Thrive

Question 1

Where was the term “failure to thrive” coined from?

Answer 1

Pediatrics- fails the growth chart ,smaller —> trigger for genetic abnormalities or defects in the major organ systems.

Question 2

How is failure to thrive defined in geriatrics?

Answer 2

An ongoing state of decline that is usually multifactorial in nature, involving chronic concurrent diseases and the self-conception of those diseases. —> *decline in ADLs and IADLs.

Question 3

How many elders are failing to thrive?

Answer 3

• Within the community —> 5-35% - Nursing home —> 25-40% - **Hospital —> 50-60%

Question 4

What is the nutrition criteria for failure to thrive? (3)

Answer 4

• 1. Weight loss >5% of baseline
     2. Anorexia
     
     3. Poor oral intake (not eating enough)

Question 5

What consequences can occur with failing to thrive?

Answer 5

Inactivity —> pressure ulcers, impaired immunity, and increased surgical mortality.

Question 6

What are common underlying physical issues with FTT?

Answer 6

• Chronic heart disease
• Chronic lung disease
• Dysphagia
• GI —> reflux or constipation - Cancer

Question 7

What common neurological diseases can contribute to FTT?

Answer 7

• Parkinson’s - Stroke - Multiple Sclerosis - ALS

Question 8

What psychological disorders can contribute to FTT?

Answer 8

• DEPRESSION. (Choosing not to live)
• Dementia
• Delirium
• Chronic mental illness, i.e. Schizophrenia, bipolar, paranoid disorders.

Question 9

What medications are commonly seen to contribute to FTT?

Answer 9

• ANY. MC- Psychotropics
• Anticholinergics
• Antidepressants

Question 10

What work up should be done if a patient is failing to thrive?

Answer 10

• PMH, PE
• Mental status screening
• Depression screening
• Functional status screening
• Med review —> maybe meds making them not hungry.

Question 11

What are the symptoms of failing to thrive?

Answer 11

- Unintentional weight loss -
 Exhaustion 
- Weakness/low physical activity - Slow walking speed 
- Cognition changes 
- Mood changes 
- Pain

Question 12

What are treatable causes of unintentional weight loss?

Answer 12

Medications causing decreased appetite, dental problems making it difficult to eat, and making diet more attractive!

Question 13

What are treatable medical conditions that can cause exhaustion or fatigue?

Answer 13

COPD,
CHF,
anemia,
insomnia.

Question 14

How can you treat a patient experiencing weakness?

Answer 14

• Increase physical activity and strength training.
• modify the patient’s environment to decrease energy expenditure
• adjust their room temperature to their most comfortable.

Question 15

What is the best treatment for mood changes or depression in geriatric patients?

Answer 15

• SSRI alone or in combination with cognitive-behavioral therapy.
• Schedule frequent encounters and listen to Pt’s concerns.
• *Avoid TCAs

Question 16

How should pain in geriatric patients be controlled?

Answer 16

1st line: nonpharmacologic approaches including clean safe environment, decreased stimuli, back rub, therapeutic touch.
2nd line: oral analgesics. Opioids are LAST line and should be prescribed with a laxative.

Question 17

What lab testing should be done in the workup for FTT? What disorders are you ruling out with each?

Answer 17

• CBC —> anemia, infection
• CMP —> malnutrition, renal failure, dehydration
• ESR, CRP —> inflammation
• PPD —> TB
• Chest x-ray —> infection, neoplasm

Question 18

If someone has an acute onset of failure to thrive, what should you be on your differential?

Answer 18

1. Infections! UTI, pneumonia, HIV, or TB
2. New medication
3. Unable to afford Rx —> not getting appropriate treatment for dz
4. Elder abuse/neglect

Question 19

If a patient with chronic disease has an acute failure to thrive, what should you consider?

Answer 19

Acute change in status of underlying disease

Question 20

What chronic diseases are associated with failure to thrive?

Answer 20

• Anemia
• Cirrhosis
• Impaired renal function
• CHF
• COPD -
  Thyroid disease -
  Arthritis

Question 21

What defines frailty in the elderly?

Answer 21

3 of the 5: - Weight loss (unintentional)

• Self-reported exhaustion
• Weakness (Decreased grip strength)
• Slow walking speed
• Low physical activity

Question 22

What disease treatments can induce failure to thrive?

Answer 22

Chemotherapy and radiation

Question 23

What systems do we have set up to help make the decisions of one’s health care when they are failing to thrive?

Answer 23

• POLST
• Ethics committee
• The “solo” elderly

Question 24

What treatments can be utilized in a patient failing to thrive who has dementia?

Answer 24

1. Treat underlying depression (could be pseudo-dementia)
2. Appetitive stimulants
3. “slow eating” speech therapists)
4. Nutritional supplements
5. Tube feeding

Question 25

If a patient has progressive frailty, what must you discuss with the patient and plan for prior to worsening?

Answer 25

Hospice and palliative care decisions

Question 26

What should be your basic guideline when caring for geriatric patients near end of life?

Answer 26

Hope but prepare! - Hope that the medical options will work and you get a miracle - Attend to the present: control pain and symptoms and maximize the quality of life. - Prepare for the worst with an advanced directive and handling unfinished business.