Failure to thrive: a growing concern in the elderly

Evaluation of older adults hospitalized with a diagnosis of failure to thrive

BACKGROUND

older adults are sometimes hospitalized with the admission diagnosis of failure to thrive (FTT), often because they are not felt safe to be discharged back to their current living arrangement. It is unclear if this diagnosis indicates primarily a social admission or suggests an acute medical deterioration. The objective of this study was to explore the level of acuity and medical investigations commonly conducted among older hospitalized adults with a diagnosis of FTT.

METHODS

We conducted a retrospective cohort study at three hospitals in Calgary, Alberta. Data were extracted from the electronic medical records of the 603 admissions of patients 65 years or older with a diagnosis of FTT between January 2010 and January 2011. Markers of medical acuity were evaluated.

RESULTS

The vast majority of patients had short hospital stays. Specialist physicians were consulted for 323 cases (54%). Allied health-care professionals were consulted in 151 cases (25%). While in hospital, patients underwent extensive investigations, including CT scans, ultrasounds, and echo-cardiograms. Many patients received IV fluids (71%) and IV antibiotics (35%).

CONCLUSIONS

The data suggest that acute illnesses, and not social factors, were the primary reason for admission among those given a diagnosis of FTT.

Identifying failure to thrive in the long term care setting

INTRODUCTION AND RATIONALE

Geriatric failure to thrive (GFTT) is commonly encountered in the long term care (LTC) setting. This syndrome of unexplained functional decline can be approached in a methodical manner. The updated Minimum Data Set (MDS) 3.0, now implemented in almost all skilled nursing facilities, includes pertinent clinical information that could be used to identify residents who manifest GFTT. A screening tool using data from the MDS 3.0 could be used by LTC providers to evaluate LTC residents.

METHODS

A literature review was completed to identify articles focused on (1) GFTT in the LTC setting and (2) tools to identify GFTT. Common components of GFTT were matched with items collected as part of the MDS 3.0 with a goal to determine its utility as a screening tool to identify GFTT in the LTC setting.

OUTCOMES AND DISCUSSION

The MDS 3.0 includes assessment of numerous components commonly observed in patients with GFTT. By using clinically validated tools, the MDS 3.0 may assist in the recognition of LTC residents with or at risk for GFTT. Once GFTT is recognized, the LTC interdisciplinary team can then identify potentially reversible causes, set goals of care, and develop a comprehensive care plan that may include diagnostic measures, curative interventions, and/or palliative measures individualized to the resident.

Revisiting geriatric failure to thrive: a complex and compelling clinical condition

Geriatric failure to thrive (GFTT) poses a complex clinical issue in gerontological nursing practice. GFTT is not a normal part of aging, nor is it an outcome of chronic illness. Rather, GFTT describes a lack of vitality and diminished capacity for life and outlines a process of functional decline that is often difficult to explain. The purpose of this article is to review GFTT, examine the literature on GFTT, and suggest strategies for the identification, assessment, and creative management of this complex condition that affects millions of older adults.

Assessing Nutritional Status in Chronically Critically Ill Adult Patients

• Background Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.

• Objectives To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.

• Methods A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients’ nutritional intake compared with physicians’ orders, dieticians’ recommendations, and indirect calorimetry and physicians’ orders compared with dieticians’ recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.

• ResultsInconsistencies among nurses’ implementation, physicians’ orders, and dieticians’ recommendations resulted in wide variations in patients’ calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%–200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).

• Conclusions In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.

Adult failure to thrive in the older rehabilitation patient

Increasing numbers of older adults require rehabilitation therapy upon discharge from a hospital. This pilot study tested a tool developed to assess failure to thrive syndrome (FTT) in patients admitted to a long-term rehabilitation unit (N = 34), examined the association among commonly recognized FTT factors (persistent, unexpected impairment in physical function, cognitive impairment, and poor nutrition and mood state), and investigated relationships between FTT factors and discharge disposition. Patients with a high level of physical function differed from those with a low level of function in terms of age, mood state, and discharge disposition. Patients discharged home differed from patients who were unable to return home in mood state, physical function score, and admission serum albumin. Suggestions for practice and further research are offered.

Thriving--a useful theoretical perspective to capture the experience of well-being among frail elderly in nursing homes?

AIM

The aim of this article is to discuss the concept of thriving and its adequacy in describing the experience of well-being among physically frail nursing home residents.

BACKGROUND

There is a lack of theoretical perspectives describing nursing home residents' experience of well-being.

METHOD

The article is based on a literature review and analysis of how the concept of thriving is used in different professional traditions. Three different theoretical perspectives are presented: (1) thriving as an outcome of growth and development; (2) thriving as a psychological state; (3) thriving as an expression of physical health state. In the second part of the paper, the three perspectives are discussed.

CONCLUSION

The authors suggest that there is a need to develop a new concept: that of thriving in physically frail nursing home residents. The article discusses how each of the three theoretical perspectives may contribute to the formation of this concept.

Detection and correction of underweight problems in nursing home residents

Subnormal weight in the elderly is a well-known phenomenon; the ramifications may result in illness and death. There are many reasons for weight loss, usually related to changes that accompany aging or against a background of acute or chronic illness. Our goal in this study was to identify the underweight people living in our retirement facility at different functional levels and to plan and carry out nursing interventions in cooperation with the rest of the multidisciplinary team to increase their weight to within normal limits. Of the 205 residents who live in the home, 48 (23.4%) were found to be under the lower limit of ideal weight tables. With the aid of individual care plans and calorie-rich, low-volume diets, we succeeded in increasing the weight of 29 residents to within the normal range within 2 to 12 months. Seven residents died during the experimental period, and three continuing to lose weight. The rest of the residents remained stable at their original low weight.

Failure to thrive: the silent epidemic of the elderly

Demographic changes have created the need for psychiatric nurses to examine knowledge and practice in the area of geropsychiatry. Older adults present unique challenges. The interaction of biological and psychosocial problems are most evident in the oldest old and necessitate a holistic approach. This report addresses psychosocial causes and treatment of "Failure to Thrive" (FTT) in the elderly. FTT is a label commonly used to describe a complex of nonspecific symptoms that often leads to increased disability and premature death. Psychiatric nurses are challenged to take a leadership role in case finding, as well as assessment and intervention.

Hardiness and death attitudes: predictors of depression in the institutionalized elderly

There are varied and high estimated prevalence rates of depression in the institutionalized elderly. Personality characteristics and attitudes are two attributes in the uniqueness of humans that have been overlooked in explaining depression. This study examined the relationships of hardiness and death attitudes to depression. The sample consisted of 90 consenting participants; 46 women and 44 men. The mean age of the sample was 73.3 years. This study produced the following three major findings: hardiness and depression are correlated; healthy death attitudes are related to low depression scores; and the combination of nonhardiness and health-limiting death attitudes are reliable predictors of depression in the institutionalized elderly.

Graduate education. Creating nursing diagnoses

Students participating in this clinical exercise learned to critically evaluate problems occurring in their practice areas. In addition, they learned ways of addressing problems through nursing diagnosis. They experienced research as they conducted surveys, calculated results, and listed characteristics. The students had the opportunity to create a product. Unfortunately, as students graduated and became busy with their new positions, they no longer pursued the academic activity of getting a diagnosis accepted by NANDA. The acceptance process seemed particularly formidable after the initial rejection. An even more serious loss exists for graduates who work in gerontological nursing--that of not having these existent problems readily identified and labeled.