What is Adult Failure to Thrive (AFTT)?
Often associated with infants, the term 'failure to thrive' also applies to adults, though the manifestation and diagnostic criteria are different. Adult failure to thrive (AFTT) is a syndrome, not a specific disease, representing a state of progressive decline in an older person's health. It is most common in frail, elderly individuals, especially those with multiple chronic medical conditions, and is a significant predictor of adverse health outcomes and increased mortality.
Unlike in children, where the focus is on growth charts, AFTT in adults is defined by a constellation of symptoms that signal a downward health spiral. The primary components of this syndrome are impaired physical function, malnutrition, depression, and cognitive impairment. For families and caregivers, recognizing these signs is the first step toward effective intervention, as AFTT can often be reversed or managed to improve quality of life.
Symptoms and Manifestations of AFTT
Recognizing the signs of Adult Failure to Thrive is crucial for early intervention. These symptoms can be subtle and develop gradually, making them easy to overlook. Common signs to watch for include:
- Unexplained Weight Loss: A significant and unintentional loss of body weight is one of the hallmark indicators of AFTT, often despite having access to adequate nutrition.
- Decreased Appetite: A noticeable loss of interest in eating and drinking, which contributes to poor nutrition and dehydration.
- Reduced Physical Activity: A decline in mobility, strength, and endurance. Patients may walk less, tire easily, and have difficulty with basic daily tasks.
- Social Withdrawal: A loss of interest in social activities and interaction with family and friends, leading to isolation and loneliness.
- Cognitive Impairment: Memory loss, confusion, and a general decline in cognitive function are often present, sometimes as an associated symptom of dementia or depression.
- Depression: Feelings of sadness, hopelessness, and anxiety are common and can exacerbate other symptoms like appetite loss and social withdrawal.
- Difficulty with Daily Activities (ADLs): Challenges with performing routine tasks such as bathing, dressing, grooming, and preparing meals.
The Multifactorial Causes of AFTT
The root causes of Adult Failure to Thrive are rarely singular, but rather a complex interplay of physical, psychological, and social factors. Identifying the underlying issues is essential for creating an effective treatment plan. Some of the most common contributing factors include:
- Physical Factors:
- Chronic diseases, such as cancer, diabetes, and heart failure.
- Chronic pain, which can reduce mobility and appetite.
- Side effects from medications, which can cause nausea, sedation, or loss of appetite.
- Sensory impairments like vision or hearing loss, which can contribute to isolation.
- Difficulty swallowing (dysphagia) or dental problems.
- Psychological Factors:
- Depression, a powerful factor in loss of appetite and motivation.
- Dementia and cognitive decline, affecting memory and ability to manage self-care.
- Significant life changes, such as the recent loss of a loved one.
- Social and Environmental Factors:
- Social isolation and loneliness, often exacerbated by mobility issues.
- Financial struggles impacting access to food and medical care.
- Inadequate caregiver support or a need for more intensive care.
Diagnosis of AFTT in Adults
Since AFTT is a syndrome and not a specific disease, there is no single diagnostic test. Instead, a healthcare provider relies on a comprehensive assessment based on clinical judgment. The diagnostic process typically includes:
- Medical History: A thorough review of past and current health conditions, hospitalizations, and medication use.
- Physical Examination: A clinical exam to assess physical health, identify underlying issues, and evaluate functional abilities.
- Blood and Urine Tests: To screen for infections, nutritional deficiencies (like low cholesterol or albumin), and undiagnosed diseases.
- Cognitive and Mental Health Screening: Assessments to check for signs of depression, cognitive impairment, and social withdrawal.
- Family and Caregiver Interviews: Valuable information from those closest to the patient, who can often spot gradual changes in behavior or function.
Comparison: Failure to Thrive in Children vs. Adults
While sharing a name, the syndrome differs significantly between pediatric and geriatric populations. Understanding the distinctions helps clarify the specific challenges adults face.
| Feature | Failure to Thrive in Children | Adult Failure to Thrive (AFTT) |
|---|---|---|
| Focus of Diagnosis | Lack of appropriate weight gain and growth based on standardized growth charts. | Overall functional decline, encompassing physical, cognitive, and social aspects. |
| Underlying Causes | Often related to nutritional, organic (medical), or psychosocial issues specific to childhood development. | A complex combination of chronic medical conditions, psychological factors (e.g., depression), and social issues (e.g., isolation). |
| Reversibility | Highly reversible with prompt intervention addressing the root cause, especially nutrition. | Often reversible or manageable, but can be more challenging due to the multifactorial nature and chronic conditions involved. |
| Key Manifestation | Stagnant or reversed physical growth and developmental delays. | Unintentional weight loss, reduced physical activity, social withdrawal, depression, and cognitive decline. |
Reversing Adult Failure to Thrive: Treatment and Intervention
The treatment for AFTT is holistic and multidisciplinary, targeting the underlying causes to reverse or manage the decline. A coordinated team may include physicians, dietitians, physical therapists, and mental health professionals.
Nutritional Support
Addressing poor nutrition is a cornerstone of AFTT treatment. Interventions include working with a dietitian to create a high-calorie, nutrient-dense meal plan, and sometimes using oral nutritional supplements. Encouraging regular meal times and making food more appealing can also help.
Medical and Medication Review
Managing underlying chronic conditions and reviewing current medications are essential. A healthcare provider can adjust dosages or change prescriptions that may be causing adverse side effects impacting appetite or energy.
Physical and Occupational Therapy
Tailored exercise programs can help improve muscle strength, balance, and endurance, which can combat physical decline and reduce fall risk. Occupational therapy can provide adaptive strategies to assist with daily living activities.
Mental Health Treatment
Therapy and, if necessary, medication can address depression and cognitive issues. Supporting the patient's mental well-being is critical for their overall recovery.
Social Re-engagement
Combatting loneliness and isolation is vital. Encouraging social interactions with family, friends, or community groups, and providing support for those who have lost a loved one, can significantly improve a patient's mood and motivation.
The Outlook: Prognosis and Prevention
The prognosis for an adult with AFTT depends heavily on the underlying causes and the timeliness of intervention. While it can be reversed, particularly with early detection, AFTT is associated with higher mortality rates, especially in hospitalized older adults.
Prevention focuses on promoting healthy aging and addressing risk factors early. This includes regular medical check-ups, maintaining a healthy lifestyle, ensuring adequate nutrition, and staying socially engaged. Caregivers play a crucial role in monitoring for subtle changes and seeking help promptly.
Read more about geriatric failure to thrive on the AAFP
Conclusion: Recognizing and Responding
To answer the question, can you get failure to thrive as an adult?, the definitive answer is yes. Adult Failure to Thrive is a complex, multifactorial syndrome that is a serious health concern for the elderly. While it signals a concerning decline, it is not an irreversible fate. By recognizing the symptoms and pursuing a coordinated, multidisciplinary approach to care that addresses the medical, nutritional, psychological, and social contributors, it is possible to improve an individual's quality of life and potentially reverse the downward spiral.
