• Failure-to-Thrive—Adult

    Definition

    Failure-to-thrive is a state of decreasing mental and physical abilities. It leads to a decrease in overall health. It often includes a combination of:
    • Poor nutrition
    • Decreased mobility
    • Depression
    • Mental impairment

    Causes

    Failure-to-thrive is caused by a blend of issues. It can be a different combination for each person. Chronic health problems often play a role.
    For example, mental and physical health challenges can make it hard for some to have a proper diet. A poor diet can then make the chronic condition and overall health worse.

    Risk Factors

    Failure-to-thrive is most common in older adults.
    Factors that increase the risk of failure-to-thrive include:
    • Having more than one chronic disease
    • Certain medications
    • Physical or cognitive limitations
    • Social isolation
    • Limited income
    The Brain
    IMAGE
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    Symptoms

    Symptoms may include:
    • Loss of appetite
    • Poor mental functioning
    • Weight loss
    • Decreased activity
    • Increased fatigue
    • Depression

    Diagnosis

    You will be asked about your symptoms, medical history, and diet. A physical exam will be done. A mental health exam may also be done.
    Tests may be done to look for conditions that may be causing problems.
    Fluids can be tested with:
    • Blood tests
    • Urine tests
    Images of internal structures may be taken with:
    • X-rays
    • CT scan
    • MRI scan
    It may take some time to find all the issues that are causing the problem.

    Treatment

    Treatment will depend on the cause or causes. Treatment may include:

    Treating Current Conditions

    Current treatments may need to be changed to better manage chronic conditions.
    If the treatment itself is causing failure-to-thrive, the plan will be changed.

    Dietary Changes

    Diet plays a large role in failure-to-thrive. A dietitian can help with meal planning and solutions for those having difficulty eating. Nutritional supplements may also help to improve nutrition.

    Supportive Therapy

    Supportive therapies may include:
    • Social workers can recommend services to help with shopping, meals delivery, and home care.
    • Physical therapy may help with mobility issues.
    • Mental health counseling can help manage mental health conditions linked to failure-to-thrive.

    Medications

    Anti-depressant medications may be prescribed to reduce depression.

    End-of-Life Care

    Sometimes failure-to-thrive is the end stage of a condition. It is important to talk to your doctor about advance directives. These formal documents can help guide medical care in case you are unable to direct your care. It may change medical care from trying to address failure-to-thrive to focusing on comfort only. Formal documents to help support your wishes include a living will and medical power of attorney.

    Prevention

    Managing chronic conditions may help reduce the risk of failure-to-thrive. Support systems for those with chronic health issues may also help alert everyone to negative changes quicker than if there was no system in place.

    RESOURCES

    Family Doctor—American Academy of Family Physicians http://www.hc-sc.gc.ca

    National Institute on Aging https://www.nia.nih.gov

    CANADIAN RESOURCES

    The College of Family Physicians of Canada http://www.cfpc.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    Evans C. Malnutrition in the elderly: a multifactorial failure-to-thrive. Perm J. 2005 Summer;9(3):38-41. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396084. Accessed August 1, 2016.

    Kumeliauskas L, Fruetel K, et al. Evaluation of older adults hospitalized with a diagnosis of failure-to-thrive. Can Geriatr J. 2013;16(2):49-53. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671012. Accessed August 1, 2016.

    Roberton R, Montagnini M. Geriatric failure-to-thrive. Am Fam Physician. 2004 Jul 15;70(2):343-350. Available at: http://www.aafp.org/afp/2004/0715/p343.html. Accessed August 1, 2016.

    Sarkisian C, Lachs M. “Failure-to-thrive” in older adults. Ann Intern Med. 1996;124(12):1072-1078. Available at: http://annals.org/article.aspx?articleid=709734. Accessed August 1, 2016.

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