for hospice care. Geriatric FTT is key decision point in the care of an elderly person. The diagnosisshould prompt discussion of end-of-life care options to prevent needlessinterventions that may prolong suffering. Common medical conditions associated with FTT:oCancer metastasesoChronic lung diseaseoCirrhosisoMental health illnesses depression, psychosisoCardiovascular disease myocardial infarction, congestive heart failureoInfectionsoRheumatologic diseaseoInfections chronic, tuberculosis, recurrent urinary tract infections, recurrentpneumonia Medications associated with FTT.

2 OAnticholinergic drugsoAntiepilepticoBenzodiazepinesoBeta -blockersoCentral alpha antagonistsoGlucocorticoidsoOpioidsv2 Etiology Ali (2015) suggest remembering eleven D words Diseases (medical illnesses) Dementia Delirium Drinking alcohol, other substance misuse Drugs Dysphagia Deafness, blindness, other sensory deficits Depression Desertion by family, social isolation Destitution (poverty) Despair (giving up) Assessment A complete work up for Geriatric FTT should include: evaluate the physical and psychological health of the patient assess physical health with tools such as the Get Up and Go Test the Geriatric Depression Scale or Cornell Scale for Depression in Dementia can be used to assess psychological health assess functional ability complete medication review o look for drug side effects or drug interactions o cross check medications with the Beers criteria for potentially inappropriate medications in the elderly assess socio-environmental factors assess the impact of existing chronic diseases and nutrition o The Mini Nutritional Assessment is a validated tool for assessing nutritional risk in the elderly and is easy to administer Laboratory and radiologic evaluations are limited to complete blood count, chemistry panel, thyroid-stimulating hormone levels, urinalysis.

3 Other studies appropriate for an individual patient (see Robertson and Montagnini, 2004). Diagnosis/Intervention FTT leads to an increase in morbidity and mortality. Diagnosis of FTT should prompt end-of-life care options to prevent burdensome interventions that may cause/prolong suffering. Medical intervention will depend on the older adult s plan of care and the etiologies contributing to the diagnosis. Interventions should be directed toward easily treatable causes of FTT with the goal to maintain or improve overall functional status. However, in selected patients based upon the patient's clinical picture and patient's preferences, the goal is to control symptoms, patient/family support at the end-of-life, and to forgo aggressive, life-prolonging, burdensome medical evaluation and treatment. References Ali, N. (2015). Failure to Thrive in Elderly Adults.

4 E-Medscape. Accessed April 6, 2016 Bogardus Jr, S. T., Bradley, E. H., Williams, , Maciejewski, , van Doorn, C, & Inouye, (2001). Goals for the care of frail older adults: do caregivers and clinicians agree? The American Journal of Medicine, 110(2), 97-102 Fink, , Cooper, , Wade, et al (2003). Updating the Beer's criteria for potentially inappropriate medication use in older people. Archives of Internal Medicine, 163:2716-2724. Mini Nutritional Assessment (1998). Nestle Research Center. Nestle Cl inical Nutrition. Available at , R. G., & Montagnini, M. (2004). Geriatric Failure to Thrive . American Family Physician, 70 (2): 343-350. Sarkisian, , & Lachs, (1996). " Failure To Thrive " in Older Adults. Annals of Internal Medicine, 124(12):1072-1078. Sheikh, & Yeavage, (1986). Geriatric Depression Scale (Short Form). Clinical Gerontology, 5:165.

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