Failure to Thrive

Question 1

Define Frailty

Answer 1

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

Question 2

Characteristics of Frailty

Answer 2

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

Question 3

Important Questions for Osteoporotic Fractures

Answer 3

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”

Question 4

Outcome Risks of Frailty

Answer 4

Falls
Acute illness
Hospitalizations
Disability
Dependency
Institutionalization
Death

Question 5

Key Components of Frailty

Answer 5

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

Question 6

Signs/Symptoms of Frailty

Answer 6

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

Question 7

Contributing Factors to Frailty

Answer 7

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

Question 8

Events that May Trigger Frailty

Answer 8

Chronic disease
Inactivity
Infection
Hip fracture

Question 9

Evens that May Block Recovery Time

Answer 9

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

Question 10

Define Failure to Thrive

Answer 10

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

Question 11

What does failure to thrive mean?

Answer 11

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

Question 12

What is the pathogenesis of failure to thrive?

Answer 12

Progression of aging with organs & medical problems getting worse

Question 13

What are the signs & symptoms of failure to thrive?

Answer 13

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

Question 14

H&P & Failure to Thrive

Answer 14

Decreased ROM & strength
Mini mental exam
Heart
Lungs
Abdomen
Senses

Question 15

Labs for Failure to Thrive

Answer 15

CBC
CMP
TSH

Question 16

Treatment for Failure to Thrive

Answer 16

Ensure
Social support
Evaluate for depression

Question 17

Components of Failure to Thrive

Answer 17

Physical frailty
Disability
Impaired neuropsychiatric function

Question 18

National Institue of Aging Definition of Failure to Thrive

Answer 18

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

Question 19

Define Disability

Answer 19

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

Question 20

Objective Assessment of Disability

Answer 20

ADLs

IADLs

Question 21

Katz Index of Independence in ADLs

Answer 21

Bathing
Dressing
Toileting
Transferring
Continence
Feeding

Question 22

Lawton IADLs Scale

Answer 22

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

Question 23

Impaired Neuropsychiatric Function

Answer 23

Delirium
Depression
Dementia

Question 24

What can impaired neuropsychiatric function result from & contribute to?

Answer 24

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

Question 25

Sarcopenia & Failure to Thrive

Answer 25

``` 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 ```

Question 26

Signs & Symptoms of Failure to Thrive

Answer 26

Impaired physical functioning Malnutrition Depression Cognitive impairment

Question 27

3 Criteria of the Working Definition of Failure to Thrive

Answer 27

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

Question 28

Underlying Principles of Failure to Thrive

Answer 28

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

Question 29

History for Failure to Thrive

Answer 29

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

Question 30

Physical for Failure to Thrive

Answer 30

``` 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 ```

Question 31

Importance of CBC in Failure to Thrive

Answer 31

Anemia Vitamin deficiency Infection Hematopoietic or lyphoprolieferative disorder

Question 32

Importance of CMP in Failure to Thrive

Answer 32

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

Question 33

Assessment & Plan for Failure to Thrive

Answer 33

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

Question 34

Team Approach to Failure to Thrive

Answer 34

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