Often, someone with AFTT also shows signs of depression , dehydration, poor immune function, low cholesterol, and sometimes, impaired physical or cognitive function. A diagnosis of failure to thrive in elderly adults can be incredibly frustrating. The good news is that there are steps you can take to help battle AFTT. A failure to thrive in adults treatment plan may include:.
An elderly adult whose health is severely debilitated, and with a failure to thrive life expectancy of 6 months or less, may be admitted to hospice. Under hospice care, some patients actually improve enough to no longer need the hospice team. To find out if hospice care might be the best choice for your loved one, ask their doctor. Do you have a loved one who has been diagnosed with AFTT? Diet Changes A dietitian can help with meal planning and food choices.
Supportive Therapy Supportive care may be: Social workers who can suggest local services to help with shopping, meal delivery, and home care Physical or occupational therapy to help with movement Mental health counseling to talk about emotions Medications Medicine may be given for depression. End-of-Life Care Failure-to-thrive may be the end stage of an illness. Prevention Get medical help for problems staying on a care plan for a chronic health problem.
Cornell, MD Cancer Care. Emergency Services. Cesarean Birth. Imaging Services. High Blood Pressure. Laboratory Services. Maternity Services. Hip Replacement. Primary Care. Type 2 Diabetes. Surgical Services. Home Care. Support Groups. Hospice care is available at home, in a nursing facility or hospital.
Regardless of the setting, hospice patients may continue treatments for conditions not related to their terminal illness. For example, a patient with diabetes can get checkups and diabetes medication covered by Medicare or other insurance. Failure to thrive requiring significant caregiver support.
Hospice care at home can be challenging, but patients and families have the full support of our hospice team. If your loved one decides to enter home hospice, our promise is to support you and your family along every step of the journey.
Unintended weight loss Loss of appetite Trouble thinking or unexpected memory loss, especially if they affect the tasks of daily living Depression or despair Chronic infections as a sign of weakening immune system Trouble swallowing.
Therefore, screening for depression is necessary for all patients who exhibit characteristics of failure to thrive. Traditional signs of depression in young persons, such as changes in attention span, concentration, and memory, are often misdiagnosed in elderly persons as dementia. Depression that occurs for the first time late in life is frequent in patients with significant chronic disease; the impact of these medical conditions is increased by depression.
The Geriatric Depression Scale Figure 1 18 and the Cornell Scale for Depression in Dementia 19 are useful tools for assessing this dynamic in patients with failure to thrive.
Clin Gerontol ;— Malnutrition is an independent predictor of mortality in older adults. The most accurate evidence of malnutrition in an elderly patient is hypocholesterolemia and hypo-albuminemia. Body weight, weight trend, and muscle wasting that is found on physical examination and confirmed by laboratory data such as serum albumin and total cholesterol levels, and lymphocyte count should be included. Treatment of failure to thrive should focus on identifiable diseases and be limited to interventions that have few risks for these frail patients.
A team approach that includes a dietitian, a speech therapist, a social worker, a mental health professional, and a physical therapist may be helpful. Algorithm for the diagnosis and management of elderly patients with failure to thrive. Information from reference Resistive and strength testing have shown promise in patients with nearly all physical conditions and resulted in increased muscle strength even in elderly, deconditioned patients living in nursing homes.
Nutritional supplementation is one of the most important interventions in patients with failure to thrive. Insufficient food intake in elderly patients may be corrected or ameliorated by manipulation of nonphysiologic factors, such as the number of people present at meals, the palatability of meals, and the time of day and location of meals. The mainstay of treatment of major depression in patients with failure to thrive should be antidepressants, supplemented with structured approaches to psychotherapy, if appropriate.
In cases where depression and deterioration are severe enough that the time required for response to antidepressants may endanger the patient, hospitalization and use of electroconvulsive therapy may be considered. In standard, controlled clinical trials, the selective serotonin reuptake inhibitors SSRIs fluoxetine Prozac , sertraline Zoloft , and paroxetine Paxil appear to be equivalent in efficacy to tricyclic antidepressants TCAs , with response rates in elderly patients of 60 to 80 percent.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Robertson holds a certificate of added qualification in geriatrics. He is also a staff geriatrician and director of the palliative care program at the Zablocki Veterans Affairs Medical Center, Milwaukee.
He is board-certified in internal medicine, geriatric medicine, and hospice and palliative medicine. Address correspondence to Russell G.
Robertson, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. McCue JD. The naturalness of dying. Institute of Medicine U. Extending life, enhancing life: a national research agenda on aging. Washington, D. Egbert AM. The dwindles: failure to thrive in older patients.
Nutr Rev. Fischer J, Johnson MA. Low body weight and weight loss in the aged. J Am Diet Assoc. Verdery RB. Clin Geriatr Med. Failure to thrive in old age: follow-up on a workshop.
Nutritional status in an academic nursing home. J Am Geriatr Soc. Failure to thrive: paradigm for the frail elder. Protein-energy under-nutrition and the risk of mortality within 1 y of hospital discharge in a select population of geriatric rehabilitation patients. Am J Clin Nutr. Ann Intern Med.
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