Defining Failure to Thrive in the Elderly

As seniors fail to thrive, they become frail and weak, impacting their quality of life and ability to perform daily tasks independently. Unfortunately, failure to thrive often indicates serious underlying illness and is associated with reduced life expectancy.

Failure to thrive refers to a state of decline that cannot be sufficiently explained by known disease processes. Doctors diagnose failure to thrive when an elderly patient experiences:

• At least two unplanned losses of more than 5% of normal body weight over a period of less than 12 months
• Ongoing nutritional deficiency despite adequate food intake
• Physical weakness that interferes with normal daily functioning

Failure to thrive results from complex biological, psychological, and social factors that prevent seniors from meeting their body’s nutritional needs.

Prevalence of Failure to Thrive

Failure to thrive is common in the elderly, though precise statistics on its prevalence are lacking. Estimates suggest between 5-10% of seniors over 65 years old meet criteria for failure to thrive diagnosis.

Rates are higher among adults receiving home health care services or residing in long-term care facilities. One study found 24% of elderly home care patients suffered from failure to thrive. Up to 34% of nursing home residents exhibit wasting and cachexia - muscle loss commonly associated failure to thrive.

Elderly adults with chronic medical conditions like dementia, cancer, chronic lung disease, congestive heart failure, diabetes, and arthritis face increased failure to thrive risks.

Causes and Contributing Factors

Failure to thrive has no single cause. A combination of age-related physical changes, chronic health conditions, medications, mobility issues, dental problems, depression, dementia, and other social factors contribute to malnutrition, muscle wasting, and weight loss.

Physical Causes

• Chronic inflammation - Inflammation from illnesses like heart disease, diabetes, and arthritis may suppress appetite and metabolism.
• Medications - Diuretics, chemotherapy, sedatives, and other drugs can cause nausea or changes in taste that lead to poor nutrition.
• Chewing and swallowing issues - Missing teeth, ill-fitting dentures, mouth pain, or difficulty swallowing make eating challenging. Food may seem unappetizing.
• Reduced absorption - Some older adults do not properly absorb key nutrients due to gastrointestinal issues like atrophic gastritis and ulcers or after gallbladder removal surgery.
• Underlying illness - Unmanaged conditions like hyperthyroidism, cancer, kidney or liver disease result in metabolic changes that promote tissue breakdown rather than growth and repair.

Social and Psychological Factors

Beyond medical problems, other issues can cause seniors to stop eating properly:

• Isolation and loneliness - Meals may seem futile without friends or family to share them with. Grieving lost loved ones impacts appetite and interest in eating.
• Income challenges - Limited budgets hinder some older adults’ ability to access or prepare nutritious foods.
• Functional impairment - Having difficulty shopping, cooking, feeding oneself or other personal care tasks presents barriers to eating.
• Cognitive issues - Between dementia, depression, and delirium, some older people experience attention, memory, or motivation issues that interfere with meals.
• Alcoholism - Heavy drinking replaces nutrients from food and causes essential vitamin and mineral deficiencies.

When multiple factors converge, elderly adults get caught in a cycle of increasing frailty. Declining health makes eating and self-care harder. Meanwhile malnutrition and muscle loss accelerate physical decline.

Failure to Thrive Signs and Symptoms

Failure to thrive develops slowly over weeks or months. At first, weight loss may not raise red flags. But without intervention, the disorder progresses to include:

• Significant unplanned weight loss - Seniors lose weight rapidly and BMI drops below normal for their height.
• Muscle wasting - Loss fat and lean muscle causes hollow cheeks, loose skin, postural changes and frailty. Clothes, jewelry, and dentures may start fitting more loosely.
• General weakness - Fatigue, exhaustion, and inability to complete usual physical tasks impacts quality of life.
• Diminished appetite - Little interest in food or eating smaller portions at meals occurs.
• GI issues - Indigestion, changed bowel patterns, diarrhea or constipation arises.
• Lab test abnormalities - Doctors may detect anemia, electrolyte imbalances, micronutrient deficiencies, hypoglycemia, hypoalbuminemia, and more.
• Skin issues - Rashes, redness, wounds, pressure injuries or ulcers may develop.
• Cognitive changes - Increased confusion, memory issues, anxiety, depression, and irritability can start to show.

Failure to thrive adults often first seek care for these nonspecific symptoms rather than weight loss itself. Getting to the root cause requires thorough evaluation.

Diagnosing Failure to Thrive in Elderly Adults

Doctors diagnose failure to thrive primarily through history, physical examination, anthropometric measurements, and lab testing.

They seek to rule out other explanations for symptoms and identify any underlying illnesses. Diagnostic steps include:

• Weight history - Tracking measurements for at least two months to establish unexplained weight loss not attributed to change in diet or physical activity.
• Patient reporting - Asking about energy levels, dietary patterns, bowel/bladder habits, pain, mood, alcohol use, chewing difficulties, and more.
• Physical exam - Assessing overall appearance and alertness plus organ systems like heart, lungs, abdomen, and skin integrity. Checking for signs of injury or pressure wounds.
• Anthropometrics - Documenting height and calculations like BMI to quantify the magnitude of muscle and weight loss.
• Blood and urine laboratory testing - Screening blood counts, electrolytes, proteins, nutrient levels, thyroid, liver, and kidney function for abnormalities signalling underlying illness.
• Imaging tests - Ordering chest X-rays, CT scans, or other diagnostic scans to uncover disease as warranted based on clinical presentation.

Once doctors establish the failure to thrive diagnosis, they work to identify all potential causal and risk factors through comprehensive geriatric assessment. Pinpointing root cause is key to reversing unplanned weight loss and decline.

Failure to Thrive Prognosis and Life Expectancy

Unfortunately, failure to thrive correlates to higher mortality rates and reduced life expectancy in the elderly. The risk of death depends on the severity of nutritional impairment and whether underlying health conditions can resolve with proper treatment.

Among elderly adults admitted to hospital with failure to thrive, estimates on short-term mortality risk vary:

• Researchers found about 1 in 10 died within one month. Mortality at one year was about 50%.
• A US study indicated a 23% mortality rate within 90 days of hospital admission. Number of comorbid conditions and low cholesterol levels independently predicted higher death risks.
• In long term care residents, failure to thrive raises mortality hazard ratios between 1.5 to 2 times higher compared to well-nourished peers depending on symptoms.

Overall life expectancy also declines in those who fail to thrive. One study found median survival dropped from 3.5 years to 1.5 years in frail elderly women diagnosed with failure to thrive versus matched healthy controls.

However, early intervention to treat reversible causes and improve nutrition, physical activity, and function can preserve quality of life and longevity in some seniors. Ongoing management is crucial.

Improving Outcomes in Failure to Thrive

Restoring weight and reversing frailty among failure to thrive elderly remains challenging. No single treatment fits all. Instead management is multidimensional based on each patient’s deficits and risk factors. Healthcare teams combine diverse medical and lifestyle strategies:

• Medication adjustments - Doctors reassess drugs that may cause side effects or interactions leading to weight loss. Changing prescriptions or dosages provides relief in some cases.
• Nutritional support - Dietitians suggest calorie-dense healthy foods tailored for chewing/swallowing abilities. Oral liquid supplements help meet protein and micronutrient needs. In home settings, meal delivery programs are beneficial.
• Physical therapy - Specially tailored activity programs build muscle strength, mobility, and balance. This improves physical functioning required for independent living.
• Home care services - Assistance from personal support workers enables community-dwelling seniors to access nutritious meals and perform self-care despite disability.
• Dental care - Fixing poorly-fitted dentures, decay, or other oral health issues. Managing mouth pain can make eating more pleasurable.
• Mental health support - Screening for neurological issues like delirium or treating depression via counseling, social contact, or medication assists some patients.
• Social intervention - Adult day programs, friendly visitors, transportation assistance, and senior congregate dining sites reduce isolation while supporting nutrition.
• Facility-based care - For seniors unable to manage at home despite extensive intervention, residential care centers or nursing homes provide 24/7 supportive care with extra assistance as needed.

Stopping and ultimately reversing the downward spiral of failure to thrive hinges on individualized, patient-centered support across medical and social domains. This comprehensive approach gives seniors the best chance at improved health.

However even with intensive efforts, life expectancy remains below average compared to robust peers.

FAQs

What are some common symptoms of failure to thrive?

Common failure to thrive symptoms include significant unexplained weight loss and muscle wasting, fatigue, weakness, reduced appetite, gastrointestinal issues, cognitive changes, skin problems like rashes or wounds, and laboratory test abnormalities signalling vitamin/mineral deficiencies or organ dysfunction.

How do doctors test for failure to thrive?

Doctors diagnose failure to thrive by tracking weight trends over time, conducting patient history and physical examination, analyzing blood and urine tests, measuring muscle mass and BMI changes, and ordering scans or other imaging studies to uncover hidden underlying illness as warranted.

What conditions lead to failure to thrive?

Failure to thrive has no single cause but many potential contributing factors including chronic health conditions, inflammation, reduced food intake, medication side effects, chewing or swallowing disorders, nutrient malabsorption, social isolation, depression, mobility impairment, poverty, and alcoholism.

What is the life expectancy for someone with failure to thrive?

Life expectancy is significantly reduced in elderly adults with failure to thrive, However prognosis varies. Some studies report between 10-50% mortality within 12 months of diagnosis. Overall median survival drops from 3-5 years to 1-1.5 years.

Death risk increases with more comorbidities and longer duration of uncorrected nutritional deficits.

Can failure to thrive be reversed with treatment?

In some cases physicians can halt or slow further decline with medications adjustments, nutrition supplements, physical rehabilitation, home care assistance, mental health support, adult day programs, residential care centers, and other individualized interventions.

However reversing frailty completely and restoring lost weight is quite difficult and unlikely for many patients despite intensive therapy. Prevention is ideal.

Conclusion

Failure to thrive syndrome is increasingly prevalent among frail elderly adults with complex medical problems and disability. This troubling state of significant unplanned weight loss, fatigue, weakness, and reduced physical function indicates the body’s failing ability to maintain homeostasis.

Contributing factors span biological, psychological, social, and environmental realms. When multiple causes converge, seniors experience nutritional deficits, progressive functional impairment, and higher mortality risk compared to their healthier counterparts.

With comprehensive assessment and intensive support, some failure to thrive older adults stabilize or partially regain lost weight and strength. Yet despite best efforts, the majority continues to decline.

More research is urgently needed to find better ways to predict, assess, treat, and hopefully prevent failure to thrive in our growing elderly population.

SOURCES

1.https://www.aafp.org/pubs/afp/issues

2.https://www.parxhhc.com/failure-to-thrive-elderly-life-expectancy

3.https://www.ncbi.nlm.nih.gov/pmc/articles

4.https://emedicine.medscape.com/article