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Flashcards in Failure to Thrive Deck (34):
1

Define Frailty

State of age-related physiologic vulnerability resulting from impaired homeostatic reserve & a reduced capacity to withstand stress
-Syndrome that results from a multi-system reduction in reserve to the extent that a number of physiological systems are close to or past the threshold of symptomatic clinical failure

2

Characteristics of Frailty

Extremes of old age
Unstable disability
Function fluctuates with minor stressors
Multiple chronic diseases and/or geriatric syndromes

3

Important Questions for Osteoporotic Fractures

Weight loss of 5+% over 2 years
Inability to stand 5 times without help from arms
Negative response to "do you feel full of energy"

4

Outcome Risks of Frailty

Falls
Acute illness
Hospitalizations
Disability
Dependency
Institutionalization
Death

5

Key Components of Frailty

Musculoskeletal function
Cognitive/integrative neurological function
Nutritional reserve: maintaining weight
Aerobic capacity

6

Signs/Symptoms of Frailty

Weight loss or malnutrition
Decreased muscle mass
Decreased bone mass
Anemia
Weakness
Fatigue
Anorexia
Inactivity

7

Contributing Factors to Frailty

Heavy drinking
Cigarette smoking
Physical inactivity
Depression
Social isolation
Multiple chronic medical problems
Poor perceived health

8

Events that May Trigger Frailty

Chronic disease
Inactivity
Infection
Hip fracture

9

Evens that May Block Recovery Time

Depression
medication interactions
Malnutrition
Fear of falling
Underlying cognitive status
Underlying functional status

10

Define Failure to Thrive

Near irreversible end of the natural history of the syndrome of frailty

11

What does failure to thrive mean?

Stop eating
Immobile
Losing muscle mass & weight
Stiff
Going down hill
Depressed
Not taking medications

12

What is the pathogenesis of failure to thrive?

Progression of aging with organs & medical problems getting worse

13

What are the signs & symptoms of failure to thrive?

Weight loss
Loss of muscle mass
Increased weakness
Increased ability to walk steadily
Increasing SOB due to CHF or COPD
HTN

14

H&P & Failure to Thrive

Decreased ROM & strength
Mini mental exam
Heart
Lungs
Abdomen
Senses

15

Labs for Failure to Thrive

CBC
CMP
TSH

16

Treatment for Failure to Thrive

Ensure
Social support
Evaluate for depression

17

Components of Failure to Thrive

Physical frailty
Disability
Impaired neuropsychiatric function

18

National Institue of Aging Definition of Failure to Thrive

Syndrome of weight loss, decreased appetite, poor nutrition, & inactivity often accompanied by dehydration, depressive symptoms, impaired immune function, & low cholesterol

19

Define Disability

Difficulty or dependency in completing tasks essential for self-care & independent living

20

Objective Assessment of Disability

ADLs
IADLs

21

Katz Index of Independence in ADLs

Bathing
Dressing
Toileting
Transferring
Continence
Feeding

22

Lawton IADLs Scale

Ability to use telephone
Shopping
Food preparation
Housekeeping
Laundry
Mode of transportation
Responsibility for own medications
Ability to handle finances

23

Impaired Neuropsychiatric Function

Delirium
Depression
Dementia

24

What can impaired neuropsychiatric function result from & contribute to?

Result of medical co-morbidities
Medication effects
Contribute to development of disability, malnutrition, & frailty

25

Sarcopenia & Failure to Thrive

Contributor to failure to thrive
Loss of muscle with age
Loss of lean body mass
Diminishes the acute phase response to physiological stress
Decreases immune competence

26

Signs & Symptoms of Failure to Thrive

Impaired physical functioning
Malnutrition
Depression
Cognitive impairment

27

3 Criteria of the Working Definition of Failure to Thrive

Biopsychosocial failure
Weight loss or undernutrition
No immediate explanation for the condition

28

Underlying Principles of Failure to Thrive

Baseline data is the foundation of elder care
Function declines at a variable rate predictably over time
Occur from organic or non-organic causes

29

History for Failure to Thrive

Provided by patient and CAREGIVER
Helps with onset of condition & uncovering potential triggers
Drug review: prescriptions, OTC, ETOH
Psychosocial history: increases memory loss, change in social structure

30

Physical for Failure to Thrive

R/O infection, constipation, exacerbation of chronic diseases (CHF, COPD, CAD, CA, TB, uncontrolled endocrine disorder, dementia, depression)
Vitals
HEENT
JVD
Breast mass
Abdominal exam
Skin
Motor
Mental status
Labs: CBC, CMP, Albumin & cholesterol, TSH, fecal occult blood, U/A, Vitamin B12 & D levels, ESR, PPD

31

Importance of CBC in Failure to Thrive

Anemia
Vitamin deficiency
Infection
Hematopoietic or lyphoprolieferative disorder

32

Importance of CMP in Failure to Thrive

Hyper/hyponatremia
Acid-base disorder
Osmolality
Renal function
Dehydration
Diabetes
Hypoglycemia
LFTs

33

Assessment & Plan for Failure to Thrive

Assess life expectancy
Symptoms/conditions reversible
Risk/benefit assessment
Provider, patient, & family collaboration
Palliative measures initiated
Maintain therapeutic relationship with patient & family

34

Team Approach to Failure to Thrive

Address advance directives
Medication reconciliation
Consultation with PharmD
Social services
Caregiver education & support/respite
Concerns about abuse/neglect discussed openly & frankly
Nutritional consult