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Failure to Thrive in Elderly Adults Clinical Presentation

  • Author: Nadia Ali, MD, MPH, MBBS, ABHIM, FACP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
 
Updated: Dec 03, 2015
 

History

A detailed history is required to diagnose the underlying cause of failure to thrive in the elderly population. All systems should be reviewed to identify new symptoms indicative of a new diagnosis or a worsening existing condition.

A detailed nutrition history to review all aspects, including food shopping, cooking, frequency of meals, and type of food groups consumed, is taken into consideration. A validated tool to assess the nutritional status in elderly persons is the Mini Nutritional Assessment.

A review of medication lists, including over-the-counter medications and herbal products, is critically important.

A social history should include documentation and quantification of alcohol and substance intake. The health provider needs to inquire about social support available from family, friends, and community, as well as barriers such as falls and balance problems leading to social isolation and need for more supervision.

An important aspect of the history is cognitive evaluation to assess dementia. Many instruments can be used for this assessment, including the Mini-Cog Test, Mini-Mental State Examination, and General Practitioner Assessment of Cognition. Dementia needs to be differentiated from pseudodementia related to depression.

Another important aspect is the functional assessment in terms of ambulation and carrying out activities of daily living (ADL). Both the Katz ADL and Lawton IADL can be used to assess the performance of ADL.

Finally, the patient is evaluated for any underlying mental health conditions such as depression or anxiety. The Geriatric Depression Scale (GDS) has been specifically designed for elderly persons.[8] Alternatively, a single screening question, “Do you often feel sad or depressed?” may effectively screen for depression.[9]

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Physical Examination

A complete examination, including a vision and hearing test, is the first step to evaluate for deterioration of existing medical conditions or diagnosis of new diseases. In addition, the examination will help identify signs of malnutrition and vitamin deficiencies.

Timed Up and Go is a quick and reliable test to assess mobility. The patient is asked to get up from a chair and walk 3 meters before returning to the chair. The time taken by the patient to complete the task is used to grade the functional mobility.

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Contributor Information and Disclosures
Author

Nadia Ali, MD, MPH, MBBS, ABHIM, FACP Clinical Assistant Professor, Temple University School of Medicine; Associate Program Director, Department of Internal Medicine, Crozer Chester Medical Center

Nadia Ali, MD, MPH, MBBS, ABHIM, FACP is a member of the following medical societies: American Medical Association, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association

Disclosure: Nothing to disclose.

References
  1. Verdery RB. Clinical evaluation of failure to thrive in older people. Clin Geriatr Med 1997; 13:769-78.

  2. Egbert AM. The dwindles. Postgrad Med 1993:94:199-210.

  3. Egbert AM. The dwindles: failure to thrive in older patients. Nutr Rev. 1996 Jan; 54(1 Pt 2):S25-30.

  4. Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002 Feb 15; 65(4):640-50.

  5. Chen CC, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs. 2001 Oct; 36(1):131-42.

  6. Fischer J, Johnson MA. Low body weight and weight loss in the aged. J Am Diet Assoc. 1990 Dec; 90(12):1697-706.

  7. Donini LM, Savina C, Cannella C. Eating habits and appetite control in the elderly: the anorexia of aging. Int Psychogeriatr. 2003 Mar;15(1):73-87.

  8. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983; 17(1):37-49.

  9. Mahoney J, Drinka TJ, Abler R, Gunter-Hunt G, Matthews C, Gravenstein S, et al. Screening for depression: single question versus GDS. J Am Geriatr Soc. 1994;42:1006–8.

  10. Dhingra S, Parle M. Non-drug strategies in the management of depression:A comprehensive study of systematic review and metaanalysis of randomised controlled trials. Journal of Neuroscience and Behavioural Health Vol. 3(5), pp. 66-73, May 2011.

  11. Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, et al. Advanced Cognitive Training for Independent and Vital Elderly Study Group. Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2271-81.

  12. Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006 Dec 20;296(23):2805-14.

  13. Yeh SS, Lovitt S, Schuster MW. Pharmacological treatment of geriatric cachexia: evidence and safety in perspective. J Am Med Dir Assoc. 2007 Jul; 8(6):363-77.

  14. American Geriatrics Society, British Geriatrics Society & American Academy of Orthopaedic Surgeons 2001. Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, vol. 49, no. 5, pp. 664–72.

  15. Kumeliauskas L, Fruetel K, Holroyd-Leduc JM. Evaluation of older adults hospitalized with a diagnosis of failure to thrive. Can Geriatr J. 2013. 16 (2):49-53. [Medline].

 
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