Endo
Failure to Thrive in the Elderly
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Failure to Thrive in the Elderly
Epidemiology
Incidence
Community adults: >5%
Nursing Home
: >25%
Hosptalized: >50%
Pathophysiology
Contributing Factors
Physical function decline: Weakness, falls, ADL decline
Malnutrition
: Weight loss,
Anorexia
, decreased immunity
Depression
Cognitive
Impairment
(
Delirium
,
Dementia
)
Causes
Medications
See
Medications to Avoid in Older Adults
See
Polypharmacy
Most common medication culprits
Psychotropic medications
Anticholinergic Medication
s
Recently added medications
Consider non-prescription drug use,
Herbals
Missed dose and non-compliance
Medication Overdosage (or with
Renal Insufficiency
)
Acute
Infection:
Pneumonia
, UTI,
Cellulitis
CHF exacerbation
COPD
exacerbation
Diabetes Mellitus
Elecrolyte disrders
Acute gastrointestinal bleeeing
See Medications above
Subacute
Anemia
Cirrhosis
Chronic Kidney Disease
Infection
Diabetes Mellitus
See Medications above
Acute
Cancer
Dementia
Endocrine conditions (
Thyroid
,
Parathyroid
disease)
Tuberculosis
HIV Infection
Chronic Obstructive Pulmonary Disease
Cardiomyopathy
Valvular heart disease
Chronic Kidney Disease
Chronic Liver Disease
Polymyalgia Rheumatica
Labs
Complete Blood Count
Chemistry panel including
Renal Function
s, electrolytes
Serum Glucose
Thyroid Stimulating Hormone
Urinalysis
(consider chronic colonization vs UTI)
Liver Function Test
s
Erythrocte sedimentation rate or
C-Reactive Protein
Malnutrition Labs
See
Lab Markers of Malnutrition
Albumin
Total Cholesterol
Imaging
Chest XRay
Consider
Echocardiogram
Consider anatomic imaging (CT, MRI)
Consider
Pulmonary Function Test
s
Evaluation
Consider causes above
Focus on medications
What medications can be stopped?
Are medications dosed correctly?
Interpret doses in light of
Renal Function
Are medication side effects resulting in failure?
Consider
Drug Interaction
s
Management
Gene
ral
Treat acute illness
Optimize chronic disease management
Manage medications as above (stop those not needed)
Address
Advanced Directive
s
See Depression in the Elderly
Management
Physical
Impairment
Avoid bed rest
Up in chair for all meals
Walk twice daily in hallway if able
Physical Therapy
Avoid restraints including
Foley Catheter
Bathroom use (up with assistance)
Management
Malnourishment
Use oral nutrition supplements
Sample protocol
Split one can supplement into four doses
Take interspersed as snacks
Take with medications
Make more palatable by mixing with ice cream
Prognosis
Nearly 16% mortality rate
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