Failure to thrive (FTT) in the elderly is a medical condition characterized by frailty, profound weight loss, loss of appetite resulting in poor nutrition and dehydration, physical inactivity, depression, immune suppression, and low level of blood cholesterol. The term Failure to Thrive has long been associated with very young children to describe their inability to gain weight and slowness of physical and cognitive development compared to established norms. In the elderly, FTT reduces quality of life and often deprives the person of freedom, and it increases hospital admission rates. Impaired self-care and social isolation are accompanying characteristics.
FTT involves a complex interaction of physiological, psychological, and social concerns leading to functional and cognitive impairments. Researchers and health professionals recommend periodically evaluating the nutritional, physiological, psychological, functional, and medical status of the elderly to detect the onset of FTT.
About 5% to 35% of community-dwelling seniors and 25% to 40% of nursing home residents are reported to suffer from this disorder.
Failure to Thrive is defined by a set of factors indicating to the physician that the patient's health condition has significantly changed. Potential contributing factors can influence the development of failure to thrive and bring about the specific symptoms of this condition. Chronic illnesses like cardiovascular diseases, respiratory system infections, stroke, cancer metastases, and cirrhosis of the liver are the most common causes of FTT. Malnutrition, physical impairments, and psychiatric disorders can play a part. Patients have to take medications for these chronic diseases and conditions, and drugs such as anticholinergic drugs, beta-blockers, antiepileptic drugs, central alpha antagonists, benzodiazepines, and glucocorticoids are associated with the development of FTT.
Patients with FTT are reported to have four main adverse outcomes:
The underlying causes can vary from patient to patient, and can be quite challenging for the clinician to figure out. The causal factors are often not detectable even by physicians who deal extensively with patients diagnosed with this condition. A complete assessment involves:
When formulating a treatment plan, the doctor considers possible causes, comorbidity, and risk factors. A treatment team comprising a physician, a dietitian, a psychologist, a speech therapist, and a physiotherapist can best serve the condition of failure to thrive. Malnutrition is a significant challenge in patients with FTT, as deficiency of vitamins and minerals can make overall health even worse. Dietary supplements can help meet energy and protein requirements. Administration of nutritional supplements between the meals is reported to have more impact than if the supplements are taken with meals.
Non-physiologic approaches like making palatable meals, offering meals at different times at the patient’s favorite locations and with good company may be helpful for encouraging sufficient food intake. Experts recommend patients do strength training, endurance exercises, and balancing and flexibility exercises to boost cognitive activity, muscle strength, and functionality. Socialization and spending time with relatives and friends are useful in treating depression.
Megestrol and dronabinol are medications used for stimulating appetite, but their possible side effects and co-administration with the patient’s existing drug therapy can present problems. Depression can be addressed with selective serotonin reuptake inhibitors, e.g., fluoxetine, sertraline, and paroxetine, and tricyclic antidepressants, e.g., mirtazapine. They are reported to lower the severity of depression in the 60 to 80 percent of elderly patients.