Managing Adult Failure to Thrive (AFTT)
Adult failure to thrive requires a multidisciplinary disease-management approach that addresses physical, cognitive, nutritional, and psychosocial factors to reduce mortality and improve quality of life. 1
Definition and Identification
Adult failure to thrive describes a state of decline characterized by:
- Weight loss and poor nutrition
- Decreased physical function
- Cognitive impairment
- Depression or social withdrawal
- Gradual decline in independence
Assessment Framework
1. Physical Health Evaluation
- Comprehensive medical assessment to identify underlying chronic diseases
- Medication review to identify side effects or interactions contributing to decline 2
- Nutritional assessment including:
- Weight history and recent changes
- Dietary intake patterns
- Barriers to adequate nutrition (dental issues, swallowing difficulties)
- Anthropometric measurements
2. Functional Assessment
- Activities of daily living (ADLs) evaluation
- Physical mobility and strength testing
- Fall risk assessment
- Monitor frailty and seek reversible causes of deterioration 1
3. Cognitive and Psychological Evaluation
- Cognitive screening using validated tools (Mini-Mental State Examination or Montreal Cognitive Assessment) 1
- Depression screening
- Assessment for delirium in acute presentations
4. Social and Environmental Factors
- Support system evaluation
- Financial resources assessment
- Home safety evaluation
- Access to transportation and food
Management Approach
1. Nutritional Interventions
- Caloric enhancement (typically 150% of normal requirements for expected weight) 3
- Nutritional supplements when indicated
- Feeding assistance if needed
- Dietary modifications based on specific needs and preferences
2. Physical Function Improvement
- Physical therapy for strength and mobility
- Occupational therapy for ADL optimization
- Assistive devices when appropriate
3. Psychological Support
- Treatment of depression when present
- Cognitive behavioral therapy when appropriate
- Support groups
4. Social Support Enhancement
- Case management and social work services 1
- Home health services when needed
- Community resource connection
- Caregiver support and education
5. Medical Management
- Optimize treatment of underlying chronic conditions
- Medication reconciliation to reduce polypharmacy 1
- Regular monitoring of response to interventions
Special Considerations
Vulnerable Populations
- Women generally present with failure to thrive later in life with more comorbidities 1
- Black patients may have higher rates of heart failure and hypertension contributing to AFTT 1
- Socioeconomically disadvantaged patients face additional barriers to care 1
- Older adults are especially vulnerable to polypharmacy, multimorbidity, and cognitive decline 1
End-of-Life Considerations
- AFTT diagnosis should prompt discussion of end-of-life care options 2
- Palliative care approaches should focus on symptom management and quality of life 1
- Advanced care planning should be initiated early in the disease trajectory 1
Implementation Strategies
Disease-management programs for AFTT should include:
- Intensive patient education
- Encouragement of patient participation in care
- Close monitoring through telephone follow-up or home nursing
- Medication review to improve adherence to guidelines
- Multidisciplinary care with nurse case management 1
Common Pitfalls to Avoid
- Mistaking normal aging for AFTT - About 25% of normal individuals shift to lower growth percentiles but then stabilize 3
- Focusing on a single cause - AFTT is typically multifactorial 4
- Overlooking depression - Depression is a common, treatable cause of AFTT 5
- Excessive laboratory testing - Few patients need extensive laboratory evaluation 3
- Delayed intervention - Early recognition and management reduces risk of functional deterioration 6
By systematically addressing the physical, cognitive, nutritional, and psychosocial factors contributing to adult failure to thrive, clinicians can significantly improve outcomes and quality of life for affected patients.