An aging father who recently broke his hip in a fall is now more sedentary and less active. He doesn’t move as often as he did before the hip fracture, and he may spend more time than usual lying in bed or sitting in his chair. He stops preparing meals and eats at a caloric deficit. Because of this nutritional deficiency, he no longer has the energy to go out, and as a result he feels isolated and depressed. This negative snowball effect is known as adult failure to thrive (AFTT): a decline seen in elderly individuals with multiple chronic medical conditions that interfere with their daily lives, resulting in a snowball effect of poor nutrition, weight loss, inactivity, depression and decreasing functional ability.
Why it’s a problem
AFTT is a serious problem in elderly individuals, especially for those who live alone and struggle with a chronic health condition such as Alzheimer’s or multiple sclerosis, because it can result in poor nutrition, lack of activity and depression, and in most cases it culminates in death.
Symptoms of failure to thrive in adults
The early symptoms of failure to thrive are often overlooked & gradually worsen over time. It’s important to pay attention to the smallest details in a person’s behavior. Generally, the symptoms are never clear-cut, and sometimes their cause is unknown.
- Unintended weight loss
- Loss of appetite
- Trouble thinking or unexpected memory loss
- Depression or mood swings
- Impaired cognitive functions
- Chronic infections as a sign of a weakening immune system
- Trouble swallowing
Adult failure to thrive diagnosis
Diagnosis begins with an in-depth medical review of the 3 main areas of AFTT syndrome: depression, malnutrition, and cognitive and functional impairments. For example, the assessment may look at the individual’s economic, spiritual, psychosocial and emotional needs, as well as some social or environmental factors. Functional ability, underlying medical conditions and medication interactions are also taken into account when evaluating for AFTT.
Depression
Depression is the most common psychiatric condition in older adults with AFTT, and understanding whether it is a consequence or the root cause of AFTT can play an instrumental role in the patient’s recovery & treatment. Patients with failure to thrive are more likely to mask depression as problems related to their physical health. For example, a patient might (whether willingly or not) disguise symptoms of depression as weight-loss-related issues, making it harder to diagnose early on. When the diagnosis and treatment of depression are delayed, the decline & severity of AFTT symptoms in senior patients typically get worse over time.
Malnutrition
Generally, nutrition is a critical predictor of mortality in elderly people. The most accurate and common evidence of malnutrition in older adult patients is hypocholesterolemia and hypoalbuminemia. When patients are assessed for malnutrition, doctors or nurses typically look at the patient’s diet history – including caloric intake, the availability of food & the ability to purchase it, the use of supplements, and overall eating habits such as food intake, number of meals per day, and daily macro/micronutrient intake. Other symptoms, such as weight loss, may also be included in the assessment.
Cognitive & functional impairment
In some patients, cognitive changes may occur due to delirium-induced effects of chronic health conditions such as Alzheimer’s or Parkinson’s. Some medications can trigger depression, functional incapacity, and nutritional deficiency. Evaluation includes a review of the individual’s cognitive status, social interactions, and mood. Doctors might also look at the patient’s relationships with family, friends and caregivers, their living situation and financial stability, and look for signs of abuse or neglect if the patient is being cared for by a home health caregiver or a family member.
Treatment for failure to thrive in adults
Treatment should focus on identifiable conditions such as poor nutrition and depression, and should limit interventions that pose a health risk to frail and elderly patients. The end goal of AFTT treatment is to improve overall quality of life through nutritional, cognitive and functional therapies & interventions. Treatment is prescribed according to the individual’s unique conditions & needs and is typically carried out by a team of medical providers such as a doctor, nurse, dietitian, psychiatrist, physical therapist and a dedicated caregiver.
What can you do to help someone with AFTT?
- Close supervision: If the patient shows a sudden decline in their health – for example, they are unwilling or unable to follow an adequate diet (i.e., they are not eating or drinking enough), they seem to have symptoms of depression such as mood swings or loss of interest in activities they once enjoyed, or they show any other sign of declining overall health – contact their medical provider (e.g., nurse, caregiver) and discuss your observations. Describe the patient’s current health condition in as much detail as you can, and with the help of that medical provider, make an action plan to improve the patient’s symptoms and keep them on track for recovery.
- Medications: Side effects or drug interactions that could have negative effects on AFTT are common, so it’s important to keep a watchful eye on the types of medications the patient takes and to tell their medical provider if the patient starts taking any new medications.
- Diet: Inadequate nutrition and dehydration can quickly worsen the symptoms of failure to thrive in adults. Keep track of what the patient consumes each day, and make sure they are meeting their calorie intake and macro/micronutrient goals.
- Keep them active: Mental & physical activity play an instrumental role in any AFTT treatment. If the patient is mobile, it’s recommended that they spend some time outdoors (ideas for outdoor activities), for example, going on walks or visiting a nearby park. For cognitive exercise, play a board game such as chess or Monopoly.
- Communicate: Keep the patient socially stimulated as often as possible. Keep an open mind and heart when talking with the patient about their feelings and struggles.
